NEW-HIRE PACKET

TABLE OF CONTENTS
1.
2.
3.
4.
5.
6.

New Employee Checklist

Employment Application
Employee Handbook Acknowledgement
At-Will Employment Acknowledgement
Time Sheet (Weekly)
Sexual Harassment Brochure

Ali Alamar, M.D. a Professional Corporation

Employee Name:

Department:

Job Title:

Supervisor:

NEW EMPLOYEE
ORIENTATION CHECKLIST
Start Date:

COMPANY ORIENTATION

Employee Forms
Application Form completed
I-9 Form and supporting documentation
Federal Withholding W-4 Form
Timecard/Sheet Issued
Company Property Receipt
Benefits Handbook (s) Issued:
Medical Insurance Form
Dental Insurance Form
Life Insurance Form
Other ______________________
Other ______________________
Employee Handbook Issued
Handbook Receipt Form
At-Will Employment Acknowledgment
Agreement re: Off-Duty Recreational Activities
Employee Number Assigned: __________________
Personnel Action Form completed
California Employee:
State Withholding Form (DE-4)
State Disability Insurance Pamphlet
Sexual Harassment Information
Pregnancy Disability Leave Information

Discuss with Employee

Company Policies
Introductory Period
Insurance Benefits
Dress Code
Timecard/Sheet Procedures
Phone Calls and Messages
Paydays/Advances
Other ______________________
Other ______________________
Other ______________________

Company Orientation Completed by:

Date:
INDIVIDUAL JOB AND SAFETY ORIENTATION

Employee Forms
Workers Compensation Information
Safety Information
Job Description

Job and Safety Orientation Completed by:

Discuss with Employee

Job Duties
Work Schedule/Overtime
Time Clock Location and Use
Attendance Policy
Facility Tour:
Explanation of Departments
Lunchroom/Smoking Areas
Restrooms
Vending Machines/Catering Truck
Parking
Date:

I acknowledge completing the documents indicated and receiving and understanding the information outlined and discussed in
this orientation. I further acknowledge that receipt of this material does not constitute an employment contract, and that I am
employed at-will, and the terms of employment including, but not limited to termination, demotion, promotion, transfer,
compensation, benefits, duties, and location of work may be changed at any time, for any reason, with or without cause and
with or without notice.
Date:

Employee Signature:

Ali Alamar, M.D. a Professional Corporation

EMPLOYMENT APPLICATION

Answer all questions completely in your handwriting in ink. We are an Equal Opportunity Employer. No question on this application is intended to be
discriminatory under any applicable Federal, State or Local Fair Employment Practices Law.

I. PERSONAL INFORMATION
Last Name

First

Middle

Date

Street Address

Home Phone
(
)

City

State

Zip

Business Phone
(
)

Have you ever been involuntarily terminated or

requested to resign? Yes
No

If hired, can you provide verification of your legal right to work in the
United States? Yes No

If you are under age 18, do you have a work permit?

Yes
No

If required for the position, do you have a valid

drivers license? Yes No

Have you ever worked under a different name? Yes No

If Yes Name:

If hired, would you have reliable transportation to

and from work? Yes
No

Do you have friends or relatives working for our company? Yes No

If Yes Name and relationship:

Emergency Contact Name:

Phone (

Have you ever been convicted of a felony? Yes No

(convictions will not necessarily disqualify you for the position)

Social Security Number

-

If Yes list offense, Date and Disposition of the Case

II. EMPLOYMENT INTERESTS

Position Desired

Date Available

Type of Employment Desired

Regular

Temporary

Salary Desired

Would you be willing to work overtime?

Yes No

Days and hours available for work

Full-Time
Part-Time

Ad (where)
___________________
Employee Referral (Name) ____________________
Agency (Name) ___________________
Other (Please specify)
____________________
Walk-in
How were you referred to our company?

III. EDUCATION INFORMATION

School Level

Name and Location of School

Course of Study

Circle last
grade
completed

Did you
graduate?

