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Grizzly Glass & Mirror, Inc

By Alfred Watson,2014-04-11 22:31
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Grizzly Glass & Mirror, Inc

Grizzly Glass & Mirror, Inc

Pay Schedule:

     Time starts on Monday morning and ends on Sunday evening.

     Time is held back one week.

     If you start on Monday, it will be two weeks before you get a paycheck.

    If you report directly to a jobsite, the foreman will record your time daily on the

    Foreman Timesheet. Initial this at the end of the week to show you are in

    agreement with the times submitted.

    If you report to the shop first, you must use a punch card be sure to include the

    job name that you are working on.

    It is your responsibility to turn in time. No time card, no paycheck.

    PERSONAL INFORMATION

    NAME:

    FIRST: _________________ MIDDLE: _____________ LAST: ________________

    MAILING ADDRESS:

    SOCIAL SECURITY #: _____ - ____ - _____

    BIRTHDATE: _____ / _____ / _______

    DRIVER’S LICENCE #: _______________

     TYPE: ________ EXP DATE: _____________

    TELEPHONE #: _____ - _____ - _______

    CELL PHONE #: _____ - _____ - _______

    SPOUSE’S NAME: ___________________________

    PERSON / PERSONS AUTHORIZED TO PICK UP PAYCHECK:

    NAME: _________________________ RELATION: ____________________

    NAME: _________________________ RELATION: ____________________

    EMERGENCY CONTACT NAME, PHONE # AND RELATION:

    NAME: _________________________ RELATION: ____________________

    PHONE: _________________________

    NAME: _________________________ RELATION: ____________________

    PHONE: _________________________

    EMPLOYMENT INFORMATION

    Applicant’s Name: ________________________________________________________

Present Address: ________________________________________________________

     ________________________________________________________

     Last Employer Name:

Phone #: Wage Amount:

Address:

    Position Held: From: To:

    Reason For Leaving:

    Second Last Employer:

    Phone #: Wage Amount:

    Address:

    Position Held: From: To:

    Reason For Leaving:

    Third Last Employer:

    Phone #: Wage Amount:

    Address:

    Position Held: From: To:

    Reason For Leaving:

    Signature: Date:

    MEDICAL QUESTIONNAIRE

    1. Are you currently taking regular medication to control epilepsy, seizures, fainting, etc. ?

    Yes: No:

    If yes, explain:

2. Are you currently taking any form of medication or tablets, capsules, etc., for

    losing weight ?

    Yes: No:

    If yes, explain:

    3. Have you ever had a head injury ?

    Yes: No:

    If yes, explain:

    4. Have you ever had a seizure, fit, convulsion or fainting ?

    Yes: No:

    If yes, explain:

    5. Have you ever had muscle spasms, muscle strain or injury to your back ?

    Yes: No:

    If yes, explain:

    6. Have you ever had back surgery ?

    Yes: No:

    If yes, explain:

    7: Have you ever had other surgery ?

    Yes: No:

    If yes, explain:

    Continued…………………….

MEDICAL QUESTIONNAIRE CONTINUED

8. Have you ever been confined to a hospital or mental institution for illness or

    injury?

    Yes: No:

    If yes, explain:

    9. Have you ever had or do you currently have:

     a. High Blood Pressure Yes: No:

     b. Heart Problems Yes: No:

     c. Low blood pressure Yes: No:

    If yes, explain:

    Signature: Date: