Employer Guidelines
(Use if no employer handbook)
Employer________________________________________________ Date _______________________
Job Title____________________________________________________ Starting wage_____________
Scheduled hours of operation from ___________to__________________
Total weekly Hours for this position ______________________________
Company Policy Guidelines and Disciplinary procedures with regards to:
Tardiness
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Absenteeism
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Conduct
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Breaks
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Job Performance
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List in detail the procedures for any benefits available to the employee:
Pay Increases
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Sick Leave
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Vacation and Personal days
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Retirement Plan
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Is Unemployment Insurance Carried on the employee Yes No
Is Insurance Available to the employee (Check all that apply)
Life Medical/Health Dental Disability Vision
Please list any other Benefits available to the employee
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Signature of Employer or Employers Representative Date
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ACDJFS Representative Date
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I have read and understand the Company’s Policy Guidelines and Disciplinary Procedures
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Employee Date
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ACDJFS Representative Date