High School

Y N

College/University

Y N

Post Graduate

Y N

Business/Trade
Technical

Y N

Degree or
Diploma

IV. SKILLS - If Applicable for Position for Which You Are Applying
Typing speed

wpm

10 key by Touch
Yes
No

Foreign Languages (indicate proficiency to speak, read and write)

PC Skills (Indicate software used)

Other Office Machines (Describe)

List manufacturing machines you operate (Circle those you can set up)

List inspection/machinist tools you can use:

Describe mechanical background that may be related to the job desired

Do you read blueprints?

Yes
No

Do you read schematics?

Yes
No

Do you have any experience, training, qualifications or skills which you think make you especially suited for work at this company? (Explain)
Page 1 of 2

V. EMPLOYMENT INFORMATION (Start with Current or Most Recent Employer)

Company Name

Phone (

Street Address

City

Job Title

Duties

)
State

Zip

From Mo./Yr.

To Mo./Yr.

Starting Pay
$

Ending Pay
$

Reason for leaving

Supervisor Name

May we contact this employer?

Yes
2

Company Name

Phone (

Street Address

City

Job Title

Duties

)
State

Zip

From Mo./Yr.

To Mo./Yr.

Starting Pay
$

Ending Pay
$

Reason for leaving

Supervisor Name

May we contact this employer?

Yes
3

Company Name

Phone (

Street Address

City

Job Title

Duties

)
State

Zip

No

From Mo./Yr.

To Mo./Yr.

Starting Pay
$

Ending Pay
$

Reason for leaving

Supervisor Name

May we contact this employer?

Yes
4

No

Company Name

Phone (

Street Address

City

Job Title

Duties

)
State

Zip

No

From Mo./Yr.

To Mo./Yr.

Starting Pay
$

Ending Pay
$

Reason for leaving

Supervisor Name

May we contact this employer?

Yes

No

VI. ACKNOWLEDGMENT

Please read carefully, initial each paragraph, and sign below

Initial

I authorize any person, school, current employer (except as expressly noted), past employer(s), and organizations named in this application form (and accompanying
resume or other documentation, if any) to provide THE COMPANY with relevant information and opinion, personal or otherwise, that may be useful in making a hiring
decision. I release all parties from all liability for any damage that may result from furnishing information and opinion to you.

Initial

In consideration of employment, I agree to obey the rules and standards of THE COMPANY. I understand that nothing contained in this application or in the interview
process is intended to create a contract between THE COMPANY and myself for either employment or for the providing of any benefits. I agree that my employment is atwill and the terms of employment may be changed with or without cause, with or without notice, including but not limited to termination, demotion, promotion, transfer,
compensation, benefits, duties and location of work, at any time, for any reason, at the option of myself or THE COMPANY. This constitutes my entire agreement with THE
COMPANY with regard to the length of my employment.

Initial

I understand that as a condition of employment I may be required to take a post-offer/pre-employment physical examination that may include an alcohol and drug test. I
further understand that at any time during my employment, I may be required to take a physical examination which may include an alcohol and drug test if management
reasonably suspects a condition exists that will prevent me from performing my job in a manner that does not endanger my own health or the safety and health of others. I
authorize all providers of health care who examine me to disclose to THE COMPANY or its agents, all medical information revealed during such examinations. I further
authorize THE COMPANY to disclose such information to any other persons, if at any time my medical condition is put at issue in any proceeding by myself or others. In
the event that I have a disability that will affect my ability to take the test, I will so inform THE COMPANY so that a reasonable accommodation can be made. THE
COMPANY reserves the right to require medical documentation concerning the need for accommodation.

Initial

I understand that all offers of employment are conditioned upon my providing satisfactory documentary proof of my identity and legal right to live and work in the United
States.

Initial

I hereby acknowledge that I have read the above statements and understand them. I certify that I, the undersigned applicant, have personally completed this
application. I declare under penalty of perjury that the facts contained in the application (or any resume or other documents submitted) are true and complete to
the best of my knowledge. I understand that any misrepresentations or omissions will disqualify me from further consideration for employment, and will be
justification for my dismissal from employment, if discovered at a later date.

