RespiteMatch.com Health Blog

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NOTE: THE FORMS AVAILABLE IN THIS ARCHIVE ARE SUBJECT TO OUR TERMS OF USE AND ARE NOT A SUBSTITUTE FOR THE ADVICE OF AN ATTORNEY. LEGAL ADVICE OF ANY NATURE SHOULD BE SOUGHT FROM COMPETENT LEGAL COUNSEL IN THE RELEVANT JURISDICTION. THESE FORMS ARE PROVIDED “AS IS.”

APPLICATION FOR EMPLOYMENT

ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS.

Position Sought: ________________________________________________________________________

How did you learn about the position? ________________________________________________________

Name_____________________________________________________________ Date________________

Address__________________________________ City___________________ State________ Zip_______

Home Phone ____________________Office Phone___________________Other Phone_________________

Email Address: ______________________________ Social Security Number:_________________________

On what date would you be available for work? ____________________ Desired Wage/Salary $_____________
Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction? [ ] Yes [ ] No
Have you ever been convicted of a felony? [ ] Yes [ ] No If yes, please describe circumstances: __________
_______________________________________________________________________________________

Have you ever been involuntarily terminated or asked to resign from any position of employment? [ ] Yes [ ] No
If yes, please describe circumstances: __________________________________________________________
_______________________________________________________________________________________
If selected for employment, are you willing to submit to a pre-employment drug screening test? [ ] Yes [ ] No

EDUCATION

School Name
Location
Years Attended
Degree Received
Major

Other training, certifications, or licenses held: ____________________________________________________
_______________________________________________________________________________________

List other information pertinent to the employment you are seeking: ___________________________________
_______________________________________________________________________________________

EMPLOYMENT

(Most Recent First.)

1. Employer_____________________________________________ Job Title_________________________

Dates Employed______________ Prior Position Held within Company (if any): _________________________

Address_________________________________ City___________________ State________ Zip_________

Phone____________________ Job Title_______________________ Supervisor_______________________

Starting Salary________________________________ Ending Salary_______________________________

Duties Performed _________________________________________________________________________

Reason for Leaving _______________________________________________________________________

2. Employer_____________________________________________ Job Title_________________________

Dates Employed______________ Prior Position Held within Company (if any): _________________________

Address_________________________________ City___________________ State________ Zip_________

Phone____________________ Job Title_______________________ Supervisor_______________________

Starting Salary________________________________ Ending Salary_______________________________

Duties Performed _________________________________________________________________________

Reason for Leaving _______________________________________________________________________

3. Employer_____________________________________________ Job Title_________________________

Dates Employed______________ Prior Position Held within Company (if any): _________________________

Address_________________________________ City___________________ State________ Zip_________

Phone____________________ Job Title_______________________ Supervisor_______________________

Starting Salary________________________________ Ending Salary_______________________________

Duties Performed _________________________________________________________________________

Reason for Leaving _______________________________________________________________________

4. Employer_____________________________________________ Job Title_________________________

Dates Employed______________ Prior Position Held within Company (if any): _________________________

Address_________________________________ City___________________ State________ Zip_________

Phone____________________ Job Title_______________________ Supervisor_______________________

Starting Salary________________________________ Ending Salary_______________________________

Duties Performed _________________________________________________________________________

Reason for Leaving _______________________________________________________________________

ACKNOWLEDGMENT AND AUTHORIZATION

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application

or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

_________________________________________ ___________________

Signature of Applicant Date

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NOTE: THE FORMS AVAILABLE IN THIS ARCHIVE ARE SUBJECT TO OUR TERMS OF USE AND ARE NOT A SUBSTITUTE FOR THE ADVICE OF AN ATTORNEY. LEGAL ADVICE OF ANY NATURE SHOULD BE SOUGHT FROM COMPETENT LEGAL COUNSEL IN THE RELEVANT JURISDICTION. THESE FORMS ARE PROVIDED “AS IS.”

