Check Here. If you have not opened your business and leave the table blank. Name Title Hours per Week Xxxx Xxx Owner 40 VACANT Server 26 1 6 7 9 10 Are you planning on hiring additional employees? Yes No If Yes, How many? I certify that all my answers above are true and correct to the best of my knowledge. I also agree that by accepting to receive assistance from the Service Provider, I will cooperate and provide staff with all requested information and documents to verify the outcomes including but not limited to job forms signed by my new and/or retained employees and payroll documents. I will cooperate and provide the Service Provider staff with all requested information and documents to verify the outcomes reported. Signature of Business Owner Date Signature of Service Provider Staff Date SERVICE PROVIDER STAFF SECTION 2 Digit NAICS Code 6 Digit NAICS Code xxxxx://xxx.xxxxxx.xxx/naics/ Council District Registered in RAMP? xxxxx://xxx.xxxxxx.xxx/s/ Needs Assessment Complete? Photo ID? Proof of Residency/Business in City? Yes No City Certifications (Check on RAMP) Local Business Enterprise (LBE) Minority Business Enterprise (MBE) Women Business Enterprise (WBE) Small Business Enterprise (SBE) Emerging Business Enterprise (EBE) County and State Certifications Small Business (SB) (State) Small Local Business (SLB) (County) Small Business Enterprise – Proprietary (SBE) LGBT Business Enterprise Disabled Veteran Business Enterprise (DVBE) Disabled Vets Business Enterprise- LAWA (DVBE) Very Small Business Enterprise- Harbor (VSBE) Disadvantaged Business Enterprise (DBE) (State)
Check Here. If you have not opened your business and leave the table blank. Name Title Hours per Week Xxxx Xxx Owner 40 VACANT Server 26 1 10 Enter the number of employees you plan to hire in each category: Official or Manager Sales Operative (Semi-skilled) Professional Office or Clerical Laborer (Unskilled) Technician Craft Worker (Skilled) Service Worker Not Sure/Undecided
Check Here. Election of Pre-Tax Benefits I understand that an amount equal to the annual contributions for the coverage I have elected divided by the number of pay periods (monthly or tenthly) in the Plan Year, will be deducted on a pre-tax basis from each of my paychecks to pay for the coverage that I elect. On a separate enrollment form(s), I have enrolled in certain insurance coverage(s) and I have received a schedule showing my share of the contributions for such coverage(s). In accordance with my rights under the Plan, I authorize salary reductions in the amount of current premiums being charged for the insurance coverage(s) I have elected. I understand that: If my required contributions to pay premiums for the elected benefits are increased or decreased while this agreement remains in effect, my salary reductions will automatically be adjusted to reflect that increase or decrease. My employer may reduce or cancel my salary reduction or otherwise modify this agreement in the event he/she believes it advisable in order to satisfy certain provisions of the Internal Revenue Code. The reduction in my salary under this agreement shall be in addition to any reductions under other agreements or benefits programs maintained by my employer. Pre-tax contributions are not subject to state or federal income or Social Security (“FICA”) taxes. This could result in a reduction in the Social Security benefits I receive at retirement if I earn less than the annual FICA “taxable wage base”. (Consult your tax advisor). Prior to the first day of each Plan Year. If I do not complete and return a new enrollment form at that time, I will be treated as having elected to continue this benefit election for the new Plan Year. In addition, this salary reduction agreement will continue by its terms in the amount of the required contribution for the benefit option for the new Plan Year. This Agreement is subject to the terms of the employer’s Section 125 cafeteria plan, as amended for time to time in effect, shall be governed by and construed in accordance with applicable laws, shall take effect as a sealed instrument under applicable laws, and revokes any prior election and compensation and reduction agreement relating to such plan. Employee Signature Date
Check Here. Xxxx X. Xxx 000 0000 Xxxx Xx. Xxxxxxxx, X.X.X. 10001 20 PAY TO THE ORDER OF $ DOLLARS MEMO ׀:122233344׀: 999111122׀"· 100 Transit Routing No. Account No. Check No.
Check Here o To the Officers and Members of Lodge No. (the “Lodge” or “Union”), I hereby tender my application for membership in the International Association of Machinists and Aerospace Workers (IAM). I understand that while I may be required to tender monthly fees to the Union, I am not required to apply for membership or be a member as a condition of employment and that this application for membership is voluntary. As a member, I agree to obey the Constitution of the IAM and the by-laws of my Lodge and to support the principles of trade unionism, and I authorize the IAM and/or its designated affiliate to act as my representative for collective bargaining. If former member of IAM: Card no. Lodge no. Location Last dues paid
