Employee Enrollment Form

Sub Contractor Enrollment Form

Personal Information

As it appears on your social security card.

To be completed by the EMPLOYER

Original Hire Date


SECTION I - DISCLOSURE AND ACKNOWLEDGMENT. NOTICE TO APPLICANT: The Client/Worksite Employer ("WSE") named above has entered into a Client Service Agreement ("CSA"), with CoAdvantage, through its subsidiary company ("CoAdvantage"). CoAdvantage is a professional employer organization, and upon acceptance of your application in the manner prescribed in the CSA, you will be assigned to work for the above named WSE and will become co-employed by CoAdvantage and your WSE. The specific subsidiary of CoAdvantage that you will be co-employed by will be identified on your paychecks. However, in no event will you be deemed co-employed by CoAdvantage for any pay period in which your WSE does not report your payroll hours or wages to CoAdvantage.

In accordance with the CSA, CoAdvantage will provide payroll administration and perform various other employer responsibilities and functions. While you are co-employed by CoAdvantage, you will work under the day-to-day, on-site supervision, control, and management of your WSE. Your WSE will also determine the amount of wages or salary you will be paid. Your WSE must comply with all applicable federal, state and local laws related to your employment, including without limitation, all wage and hour laws, occupational health and safety laws, equal employment opportunity laws, and anti-discrimination laws.

If you become co-employed by CoAdvantage, your employment will be subject to a 90 day probationary period. In addition, your employment with CoAdvantage is "at will" and may be terminated by CoAdvantage at any time with or without cause (unless and except to extent prohibited by applicable law). If the CSA between your WSE and CoAdvantage is terminated for any reason, your employment with CoAdvantage will also terminate as of the effective date of the termination of the CSA unless you are assigned by CoAdvantage to work for another WSE of CoAdvantage. If your employment with CoAdvantage terminates, it is up to your WSE to determine whether or not you will continue to remain an employee of your WSE, and if your WSE chooses to continue your employment, your WSE will be exclusively responsible for all employer related responsibilities. If your WSE does not make payment to CoAdvantage as required by the CSA, CoAdvantage's liability, if any, is to pay your wages during any period where you are employed by CoAdvantage shall be limited to the payment of the applicable minimum wage (or the legally required salary or overtime pay in
a work week in which you have worked overtime).

• Comply with all applicable Federal, State and local safety laws, rules and regulations.
• Report ALL injuries or unsafe acts to your supervisor IMMEDIATELY. Except in cases of emergency, your Supervisor must notify CoAdvantage in order for any treatment to be authorized. Report all job accidents on the same day of the occurrence.
• The use or possession of intoxicating beverages, drugs, firearms or other weapons is forbidden and may be cause for immediate termination.
• Personal protective equipment, i.e., work shoes, safety glasses, rubber gloves, oven mitts, etc. will be worn at all times when your work activities and surroundings dictate.

SECTION 3: SEXUAL HARASSMENT POLICY. Sexual harassment is a form of sexual discrimination prohibited by Title VII of the 1964 Civil Rights Act. CoAdvantage's policy is not to condone or permit sexual harassment. Sexual harassment includes unwelcome sexual advances or requests for sexual favors, unwelcome verbal or physical conduct of a sexual nature, or any other unwelcome sexual conduct that has the purpose or effect of unreasonably interfering with an affected person's work performance, or creating an intimidating, hostile, or offensive work environment. In addition, it is sexual harassment to indicate that submission to or rejection of unwelcome sexual conduct is either explicitly or implicitly a term or condition of employment, or utilizing submission to or rejection of such conduct as a basis for an employment decision affecting the person submitting to or rejecting the conduct. Any employee who feels that he or she may have been subjected to sexual harassment must report it immediately to their Manager and notify CoAdvantage's Human Resources Department at 1-888-925-2990. All allegations of sexual harassment will be investigated promptly and thoroughly, and proper
remedial action will be taken according to the specific circumstances of the situation. All investigations of alleged sexual harassment and other types of discrimination are strictly confidential. Federal, state, and local law prohibits taking adverse employment action in retaliation for reporting an incident of sexual harassment or other types of discrimination. Any person, who, after a full investigation of any allegation of sexual harassment, is found to have committed an act of sexual harassment, will be disciplined and, in appropriate situations, terminated from employment.