DISCIPLINARY NOTICE

Employee Name: ______________________________________________________

First Middle Last

Department: ______________________________________________________

_____ Written Warning _____ Final Warning

1. Statement of the problem: ____________________________________________

_________________________________________________________________________

_________________________________________________________________________

2. Prior discussion or warnings on this subject, whether oral or written:

_________________________________________________________________________

_________________________________________________________________________

3. Company policy on this subject:_______________________________________

_________________________________________________________________________

_________________________________________________________________________

4. Summary of corrective action to be taken by the Company and/or employee:

_________________________________________________________________________

_________________________________________________________________________

5. Consequences of failure to improve performance or correct behavior:

_________________________________________________________________________

_________________________________________________________________________

6. Employee Statement:________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Employee Signature: __________________________________ Date: ____________

Management Approval: __________________________________ Date: ____________

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NOTE: THE FORMS AVAILABLE IN THIS ARCHIVE ARE SUBJECT TO OUR TERMS OF USE AND ARE NOT A SUBSTITUTE FOR THE ADVICE OF AN ATTORNEY. LEGAL ADVICE OF ANY NATURE SHOULD BE SOUGHT FROM COMPETENT LEGAL COUNSEL IN THE RELEVANT JURISDICTION. THESE FORMS ARE PROVIDED “AS IS.”

CONSENT FOR DRUG/ALCOHOL TESTING

If you are offered and accept employment with __________________________________
(Company), in the interest of safety for all concerned, you will be required to take a urine test for drug and/or alcohol use.

I, ___________________________________, have been fully informed of the reason for this urine test for drug and/or alcohol (I understand what I am being tested for), the procedure involved, and do hereby freely give my consent. In addition, I understand that the results of this test will be forwarded to my potential employer and become part of my record.

If this test is positive, and for this reason I am not hired, I understand that I
will be given the opportunity to explain the results of this test.

I hereby authorize these test results to be released
to____________________________________________________________________ (Company Name).

Signature:

_______________________________________ Date: ______________

Witness:

_______________________________________ Date: ______________

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NOTE: THE FORMS AVAILABLE IN THIS ARCHIVE ARE SUBJECT TO OUR TERMS OF USE AND ARE NOT A SUBSTITUTE FOR THE ADVICE OF AN ATTORNEY. LEGAL ADVICE OF ANY NATURE SHOULD BE SOUGHT FROM COMPETENT LEGAL COUNSEL IN THE RELEVANT JURISDICTION. THESE FORMS ARE PROVIDED “AS IS.”

NOTICE OF DISMISSAL

Date:________________________________

To:__________________________________

We regret to notify you that your employment with the firm shall be terminated on ________________________ , 20____, because of the following reasons:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Severance pay shall be in accordance with company policy. Within 30 days of termination we shall issue you a statement of accrued benefits. Any insurance benefits shall continue in accordance with applicable law and/or provisions of our personnel policy. Please contact ________________________________, at your earliest convenience, who will explain each of these items and arrange with you for the return of any company property.

We sincerely regret this action is necessary.

Very truly,

____________________________________

Copies to:

[Insert List]

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NOTE: THE FORMS AVAILABLE IN THIS ARCHIVE ARE SUBJECT TO OUR TERMS OF USE AND ARE NOT A SUBSTITUTE FOR THE ADVICE OF AN ATTORNEY. LEGAL ADVICE OF ANY NATURE SHOULD BE SOUGHT FROM COMPETENT LEGAL COUNSEL IN THE RELEVANT JURISDICTION. THESE FORMS ARE PROVIDED “AS IS.”

NOTICE OF TERMINATION DUE TO WORK RULES VIOLATION

Date:_______________________

To:

You are hereby given notice that your employment with the company shall be terminated on _________________________, 20____.

This action is necessary due to the following violations of company work rules:

Your final paycheck shall be for the period ending ______________. There shall be no severance pay since your termination was for just cause. Please contact_______________________________ concerning insurance coverage or other accrued benefits to which you may be entitled.

We regret this action is necessary and wish you success in your future endeavors.

