PREMIER ELECTRICAL STAFFING Employment Application

FL, GA, MD, NC, PA, SC, TN, TX, VA, DC, OK,CA, MD

www.pes123.com

APPLICANT INFORMATION Last Name: M.I. First Name:

Street Address: Apt.#/ Unit:

City: State: Zip:

Cell Phone: Cell phone provider:

E-mail Address:

Date Available: Desired Salary:

Have you ever worked for Premier Electrical Staffing? -If so, when?

Have you had formal training in Electrical Work ?

-If yes, explain

Have you ever worked for a staffing company before? -If yes, for who

YES NO

YES NO

YES NO

PREVIOUS EMPLOYMENT Company: Starting date: End Date: Supervisor: Supervisors Phone #:

YES NO May we contact your previous supervisor for a reference?

City: State: Job Title: Starting Salary: Ending Salary: Reason for leaving: Types of Projects:

Company: Starting date: End Date: Supervisor: Supervisors Phone #:

YES NO May we contact your previous supervisor for a reference?

City: State: Job Title: Starting Salary: Ending Salary: Reason for leaving: Types of Projects:

Company: Starting date: End Date: Supervisor: Supervisors Phone #:

YES NO May we contact your previous supervisor for a reference?

City: State: Job Title: Starting Salary: Ending Salary: Reason for leaving: Responsibilities:

PREMIER ELECTRICAL STAFFING Employment Application

FL, GA, MD, NC, PA, SC, TN, TX, VA, DC, OK

www.pes123.com

EDUCATION College:

From: To: Did you graduate? YES

NO

Other:

From: To: Did you graduate? YES

NO

MILITARY SERVICE Branch: From: To: Rank at discharge: Type of discharge: If other than Honorable, explain:

REFERENCES

Please list two professional references: Full Name: Phone: Company: Relationship: Full Name: Phone: Company: Relationship:

Premier Electrical Staffing, LLC is an equal opportunity employer. Premier Electrical Staffing, LLC does not discriminate in employment on account of race, color, religion, creed, national origin, age, sex (including pregnancy), marital or veteran status, or any other legally protected status.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Premier Electrical Staffing, LLC to hire me. If I am hired, I understand that Premier Electrical Staffing, LLC or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Premier Electrical Staffing, LLC has the authority to make any assurance to the contrary.

I attest with my signature below that I have given Premier Electrical Staffing, LLC true and complete information on this application. No requested information has been concealed. I authorize Premier Electrical Staffing, LLC to contact references provided for employment reference checks, criminal background checks, credit checks, DMV history and drug testing. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the PES, LLC. However, I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of implied employment contract.

-MUST SIGN-

SIGNATURE: ________________________________________ DATE: ____________________________

MPT2016

MPT2016

DRUG FREE WORKPLACE POLICY

The use, manufacture, purchase, sale, offer for sale, distribution or possession of any illegal drugs or controlled substances on Premier Electrical Staffing, LLC premises is prohibited, as is being under the influence of illegal drugs or controlled substances upon reporting to work, while working, or on duty at any Premier Electrical Staffing, LLC client property or in a Premier Electrical Staffing, LLC vehicle. Reporting to work or working while under the influence of alcohol is also prohibited.

Violation of this policy may lead to disciplinary action up to and including termination. Any associate who has information concerning possible violations of Premier Electrical Staffing, LLC’s Drug Free Workplace policy should contact Human Resources. Similarly, if a supervisor suspects that an associate has a drug or alcohol abuse problem, the supervisor should contact Human Resources. Associates who voluntarily come forward to management, prior to a situation requiring testing based upon reasonable suspicion and who cooperate with the Company with regard to treatment, may not be subject to discipline. An associate who requests a leave of absence to enter a drug or alcohol rehabilitation program will be reasonably accommodated with an unpaid leave of absence, as required by law, to enroll in such a program if such an accommodation is not an undue hardship on the Company. Associates voluntarily entering a drug or alcohol rehabilitation program may be required to provide medical validation of satisfactory completion of the program. Associates returning to work following satisfactory completion of a rehabilitation program may be subject to drug or alcohol tests without prior notice for up to one (1) year following the return date. A recurrence of a positive drug or alcohol test following return to work may lead to disciplinary action up to and including termination. If there is a reasonable suspicion that an associate is under the influence of alcohol or drugs while on duty, the associate will be required to take a drug or alcohol screen at a certified laboratory or collection site.