Applicant Signature:

Date:
Page 2 of 2

Ali Alamar, M.D. a Professional Corporation

EMPLOYEE HANDBOOK
ACKNOWLEDGMENT

The ______________________ Employee Handbook describes important information about THE

COMPANY, and I understand that I should consult my supervisor or the Human Resources Manager
regarding any questions not answered in the manual.
I have received a copy of the Employee Handbook and understand that it contains important
information about THE COMPANYs general personnel policies and about my privileges and
obligations as an employee. I acknowledge that I am expected to read, understand, and adhere to
Company policies and to familiarize myself with the material in the Handbook, and that THE
COMPANY may change, rescind, delete, or add to any policies, benefits, and practices described in
the Handbook from time to time, at its sole and absolute discretion, with or without prior notice. THE
COMPANY will advise employees of material changes within a reasonable time. I understand that
revised information may supersede, modify, or eliminate existing policies, benefits, and practices.
Only the President of THE COMPANY has the ability to adopt any revisions to the policies in this
handbook.
I received a copy of the Employee Handbook on _____________________.

EMPLOYEE SIGNATURE:
EMPLOYEE NAME: (TYPED OR PRINTED)

DATE:

Ali Alamar, M.D. a Professional Corporation

AT-WILL EMPLOYMENT
ACKNOWLEDGMENT

I acknowledge that my employment at THE COMPANY is at-will, meaning that the

terms of employment may be changed with or without notice, with or without cause,
including but not limited to termination, demotion, promotion, transfer,
compensation, benefits, duties, and location of work. I have entered into my
employment with THE COMPANY voluntarily, and acknowledge that there is no
agreement or contract express or implied between THE COMPANY and me for
continuing or long-term employment. While supervisors and managers have certain
hiring authority, no supervisor or manager or representative of THE COMPANY has
any authority to alter the at-will relationship.

Employee Signature:
Employee Name (typed or printed)

Date:

Ali Alamar, M.D. a Professional

Corporation
TIME SHEET
- Weekly Employee Name

Day

Date

Time
In

Department #

Lunch

Time
Out

Period Begin
Date

IN

WOP

SUN

MON

TUE

WED

THU

FRI

SAT

Check if Employees work week is other

than Monday-Friday. Specify Days:

REG

Total
Reg. Hr.

OT

CODE
WP

Total
OT Hrs.

OTHER

Total
Other
Hrs

CODE: WP - WITH PAY

S Sick
T Tardy/Early Leave
V Vacation
H Holiday
P Personal

I hereby certify that this time record was kept

current by me and that I had at least the minimum
break/meal periods prescribed by law and that this
record is correct.
Employee Signature:
SUPERVISOR COMMENTS:

Employee Number

THIS AREA TO BE COMPLETED BY SUPERVISOR

Total
Hours

HOURS
OUT

Period
End Date

Supervisor Signature:

EXPLANATION

WOP - WITHOUT PAY

L
W
D
E

Leave of Absence
Workers Compensation
Disciplinary/Suspension
Excused/Other

Date:

Date:

Ali Alamar, M.D. a Professional Corporation

SEXUAL HARRASMENT BROCHURE
Employee Notice
Sexual harassment is prohibited by this Company and is against the law.
Every employee should be aware of:

what sexual harassment is

what steps to take if harassment occurs
state law prohibiting retaliation for reporting sexual harassment

Please read this information sheet. If you have any questions or concerns about it, contact your supervisor, personnel department
representative or your investigative officer for further information.

How to Stop Sexual Harassment

1.

When possible, simply tell the harasser to stop.

The harasser may not realize the advances or behavior are offensive. When it is appropriate and sensible, simply tell the
harasser the behavior or advances are unwelcome and must stop.

2.

You are strongly encouraged to report sexual harassment.

resources department representative.

Contact your supervisor, another manager or the human

Sexual harassment or retaliation should be reported in writing or verbally. You may report such activities even though you
were not the subject of harassment.
3.