Sincerely,

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NOTE: THE FORMS AVAILABLE IN THIS ARCHIVE ARE SUBJECT TO OUR TERMS OF USE AND ARE NOT A SUBSTITUTE FOR THE ADVICE OF AN ATTORNEY. LEGAL ADVICE OF ANY NATURE SHOULD BE SOUGHT FROM COMPETENT LEGAL COUNSEL IN THE RELEVANT JURISDICTION. THESE FORMS ARE PROVIDED “AS IS.”

POLYGRAPH CONSENT

Name: _________________________________________________________

Date of Polygraph Examination: ______________________________________

I voluntarily agree to a polygraph examination on the above date.

A company representative has advised me of the following:

(1) I am guaranteed by the law the right not to take this examination as a condition of employment or continued employment.

(2) I have not been coerced in any way into either taking this test or signing this consent agreement. This act is entirely voluntary on my part.

(3) I have retained a copy of this agreement for my records.

Signature_________________________________ Date______________________

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NOTE: THE FORMS AVAILABLE IN THIS ARCHIVE ARE SUBJECT TO OUR TERMS OF USE AND ARE NOT A SUBSTITUTE FOR THE ADVICE OF AN ATTORNEY. LEGAL ADVICE OF ANY NATURE SHOULD BE SOUGHT FROM COMPETENT LEGAL COUNSEL IN THE RELEVANT JURISDICTION. THESE FORMS ARE PROVIDED “AS IS.”

WARNING NOTICE

[DATE]

To: [EMPLOYEE’S NAME]

Dear [EMPLOYEE’S NAME]:

On ___________, 20_____, at ____________, we met to discuss your unsatisfactory performance. Specifically, we identified the following as being unsatisfactory:

In order to improve your performance, you should:

I will assist you in any way I can to remedy the problem; however, unless these matters can be corrected, I shall have no alternative but to undertake further disciplinary or corrective action, which may include suspension.

Sincerely,
[NAME OF COMPANY]

______________________________
[SUPERVISOR NAME]
[TITLE]

I hereby acknowledge receipt of this warning:

______________________________
[EMPLOYEE’S NAME]

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NOTE: THE FORMS AVAILABLE IN THIS ARCHIVE ARE SUBJECT TO OUR TERMS OF USE AND ARE NOT A SUBSTITUTE FOR THE ADVICE OF AN ATTORNEY. LEGAL ADVICE OF ANY NATURE SHOULD BE SOUGHT FROM COMPETENT LEGAL COUNSEL IN THE RELEVANT JURISDICTION. THESE FORMS ARE PROVIDED “AS IS.”

INDEPENDENT CONTRACTOR AGREEMENT

This Agreement is entered into as of the ________ day of ________________, 20____, between [company name] (”the Company”) and [service provider’s name] (”the Contractor”).

1. Independent Contractor. Subject to the terms and conditions of this Agreement, the Company hereby engages the Contractor as an independent contractor to perform the services set forth herein, and the Contractor hereby accepts such engagement.

2. Duties, Term, and Compensation. The Contractor’s duties, term of engagement, compensation and provisions for payment thereof shall be as set forth in the estimate previously provided to the Company by the Contractor and which is attached as Exhibit A, which may be amended in writing from time to time, or supplemented with subsequent estimates for services to be rendered by the Contractor and agreed to by the Company, and which collectively are hereby incorporated by reference.

3. Expenses. During the term of this Agreement, the Contractor shall bill and the Company shall reimburse [him or her] for all reasonable and approved out-of-pocket expenses which are incurred in connection with the performance of the duties hereunder. Notwithstanding the foregoing, expenses for the time spent by Contractor in traveling to and from Company facilities shall not be reimbursable.

4. Written Reports. The Company may request that project plans, progress reports and a final results report be provided by Contractor on a monthly basis. A final results report shall be due at the conclusion of the project and shall be submitted to the Company in a confidential written report at such time. The results report shall be in such form and setting forth such information and data as is reasonably requested by the Company.