Premier Electrical Staffing, LLC will perform drug testing in the following situations: Pre-Employment Reasonable Suspicion Post Injury, where reasonable cause exists that an associate is under the influence of alcohol,

drugs, or controlled substances; or Random testing for “safety sensitive” positions in California, and as permitted by law in other

states

The following may result in disciplinary action up to and including termination of employment:

Drug screen results that are positive (based on federally prescribed cut-off levels) for prohibited drugs

Alcohol screen results that indicate an alcohol level of 0.04% or greater Refusal to participate in the screening process Any attempt to alter, falsify or intentionally contaminate a drug test

Employee Name (Print) Employee Signature and Date

www.premierelectricalstaffing.com

www.premierelectricalstaffing.com MPT2016

New Hire Paperwork

Complete the full Application forms that are attached

You must sign and date every page that has an Employee’s Signature and Date option

Things that you will need to complete the Application

Forms of Valid ID Complete I-9

Health Insurance Enrollment Form (signed and date) We E-Verify, Drug Test, and Background Checks

Safety Test Direct Deposit Form/Global Cash Card

Very Important

**Completing the I-9 (Employment Eligibility Verification Form)**

Make sure that you complete Section One ending with your Employee Signature and Date in

Format MM/DD/YYYY

Put Employee name on the Top of Section 2

Do NOT fill out any other part of the form

** Health Insurance Application**

*Make sure you get a the full enrollment package from your Recruiter*

You will NOT be able to Start Work until this is completed

The last 2 pages of the Application are are for your reference only

Employee Handbook and Safety Manual Employee Acknowledgement form Tools List

Make sure that you do the proper State Withholding Tax form that applies to your State. If it

is not in your file, please go to our website and download your State form or call your

representative to obtain a copy.

If you have any questions call 919-420-7576 x102

www.premierelectricalstaffing.com MPT2016

Pre-Employment Background Check Disclosure & Authorization Form

In connection with my application for employment (including contract for services or volunteer services) or tenancy with

Premier Electrical Staffing, LLC. These consumer reports (investigative consumer reports in California) may include the

following types of information: names and dates of previous employers, salary, work experience, education, accidents, licensure,

credit (except California), etc. I further understand that such reports may contain public record information such as, but not

limited to: my driving record, workers’ compensation claims, judgments, bankruptcy proceedings, criminal records, etc., from

federal, state and other agencies which maintain such records. In addition, investigative consumer reports as defined by the

federal Fair Credit Reporting Act, gathered from personal interviews with former employers and other past or current associates

of mine to gather information regarding my work performance, character, general reputation and personal characteristics may be

obtained.

I have the right to make a request to the consumer-reporting agency: INTELIFI, Inc. 8730 Wilshire Blvd, Suite 412, Beverly

Hills, California 90211; telephone (888) 409-1819 (“Agency”) , upon proper identification, to request the nature and substance

of all information in its files on me at the time of my request, including the sources of information and the agency, on our behalf,

will provide a complete and accurate disclosure of the nature and scope of the investigation covered by the investigative consumer

report(s); and the recipients of any reports on me which the agency has previously furnished within the two year period for

employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to your

obtaining the above information from the agency. You may view our privacy policy at our website: www.intelifi.com . I hereby

authorize procurement of consumer report(s) and investigative consumer report(s).If hired (or contracted), this authorization shall

remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment

(or contract) period.

California, Minnesota and Oklahoma Applicants: Check box if you request a copy of your consumer report

Notice to California Residents: You have the right under Section 1786.22 of the California Civil Code to contact the Agency

during reasonable hours (9:00 a.m. to 5:00 p.m. (PTZ) Monday through Friday) to obtain all information in your file for your

review. You may obtain such information as follows: 1) In person at the Agency’s offices, which address is listed above. You

can have someone accompany you to the Agency’s offices. Agency may require this third party to present reasonable

identification. You may be required at the time of such visit to sign an authorization for Agency to disclose to or discuss your

information with this third party; 2) By certified mail, if you have previously provided identification in a written request that

your file be sent to you or to a third party identified by you; 3) By telephone, if you have previously provided proper

identification in writing to Agency; and 4) Agency has trained personnel to explain any information in your file to you and if the

file contains any information that is coded, such will be explained to you.

