(740)-928-1105

Employee Application

Name
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Address
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Are you a citizen of the United States?
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?
MM slash DD slash YYYY
Have you ever been convicted of a felony?

Education

Address
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Did you graduate?
Address
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MM slash DD slash YYYY
Did you graduate?
Address
MM slash DD slash YYYY
MM slash DD slash YYYY
Did you graduate?

References

Name
Address
Name
Address
Name
Address

Previous Employment

Address
Supervisor
MM slash DD slash YYYY
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May we contact your previous supervisor for a reference?
Address
Supervisor
MM slash DD slash YYYY
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May we contact your previous supervisor for a reference?
Address
Supervisor
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact your previous supervisor for a reference?

Military Service

MM slash DD slash YYYY
MM slash DD slash YYYY

Disclaimer and Signature

Signature

Emergency Contact Sheet

Employee Name
Address

In case of Emergency, Please Contact

Name
Name

Ohio New Hire Reporting Form

Effective October 1, 1997 Ohio Revised Code Section 3121.89-3121.8911 requires all Ohio Employers, both public and private, to report all newly hired, rehired, or returning to work employees to the State of Ohio within 20 days of hire or rehire date. Information about new hire reporting and online reporting is available on our Web site· www.oh-newhire.com

Employer Information

Employer Name
Employer Address (Please indicate the address where the Income Withholding Orders should be sent).

Employee Information

Employee State of Hire
Name
Employee Address
MM slash DD slash YYYY
MM slash DD slash YYYY
Is this employee an Independent Contractor?
REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING
Questions? CalI us at (614) 221-5330 or toll-free 1 (888) 872-1490
This form may be duplicated

Notice to Employee

1. For state purposes, an individual may claim only natural de­pendency exemptions. This includes the taxpayer, spouse and each dependent. Dependents are the same as defined in the Internal Revenue Code and as claimed in the taxpayer's federal income tax return for the taxable year, or which the taxpayer would have been permitted to claim had the tax­payer filed such a return.
2. You may file a new certificate at anytime if the number of your exempts increases.
You must file a new certificate within 10 days if the number of exemptions previously claimed by you decreases because:
(a) Your spouse for whom you have been claiming exemption is divorced or legally separated, or claims her (or his) own exemption on a separate certificate.
(b) The support of a dependent for whom you claimed ex­emption is taken over by someone else.
(c) You find that a dependent for whom you claimed exemp­tion must be dropped for federal purposes.
The death of a spouse or a dependent does not affect your withholding until the next year but requires the filing of a new certificate. If possible, file a new certificate by Dec. 1st of the year in which the death occurs.
For further information, consult the Ohio Department of Taxa­tion, Income Tax Division, or your employer.
3. If you expect to owe more Ohio income tax than will be with­held, you may claim a smaller number of exemptions; or under an agreement with your employer, you may have an additional amount withheld each pay period.
4. A married couple with both spouses working and filing a joint return will, in many cases, be required to file an individual estimated income tax form IT 1040ES even though Ohio in­come tax is being withheld from their wages. This result may occur because the tax on their combined income will be greater than the sum of the taxes withheld from the husband's wages and the wife's wages. This requirement to file an individual estimated income tax form IT 1040ES may also apply to an individual who has two jobs, both of which are subject to withholding. In lieu of filing the individual estimated income tax form IT 1040ES, the individual may provide for additional withholding with his employer by using line 5.

Employee's Withholding Exemption Certificate

Name
Address
Signature

ACKNOWLEDGMENT OF COMPANY'S SUBSTANCE ABUSE POLICY, CONSENT TO TESTING, AND RELEASE OF INFORMATION AND LIABILITY

I acknowledge that I have seen and reviewed project: Construction Company's (the "Company") Substance Abuse Policy (the "Policy"). I understand that pursuant to the Policy I may be required to submit a body fluid sample (such as of my urine, blood, saliva, and/or breath) to a collection and laboratory facility, which the Company selects, for chemical analysis to determine whether illegal drugs or alcohol are present in my system. I further understand that if I fail to pass my test and/or refuse to abide by all sample collection and chain of custody procedures, I will be suspect to disciplinary action as set forth in the Policy.
I hereby knowingly and voluntarily consent to the Company's, the laboratory's and/or the collection facility's (and their respective agents') request for my body fluid sample for chemical analysis. I further authorize the laboratory or collection facility (and their agents) to release to the Company any information regarding the results of any such chemical analysis of my body fluid sample. In exchange for current and continuing employment, I also release the Company, including any and all of its officers, directors, managers, and employees, from any and all claims, suits, charges, causes of action, liability and damages relating to or arising from (a) the submission ofmy body fluid sample for chemical analysis; (b) my refusal to submit a sample; ( c) the release of any information to the Company pertaining to the collection, testing, or test results of my sample; and/or (d) the termination of my employment based on a positive drug or alcohol test result and/or my refusal to submit to testing.
I also understand that this acknowledgment, consent, and release will remain valid, binding, and useable throughout my employment with the Company, whenever the company requires that I submit to a drug and/or alcohol test, whether random selection, following a work related accident or injury, or for some other reason.
Signature

Authorization for Direct Deposit (ACH Credit)

Direct Deposit via ACH is the deposit of funds to an account for payroll, employee expense reimbursement, government benefits, tax and other refunds, and annuities and interest payments.

Company Name ("COMPANY")

For the account listed below, I (we) hereby authorize COMPANY to electronically credit my (our) account, and if necessary, to electronically debit my (our) account to correct erroneous credits. I (we) agree that ACH transactions I (we) authorize comply with all applicable law. I (we) understand that this authorization will remain in full force and effect until I (we) notify COMPANY in writing that I (we) wish to revoke this authorization and COMPANY has a reasonable opportunity to act on it.
Type of account
Recipient Name(s)
Signature
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Project Architecture Ltd. Project Construction Company

Connect with Us

Project Architecture Ltd
Project Construction Company

149 E. Main Street
Hebron, OH 43025
Tel: (740)-928-1105

Name(Required)
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