5. Inventions. Any and all inventions, discoveries, developments and innovations conceived by the Contractor during this engagement relative to the duties under this Agreement shall be the exclusive property of the Company; and the Contractor hereby assigns all right, title, and interest in the same to the Company. Any and all inventions, discoveries, developments and innovations conceived by the Contractor prior to the term of this Agreement and utilized by [him or her] in rendering duties to the Company are hereby licensed to the Company for use in its operations and for an infinite duration. This license is non-exclusive, and may be assigned without the Contractor’s prior written approval by the Company to a wholly-owned subsidiary of the Company.

6. Confidentiality. The Contractor acknowledges that during the engagement [he or she] will have access to and become acquainted with various trade secrets, inventions, innovations, processes, information, records and specifications owned or licensed by the Company and/or used by the Company in connection with the operation of its business including, without limitation, the Company’s business and product processes, methods, customer lists, accounts and procedures. The Contractor agrees that [he or she] will not disclose any of the aforesaid, directly or indirectly, or use any of them in any manner, either during the term of this Agreement or at any time thereafter, except as required in the course of this engagement with the Company. All files, records, documents, blueprints, specifications, information, letters, notes, media lists, original artwork/creative, notebooks, and similar items relating to the business of the Company, whether prepared by the Contractor or otherwise coming into [his or her] possession, shall remain the exclusive property of the Company. The Contractor shall not retain any copies of the foregoing without the Company’s prior written permission. Upon the expiration or earlier termination of this Agreement, or whenever requested by the Company, the Contractor shall immediately deliver to the Company all such files, records, documents, specifications, information, and other items in [his or her] possession or under [his or her] control. The Contractor further agrees that [he or she] will not disclose [his or her] retention as an independent contractor or the terms of this Agreement to any person without the prior written consent of the Company and shall at all times preserve the confidential nature of [his or her] relationship to the Company and of the services hereunder.

7. Conflicts of Interest; Non-hire Provision. The Contractor represents that [he or she] is free to enter into this Agreement, and that this engagement does not violate the terms of any agreement between the Contractor and any third party. Further, the Contractor, in rendering [his or her] duties shall not utilize any invention, discovery, development, improvement, innovation, or trade secret in which [he or she] does not have a proprietary interest. During the term of this agreement, the Contractor shall devote as much of [his or her] productive time, energy and abilities to the performance of [his or her] duties hereunder as is necessary to perform the required duties in a timely and productive manner. The Contractor is expressly free to perform services for other parties while performing services for the Company. For a period of six months following any termination, the Contractor shall not, directly or indirectly hire, solicit, or encourage to leave the Company’s employment, any employee, consultant, or contractor of the Company or hire any such employee, consultant, or contractor who has left the Company’s employment or contractual engagement within one year of such employment or engagement.

8. Right to Injunction. The parties hereto acknowledge that the services to be rendered by the Contractor under this Agreement and the rights and privileges granted to the Company under the Agreement are of a special, unique, unusual, and extraordinary character which gives them a peculiar value, the loss of which cannot be reasonably or adequately compensated by damages in any action at law, and the breach by the Contractor of any of the provisions of this Agreement will cause the Company irreparable injury and damage. The Contractor expressly agrees that the Company shall be entitled to injunctive and other equitable relief in the event of, or to prevent, a breach of any provision of this Agreement by the Contractor. Resort to such equitable relief, however, shall not be construed to be a waiver of any other rights or remedies that the Company may have for damages or otherwise. The various rights and remedies of the Company under this Agreement or otherwise shall be construed to be cumulative, and no one of the them shall be exclusive of any other or of any right or remedy allowed by law.

9. Merger. This Agreement shall not be terminated by the merger or consolidation of the Company into or with any other entity.

10. Termination. The Company may terminate this Agreement at any time by 10 working days’ written notice to the Contractor. In addition, if the Contractor is convicted of any crime or offense, fails or refuses to comply with the written policies or reasonable directive of the Company, is guilty of serious misconduct in connection with performance hereunder, or materially breaches provisions of this Agreement, the Company at any time may terminate the engagement of the Contractor immediately and without prior written notice to the Contractor.

