APPLICATION PAGE

Application Form

I-9*
- Yes
- No
Filing Status*
- Married
- Single
Dependents

Lastname*
Firstname*
Middle*
Nickname
Social Security Number
Street Address*
Apt #
City*
State*
Zip Code*
Date Available*
Date Format: MM slash DD slash YYYY
Primary Phone*
Secondary Phone
Email Address

Date of Birth*
Date Format: MM slash DD slash YYYY
Smoker?
- Yes
- No
Travel?
- Yes
- No
Type of Work Preferred
Hourly Wage Desired
($ ________ per hour)
Have you ever been convicted of a crime?
- Yes
- No
If YES, please explain.

Trade Years Mastery Level Specialty
I have :
- Vehicle
- Gloves
- Hard Hat
- Steel Toe Boots

Employment History (Latest Employers First)
Date (MO/YR)
Company Name
Pay Rate
Phone Number
Duties
Reason for leaving
Date (MO/YR)
Company Name
Pay Rate
Phone Number
Duties
Reason for leaving
Date (MO/YR)
Company Name
Pay Rate
Phone Number
Duties
Reason for leaving

I UNDERSTAND AND AGREE:

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.

ID*
SScard*
Signature*

Employee’s Withholding Certificate

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.

Step 1: Enter Personal Information
(a) First name and middle initial*
Last name*
Address
City or town, state, and ZIP code
(b) Social security number
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.
(c)
- Single or Married filing separately
- Married filing jointly (or Qualifying widow(er))
- Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

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.

Step 2: Multiple Jobs or Spouse Works
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.
Do only one of the following.
- (a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or
- (b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or
- (c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld
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.
Step 2(b)—Multiple Jobs Worksheet
(Keep for your records.)
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.
1 Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have onejob, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter that value on line 1. Then, skip to line 3
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.
2a Find the amount from the appropriate table on page 4 using the annual wages from the highest paying job in the “Higher Paying Job” row and the annual wages for your next highest paying jobin the “Lower Paying Job” column. Find the value at the intersection of the two household salaries and enter that value on line 2a
2b Add the annual wages of the two highest paying jobs from line 2a together and use the total as the wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount on line 2b
2c Add the amounts from lines 2a and 2b and enter the result on line 2c
3 Enter the number of pay periods per year for the highest paying job. For example, if that job paysweekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc.
4 Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter thisamount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additionalamount you want withheld)

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.)

Step 3: Claim Dependents
If your income will be $200,000 or less ($400,000 or less if married filing jointly):
Multiply the number of qualifying children under age 17 by $2,000
Multiply the number of other dependents by $500
Add the amounts above and enter the total here

Step 4 (optional): Other Adjustments
(a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income
(b) Deductions. If you expect to claim deductions other than the standard deductionand want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here
(c) Extra withholding. Enter any additional tax you want withheld each pay period

Step 4(b) - Deductions Worksheet (Keep for your records.)
1 Enter an estimate of your 2020 itemized deductions (from Schedule A (Form 1040 or 1040-SR)). Such deductions may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 7.5% of your income
2 Enter: (a) $24,800 if you’re married filing jointly or qualifying widow(er) (b) $18,650 if you’re head of household (c) $12,400 if you’re single or married filing separately
3 If line 1 is greater than line 2, subtract line 2 from line 1. If line 2 is greater than line 1, enter “-0-”
4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other adjustments (from Part II of Schedule 1 (Form 1040 or 1040-SR)). See Pub. 505 for more information
5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4

Step 5: Sign Here
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Employee’s signature (This form is not valid unless you sign it.)*
Date
Date Format: MM slash DD slash YYYY

Employers Only
Employer’s name and address
First date of employment
Date Format: MM slash DD slash YYYY
Employer identification number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Form W-4

Form I-9

Employment Eligibility Verification
Department of Homeland Security
U.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.

Section 1. Employee Information and Attestation
(Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)
Last Name (Family Name)*
First Name (Given Name)*
Middle Initial*
Other Last Names Used (if any)
Address (Street Number and Name)
Apt. Number
City or Town
State
ZIP Code
Date of Birth (mm/dd/yyyy)
Date Format: MM slash DD slash YYYY
U.S. Social Security Number
Employee's E-mail Address
Employee's Telephone Number

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.
I attest, under penalty of perjury, that I am (check one of the following boxes):
- 1. A citizen of the United States
- 2. A noncitizen national of the United States (See instructions)
- 3. A lawful permanent resident
- 4. An alien authorized to work
Alien Registration Number/USCIS Number :
Expiration date, if applicable, mm/dd/yyyy
Some aliens may write "N/A" in the expiration date field. (See instructions)
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.
1. Alien Registration Number/USCIS Number:
OR
2. Form I-94 Admission Number:
OR
3. Foreign Passport Number:
Country of Issuance:

Signature of Employee
Today's Date (mm/dd/yyyy)
Date Format: MM slash DD slash YYYY

Preparer and/or Translator Certification (check one):
- I did not use a preparer or translator.
- A preparer(s) and/or translator(s) assisted the employee in completing Section 1.
(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.
Signature of Preparer or Translator
Today's Date (mm/dd/yyyy)
Date Format: MM slash DD slash YYYY
Last Name (Family Name)
First Name (Given Name)
Address (Street Number and Name)
City or Town
State
ZIP Code

Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")
Employee Info from Section 1
Last Name (Family Name)*
First Name (Given Name)*
M.I.*
Citizenship/Immigration Status

Lista A
Identity and Employment Authorization
Document Title Issuing Authority Document Number Expiration Date (if any)
OR

List B
Identity
Document Title Issuing Authority Document Number Expiration Date (if any)
AND

List C
Employment Authorization
Document Title Issuing Authority Document Number Expiration Date (if any)
Additional Information
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.
The employee's first day of employment (mm/dd/yyyy):
(See instructions for exemptions)
Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)
Date Format: MM slash DD slash YYYY
Last Name of Employer or Authorized Representative
First Name of Employer or Authorized Representative
Title of Employer or Authorized Representative
Employer's Business or Organization Name
Employer's Business or Organization Address (Street Number and Name)
City or Town
State
ZIP Code

Section 3. Reverification and Rehires
(To be completed and signed by employer or authorized representative.)
A. New Name (if applicable)
Last Name (Family Name)
First Name (Given Name)
Middle Initial
B. Date of Rehire (if applicable)
Date (mm/dd/yyyy)
Date Format: MM slash DD slash YYYY
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.
Document Title
Document Number
Expiration Date (if any)
Date Format: MM slash DD slash YYYY
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.
Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)
Date Format: MM slash DD slash YYYY
Name of Employer or Authorized Representative

Document Title	Issuing Authority	Document Number	Expiration Date (if any)

Trade	Years	Mastery Level	Specialty

Step 1 of 3

Application Form

Employment History (Latest Employers First)

I UNDERSTAND AND AGREE:

Employee’s Withholding Certificate

Step 1: Enter Personal Information

Step 2: Multiple Jobs or Spouse Works

Step 2(b)—Multiple Jobs Worksheet

Step 3: Claim Dependents

Step 4 (optional): Other Adjustments

Step 4(b) - Deductions Worksheet (Keep for your records.)

Step 5: Sign Here

Employers Only

Form I-9

Section 1. Employee Information and Attestation

Section 2. Employer or Authorized Representative Review and Verification

Section 3. Reverification and Rehires