SECTION 4: HARASSMENT IN THE WORKPLACE POLICY. CoAdvantage and the client to which you are assigned are committed to provide a work environment that is free of discrimination and harassment. We do not tolerate any form of harassment, whether it comes from supervisors, fellow employees, or anyone else. Any employee guilty of committing any act of harassment may be disciplined, or where appropriate, discharged without notice. Harassment includes verbal or physical conduct that denigrates or shows hostility or aversion toward an individual because of his or her race, color, religion, sex, national origin, age, marital status, disability or any other characteristic protected by law, and that (1) has the purpose or effect of creating an intimidating, hostile, or offensive working environment; (2) has the purpose or effect of unreasonably interfering with an individual 's work performance; or (3) otherwise adversely affects an individual's employment opportunities. Any employee who is subjected to any kind of discrimination or harassment must immediately report it to their Manager and notify CoAdvantage's Human Resources Department at 1-888-925-2990. In order
to obtain assistance in the resolution of such matters, I agree to allow CoAdvantage the opportunity to resolve any such claim or issue through mediation, arbitration, or government agency prior to seeking resolution through another means.

SECTION 5: DRUG AND ALCOHOL FREE WORKPLACE PROGRAM AND TESTING CONSENT. CoAdvantage and the WSE to which you are assigned (collectively referred to as the "Company") have established a drug and alcohol free workplace program. The Company's policy and program is set forth in the CoAdvantage Employee Handbook, receipt of which is acknowledged below. It is the policy of the Company that the unlawful/ unauthorized possession, use, consumption, sale, purchase, distribution, or manufacture by any employee of alcohol or any illegal drugs or illegally obtained drugs in the workplace, on Company premises or within its facilities, or when operating Company vehicles on or off duty, or in the conduct of Company-related work off Company premises is strictly prohibited. The foregoing prohibitions apply at all times during the work day, including meal­ times and break periods. The Company does not permit any employees to report to work or to perform his or her duties with the presence of illegal or illegally obtained drugs or alcohol in his or her body, or while impaired or under the influence of any illegal drug, or alcohol. For purposes of this policy, "impaired" or "under the influence" means testing positive pursuant to the cut-off levels applicable to the Company's testing program. The Company also does not permit any employee to report to work or to perform his or her duties while taking prescription or non-prescription medication which is adversely affecting the person's ability to safely and effectively perform his or her job functions. Employees are required to notify their supervisor in such instances, but need not disclose the medication being used or the medical condition involved.

I understand that according to the Company's Drug and Alcohol Free Workplace Program, as a condition of employment with the Company, I may be required to submit a sample of my urine, blood, and/or other legally approved specimen, for chemical analysis. The purpose of this analysis is to determine the absence or presence of illegal drugs and/or alcohol. I consent and agree freely and voluntarily to provide a specimen upon the request of CoAdvantage or my on-site employer. I hereby release and hold harmless the Company from any liability whatsoever arising from any request to
furnish my specimens and the testing of my specimens. I further consent to the release of the result(s) of any analysis to the Company and understand
that in the event I refuse to be tested, refuse to provide this Consent, or test positive, I will be subject to disciplinary action up to and including termination of employment by the Company. I also understand that, in the event I was injured in the course and scope of my employment, and refuse to be tested or test positive, I may, in addition to the above, forfeit all my Workers' Compensation medical and indemnity benefits.

I also consent, in the event of a confirmed positive test, to the release by the Company of such result(s) to any person(s) with a need to know in connection with any administrative proceeding, lawsuit or other legal action or proceeding where my test result(s) would be at issue or otherwise relevant to the outcome of the action/proceeding.

Please type your first and last name. *Employees under 18 years of age must have a parent or guardian sign this Consent.

Employee Handbook

RECEIPT & ACKNOWLEDGMENT OF EMPLOYEE HANDBOOK. I , the undersigned employee, acknowledge by my signature, that I have been informed that I am an assigned employee of CoAdvantage. I am aware that CoAdvantage has an employee handbook applicable to all assigned employees, that a copy of CoAdvantage's employee handbook is posted on CoAdvantage's CoAd360 Pulse portal and that I have either been provided a copy of CoAdvantage's employee handbook or that I have obtained a copy of it from CoAdvantage's CoAd360 Pulse portal. I understand and agree that it is my responsibility to read and comply with all policies and guidelines in CoAdvantage's employee handbook. I understand that CoAdvantage's employee handbook does not establish any contractual relationship and that its provisions may be changed at any time by management, and that this handbook is not a guarantee of employment. I further understand that my worksite employer may also establish additional policies and guidelines that relate to my employment, and it is my responsibility to ask questions to my Manager or to CoAdvantage regarding any policies and guidelines that I do not understand.
Please type your first and last name. *Employees under 18 years of age must have a parent or guardian sign this Consent.