11. Independent Contractor. This Agreement shall not render the Contractor an employee, partner, agent of, or joint venturer with the Company for any purpose. The Contractor is and will remain an independent contractor in [his or her] relationship to the Company. The Company shall not be responsible for withholding taxes with respect to the Contractor’s compensation hereunder. The Contractor shall have no claim against the Company hereunder or otherwise for vacation pay, sick leave, retirement benefits, social security, worker’s compensation, health or disability benefits, unemployment insurance benefits, or employee benefits of any kind.

12. Insurance. The Contractor will carry liability insurance (including malpractice insurance, if warranted) relative to any service that [he or she] performs for the Company.

13. Successors and Assigns. All of the provisions of this Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, if any, successors, and assigns.

14. Choice of Law. The laws of the state of [______________] shall govern the validity of this Agreement, the construction of its terms and the interpretation of the rights and duties of the parties hereto.

15. Arbitration. Any controversies arising out of the terms of this Agreement or its interpretation shall be settled in [____________________] in accordance with the rules of the American Arbitration Association, and the judgment upon award may be entered in any court having jurisdiction thereof.

16. Headings. Section headings are not to be considered a part of this Agreement and are not intended to be a full and accurate description of the contents hereof.

17. Waiver. Waiver by one party hereto of breach of any provision of this Agreement by the other shall not operate or be construed as a continuing waiver.

18. Assignment. The Contractor shall not assign any of [his or her] rights under this Agreement, or delegate the performance of any of [his or her] duties hereunder, without the prior written consent of the Company.

19. Notices. Any and all notices, demands, or other communications required or desired to be given hereunder by any party shall be in writing and shall be validly given or made to another party if personally served, or if deposited in the United States mail, certified or registered, postage prepaid, return receipt requested. If such notice or demand is served personally, notice shall be deemed constructively made at the time of such personal service. If such notice, demand or other communication is given by mail, such notice shall be conclusively deemed given five days after deposit thereof in the United States mail addressed to the party to whom such notice, demand or other communication is to be given as follows:

If to the Contractor:
[name]
[street address]
[city, state, zip]

If to the Company:
[name]
[street address]
[city, state, zip]

Any party hereto may change its address for purposes of this paragraph by written notice given in the manner provided above.

20. Modification or Amendment. No amendment, change or modification of this Agreement shall be valid unless in writing signed by the parties hereto.

21. Entire Understanding. This document and any exhibit attached constitute the entire understanding and agreement of the parties, and any and all prior agreements, understandings, and representations are hereby terminated and canceled in their entirety and are of no further force and effect.

22. Unenforceability of Provisions. If any provision of this Agreement, or any portion thereof, is held to be invalid and unenforceable, then the remainder of this Agreement shall nevertheless remain in full force and effect.

IN WITNESS WHEREOF the undersigned have executed this Agreement as of the day and year first written above. The parties hereto agree that facsimile signatures shall be as effective as if originals.

[company name]

By:____________________
Its:____________________ [title or position]

[contractor’s name]

By:____________________
Its:____________________ [title or position]

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SCHEDULE A

DUTIES, TERM, AND COMPENSATION

DUTIES: The Contractor will [describe here the work or service to be performed]. [He or she] will report directly to [name] and to any other party designated by [name] in connection with the performance of the duties under this Agreement and shall fulfill any other duties reasonably requested by the Company and agreed to by the Contractor.

TERM: This engagement shall commence upon execution of this Agreement and shall continue in full force and effect through [date] or earlier upon completion of the Contractor’s duties under this Agreement. The Agreement may only be extended thereafter by mutual agreement, unless terminated earlier by operation of and in accordance with this Agreement.

COMPENSATION: (Choose A or B)
A. As full compensation for the services rendered pursuant to this Agreement, the Company shall pay the Contractor at the hourly rate of [dollar amount] per hour, with total payment not to exceed [dollar amount] without prior written approval by an authorized representative of the Company. Such compensation shall be payable within 30 days of receipt of Contractor’s monthly invoice for services rendered supported by reasonable documentation.

B. As full compensation for the services rendered pursuant to this Agreement, the Company shall pay the Contractor the sum of ____________________ [dollar amount], to be paid _____________________________________ [time and conditions of payment.]