Notice to New York Residents: I acknowledge receiving a copy of Article 23A of the NY Correction Law

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY THE CONSUMER REPORTING

AGENCY TO FURNISH THE ABOVE-MENTIONED INFORMATION. I acknowledge that I have been provided a copy of consumer’s

rights under the Fair Credit Reporting Act. _______________________________ _______-______-________ _______/_____/________ Print Name Social Security # Date of Birth

__________________________________ _______/______/_______

Applicant’s Signature Date

______________________________________________________ ________________________________________

Email (required in order to receive legal notices) Any other names used

Pre Verlflcaclon De Antecedentes De Empleo Dlfuslon y Autorlzaclon

En conexion con mi aplicacion de empleo (incluyendo contratos de servicios o servicios de voluntariados) o alquiler con

Premier Electrical Staffing, LLC Estos informes del consumidor (en California referidos como informes investigativos

del consumidor) pueden incluir el siguiente tipo de informacion: nombres y fechas de empleadores anteriores, salarios,

experiencia laboral, educacion, accidentes, licenciatu.ras, credito (a excepcion de California), etcetera. Igua]mente

entiendo que dichos informes pueden incluir informacion de registro publico, pero no limitada a: mi registro de conducir,

reclamos de indemnizacion de trabajadores, sentencias y fallos juridicos, procedimientos de bancarrota, antecedentes

penates, etcotera, de agencias federales, estatates, y de otras agencias que mantienen ese tipo de reportes. Ademos,

informes de investigacion del consumidor definidas por la Ley Federal de Informes de Credito Justo (Fair Credit

Reporting Act ), obtenidas de entrevistas personates con mis empleadores anteriores y asociadas anteriores o actuates

para obtener informacion de mi rendimiento de trabajo, caracter, reputacion general y caracteristicas personates pueden

ser obtenidas.

Tengo el derecho de solicitar a Ia agencia de informes de consumidor, Intelifi, Inc. 8730 Wilshire Blvd, Suite 412,

Beverly Hills, California 90211; telefono (888) 409-1819 ("AGENCIA"), con identificacion apropiada, solicitar Ia

natu.raleza y sustancia de toda la informacion en sus archivos sobre mi persona en el momento de mi solicitud, incluyendo

los recursos de informacion y ta Agencia, de nuestra parte, suministrara una difusion completa y precisa de Ianaturaleza y

alcance de la investi.gacion cubierta por los infonne(s) investi.gati.vos del consumidor; y los destinatarios de cualquier

informe sobre mi persona que fue anteriormente suministrado por la Agencia durante el periodo de dos aiios para

solicitudes de empleo, y un aiio para otros propositos que anteceden a mi solicitud (tres aiios para California). Por este

medio consiento obtengan dicha informacion de IaAgencia. Puede ver nuestra politica de privacidad en nuestra pagina de

web: www.intelifi.com . Por la presente autorizo la adquisicion de informe(s) del consumidor e informe(s) investigativos

del consumidor. En el caso de ser empleado (o contratado), esta autorizacion se mantendra archivada y serviri. como su

autorizacion en curso para obtener informes del consumidor en cualquier ocasion durante su periodo de empleo (o

contrato).

Solicitantes California, Minnesota y Oklahoma: marquen la casilla para solicitar una copia de su informe al consumidor.

Aviso a residentes de California: Tiene el derecho bajo la Seccion 178o.22 del Codigo Civil de California para

contactarse con Ia Agencia durante horas razonables (9:00a.m. a 5:00p.m. (bora del pacifi.co) de tunes a viemes) para

obtener toda Ia informacion de su archivo para su revision. Puede obtener Ia informacion de las siguientes maneras: 1) en

persona en las oficinas de Ia Agencia, en Ia direccion que aparece arriba. Se permite un acompaiiante a las oficinas de Ia Agencia. La Agencia puede requerirle al acompatlante que presente identificacion apropiada. La Agencia puede requerir que en el momento de su visita fume una autorizacion para que Ia Agencia divulgue o hable de su informacion con un

tercero; 2) Por correo certificado, si usted anteriormente propon:iono identificacion por escrito solicitando su archivo sea

enviado a usted o a un tercero identificado por usted; 3) Por telefono, si usted anteriormente proporciono identificacion

adecuada por escrito ala Agencia; y 4) la Agencia tiene personal capacitado para explicarle cualquier informacion en su

archivo y si su archivo ti.ene inform.acion que esta codificada, esto se le explicaria.

Aviso a residentes de Nueva York: reconozco la recepcion de una copia del Articulo 23 A de Ia ley de Correccion de

NYAutorizo, sin reservas a cualquier parte o agenda contac:tada por Ia Agenda de informes del consumidor

propordonar Iainformacion antes mendonada.

Reconozco que han entregado una copia de los derechos del consumidor bajo Ia Ley de Informes de Credito Justo (Fair

Credit Reporting Act ).