An investigation will be conducted

THE COMPANY will investigate, in a discreet manner, all reported incidents of sexual harassment and retaliation.

4.

Appropriate action will be taken

Where evidence of sexual harassment or retaliation is found, disciplinary action, up to and including termination, may result.

What is Sexual Harassment

Although many people think of sexual harassment as involving a male boss and a female employee, not all sexual harassment is
done by males. Sexual harassment often involves co-workers, other employees of THE COMPANY or other persons doing business
with or for THE COMPANY. It's against the law for females to sexually harass males or other females, and for males to harass other
males or females.

California Law
California law defines harassment due to sex as sexual harassment, gender harassment and harassment due to pregnancy, childbirth
or related medical conditions .

1.

Verbal harassment - epithets, derogatory comments or slurs.

Examples: Name-calling, belittling, sexually explicit or degrading words to describe an individual, sexually explicit jokes,
comments about an employee's anatomy and/or dress, sexually oriented noises or remarks, questions about a person's
sexual practices, use of patronizing terms or remarks, verbal abuse, graphic verbal commentaries about the body.

2.

Physical harassment - assault, impeding or blocking movement, or any physical interference with normal work or
movement, when directed at an individual.
Examples: Touching, pinching, patting, grabbing, brushing against or poking another employee's body, requiring an
employee to wear sexually suggestive clothing.

3.

Visual harassment - derogatory posters, cartoons, or drawings.

Example: Displaying sexual pictures, writings or objects, obscene letters or invitations, staring at an employee's anatomy,
leering, sexually oriented gestures, mooning, unwanted love letters or notes.

4.

Sexual favors - unwanted sexual advances which condition an employment benefit upon an exchange of sexual favors.
Example: Continued requests for dates, any threat of demotion, termination, etc, if requested sexual favors are not
given, making or threatening reprisals after a negative response to sexual advances, propositioning an individual.

It is impossible to define every action or all words that could be interpreted as sexual harassment. The examples listed above with
the state definition of sexual harassment are not meant to be a complete list of objectionable behavior nor do they always
constitute sexual harassment.

Federal Law
Under federal law, unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual
nature constitute sexual harassment when:
1.

Submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment;

2.

Submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such
individual; or

3.

Such conduct has the purpose or effect of unreasonably interfering with an individual's work performance creating an
intimidating, hostile, or offensive working environment

Harassers Are Personally Liable

If you, as an employee, are found to have engaged in sexual harassment, or if you as a manager know or should have known about
the conduct and condone or ratify it, you may be personally liable for monetary damages. This Company will not pay damages
assessed against you personally.
In addition, this Company will take appropriate disciplinary measures - termination is one possible action against any employee who
engages in sexual harassment.

Protection Against Retaliation

Company policy and California state law forbid retaliation against any employee who opposes sexual harassment, files a complaint,
testifies, assists or participates in any manner in an investigation, proceeding or hearing conducted by THE COMPANY, the
Department of Fair Employment and Housing or the Fair Employment and Housing Commission.
Prohibited retaliation includes but is not limited to:

Demotion
Suspension
Failure to hire or consider for hire
Failure to give equal consideration in making employment decisions
Adversely affecting working conditions or otherwise denying any employment benefit to an individual.

Additional Information
The Department of Fair Employment and Housing (DFEH) is the state agency that resolves complaints of unlawful discrimination,
including sexual harassment. After a complaint is filed, the DFEH has one year to investigate the complaint.
The Fair Employment and Housing Commission (FEHC), decides cases prosecuted by the DFEH at the state level.
To contact the DFEH, consult your local telephone directory under State Government Offices or ask directory assistance for the
number of Department of Fair Employment and Housing headquarters in Sacramento or write to Department of Fair Employment and
Housing 2014 T Street, Suite 210, Sacramento, CA 95814-6824.

The Equal Employment Opportunity Commission (EEOC) is the federal agency that resolves sexual harassment claims. To contact
the commission, consult directory assistance for Washington, D.C. or write to Equal Employment Opportunity Commission, 1801 L
Street, NW, Washington, D.C. 20507.