Employee Enrollment

Full Name:

Address

Date of Birth:

Social Security Number:

Phone

Emergency Contact Name:

Emergency Contact Phone:

W-4 Form Link: https://www.irs.gov/pub/irs-pdf/fw4.pdf

Filing status & allowances (W-4)

Arizona Form A-4: https://azdor.gov/sites/default/files/document/FORMS_WITHHOLDING_2025_A-4_f.pdf

State withholding info (AZ state form)

Direct Deposit Information:

Bank Name:

Routing #:

Account #:

Type of Account:

Upload Direct Deposit Info If Applicable

I-9 Form: https://www.uscis.gov/sites/default/files/document/forms/i-9.pdf

I-9 information (citizenship status, ID type, expiration date)

Upload ID

Work Opportunity Tax Credit (WOTC) Prescreening Employee Questionnaire

The information you provide in this form will be used solely for the purpose of determining your eligibility for the Work Opportunity Tax Credit (WOTC) and will be kept strictly confidential. This information will not affect your employment status or your consideration for employment in any way. The decision to hire or retain you as an employee is independent of your responses to these questions.

Were you convicted of a felony in the last year?

Yes

Are you a member of any of the following groups? (Check all that apply):

Qualified veteran (VOW or VEA)

Long-term unemployed (unemployed for at least 27 weeks)

Temporary Assistance for Needy Families (TANF) recipient

Supplemental Nutrition Assistance Program (SNAP) recipient (formerly food stamps)

Supplemental Security Income (SSI) recipient

Vocational Rehabilitation (VR) services participant

Ex-foster care youth (ages 18-24)

Disabled individual

Youth aged 16-17 living in a rural area (with family income below poverty level)

Are you currently receiving or have you recently received any of the following government assistance programs? (Please check all that apply)

TANF (Temporary Assistance for Needy Families)

SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

SSI (Supplemental Security Income)

Other public assistance programs

(Please specify):

Were you a member of a family receiving government assistance in the last 6 months?

Yes

Do you have any of the following conditions? (Please check all that apply)

Disabled individual

Recently released from prison or jail

Homeless (including living in temporary or transitional housing)

Youth aged 18-24 who has aged out of the foster care system

Unemployed for 6 months or longer

NON-COMPETE, CONFIDENTIALITY, AND NON-DISCLOSURE AGREEMENT

This Non-Compete, Confidentiality, and Non-Disclosure Agreement (“Agreement”) is entered into as of hire date, by and between:

The Company an Arizona limited liability company/corporation (“Company”), and Employee:

Full Name:

1. Confidential Information

1.1 Definition: “Confidential Information” means any non-public information, whether oral, written, electronic, or otherwise, relating to the Company’s business, including but not limited to: customer lists, vendor lists, pricing, financial data, trade secrets, marketing plans, business strategies, intellectual property, processes, and software.

1.2 Exclusions: Confidential Information does not include information that: • Is publicly available through no fault of Employee;

• Was lawfully obtained by Employee from a third party without confidentiality obligations; or

• Was independently developed by Employee without reference to Company’s Confidential Information.

2. Confidentiality & Non-Disclosure Obligations

2.1 Employee agrees not to disclose, use, copy, or permit the use of any Confidential Information except as necessary in the scope of employment with the Company.

2.2 Upon termination of employment, Employee shall return or securely destroy all Confidential Information in their possession, including all copies, notes, or summaries.

2.3 This confidentiality obligation survives termination of employment indefinitely.

3. Non-Compete Covenant

3.1 Restriction: For a period of [12 months] following termination of employment, Employee shall not, directly or indirectly:

• Engage in, own, manage, operate, control, or be employed by any business that competes with Company in the state of Arizona within a [50-mile radius] of [Company’s primary business location];

• Solicit Company’s clients or customers for competing services;

• Induce or attempt to induce any employee or contractor of Company to leave their position.

3.2 Reasonableness: The parties acknowledge this restriction is reasonable in duration and scope and is necessary to protect the Company’s goodwill and confidential information.

4. Non-Solicitation

For a period of [12 months] after termination, Employee shall not directly or indirectly solicit, divert, or take away:

• Any client, prospect, or referral source of the Company that Employee had material contact with;

• Any employee, consultant, or contractor of the Company.

5. Intellectual Property

Any work product, invention, discovery, or idea developed by Employee during employment and related to the Company’s business shall be the sole property of the Company.

6. Remedies

Employee acknowledges that a breach of this Agreement will cause irreparable harm to the Company. Therefore, the Company is entitled to seek injunctive relief in addition to monetary damages.

7. Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of Arizona.

8. Entire Agreement

This Agreement constitutes the entire understanding between the parties and supersedes all prior discussions, agreements, or understandings.

9. Severability

If any provision is found unenforceable, the remaining provisions shall remain in effect to the fullest extent permissible.

IN WITNESS WHEREOF, the parties have executed this Agreement as of the date written above.

Name:

Signature

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