Spanish Application Form
1. That the information on this application is true and complete to the best of my knowledge and that any false statements is a violation of company policy.
2. That I not solicit nor accept work with the clients or
at a job site of UCP Personnel Services without prior written authorization.
3. That I will not disclose or use any confidential information on UCP Personnel Services or its clients where I may be sent.
4. That I will not work for UCP Personnel Services under the influence of any illegal or controlled substance.
5. That I will make myself available for drug testing to be administered at the discretion of UCP Personnel Services.
6. That I authorize UCP Personnel Services to contact my former employees for reference checks.
7. That UCP Personnel Services is an equal opportunity employer & a drug free work place.
8. That as an employee you are covered under UCP Personnel Services for any type of workers comp insurance claim, and that following the safety procedures of UCP Personnel Services is mandatory. Failure to comply can result in immediate termination.
9. That UCP Personnel Services can/will request a background check for my employment.
10. As a temporary agency, UCP Personnel Services needs to be contacted once the job assignment ends for the next jobs assignment or to be placed on our availability list. If not contacted, unemployment benefits can be affected.
Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
Give Form W-4 to your employer.
Your withholding is subject to review by the IRS.
Does your name match the name on your social security card?If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, when to use the online estimator, and privacy.
Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spousealso works. The correct amount of withholding depends on income earned from all of these jobs.
TIP: To be accurate, submit a 2020 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.
If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job.
Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional tables; or, you can use the online withholding estimator at www.irs.gov/W4App.
Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 2c below. Otherwise, skip to line 3.
Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)
If your income will be $200,000 or less ($400,000 or less if married filing jointly):
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
For Privacy Act and Paperwork Reduction Act Notice, see page 3.
Employment Eligibility VerificationDepartment of Homeland SecurityU.S. Citizenship and Immigration Services
A NTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
Employee Info from Section 1
Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.
A. New Name (if applicable)
B. Date of Rehire (if applicable)
C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.
I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.