Nombre Nfunero de seguro social Fecha de nacimiento

Firma del solicitante Correo electronico (requeridopara recibir avisos legales)

Otros nombres utilizados

MPT2016

Employee Emergency Contact Form

NAME: ___________

EMERGENCY CONTACT INFORMATION

Name: __________________________________ Relationship: _________________ _

Address: ________________________________________________________________ _

City, ST, Zip: ______

Home Phone: ________________________________________ Cell: ___________________

Name: __________________________________ Relationship:__________________ _

Address: ________________________________________________________________ _

City, ST, Zip: ______

Home Phone: ________________________________________ Cell: ____________________

Medical Contact Information:

□ I have voluntarily provided the above contact information and authorize Premier

Electrical Staffing, LLC and its representatives to contact any of the above on my behalf

in the event of an emergency.

□ I choose not to furnish emergency contact information to Premier Electrical Staffing, LLC

at this time

Employee Signature: ________________________________________ Date: ____________ (required) (required)

Form W-4 (2016) The exceptions do not apply to supplemental wagesgreater than $1,000,000.Basic instructions. lf you are not exempt, completethe Personal Allowances Worksheet below. Theworksheets on page 2 further adjust yourwithholding allowances based on itemizeddeductions, certain credits, adjustments to income,or two-earners/multiple jobs situations.

Complete all worksheets that apply. However, youmay claim fewer (or zero) allowances For regularwages, withholding must be based on allowancesyou claimed and may not be a flat amount orpercentage of wages.

Head of household. Generally, you can claim headof household filing status on your tax return only ifyou are unmarried and pay more than 50% of tlrecosts of keeping up a home for yourself and yourdependent(s) or other qualifying individuals. SeePub 501, Exemptions, Standard Deduction, andFiling Information, for information.

Nonwage income. lf you have a large amount ofnonwage income, such as inlerest or dividends,conslder making estimated tax payments using Form1 040-ES, Estimaled Tax for Individuals. Otherwise, youmay owe addilional tax lf you have pension or annuityincome, see Pub. 505 to tind out if you should adjustyour withholding on Form W-4 or W-4P.

Two earners or multiple jobs. lf you have aworking spouse or more than one job, figure thetotal number of allowances you are entitled to claimon all jobs using worksheets from only one FormW-4. Your withholding usually will be most accuratewhen all allowances are claimed on the Form W-4for the highest paying job and zero allowances areclaimed on the others See Pub.505 for details.

Nonresident alien, If you are a nonresident alien,see Notice 1392, Supplemental Form W-4lnstructions for Nonresident Aliens. beforecompleting this form.

Check your withholding. After your Form W-4 takeseffect, use Pub. 505 to see how the amount you arehaving withheld compares to your projected total tax

1 6. See Pub. 505, especially if your earningsd $130,000 (Single) or $180,000 (Married),

Future developments. Information about any lulure

Purpose. Compleie Form W-4 so that your employercan withhold the correcl federal income tax from yourpay. Consider completing a new Form W-4 each yearand when your personal or financial situation changes

Exemption from withholding. lf you are exempt,complete only llnes 1, 2, 3, 4, and 7 and sign the formto validate it. Your exemption for 201 6 expiresFebruary 15,2017. See Pub.505, Tax Withholdingand Estimated Tax.

Note: It another person can claim you as a dependentexemotion$1.050 andome (for

example, interest and dividends).

Exceptions. An employee may be able to claimexemption trom withholding even if the employee is adependent, if the employee:. lc 2da A{

^r ^ldar. ls blind, or

. Will claim adjustments to incomei tax credits; oritemized deductions, on his or her lax relurn.

Tax credits, You can take projected tax credits into accountin figuring your allowable number of withholding allowancesCredits for child or dependent care expenses and the childtax credit may be claimed using the Personal AllowancesWorksheet below See Pub 505 for informalion onconverting your other credils into withholding allowances

D

E

F

develooments aFfectino Form W-4 h as leoislationenacteb after we releaie it) will be ed at r,iww.rrs.g

for r records.)Enter "1" for yourself if no one else can claim you as a dependent .

[ . You are single and job; or IEnter "1" if : | . You are married, h b, and your spouse does not work; or

It . Your wages from a our spouse's wages (or the total of both) are $ 1 ,500 or less. /

Enter "1" for your spouse. But, you may choose to enter "-0-" if you are married and have either a working spouse or more

than one job. (Entering "-0-" may help you avoid having too little tax withheld.) C

Enter number of dependents (other than your spouse or yourselfl you will claim on your tax return . D

Enter "1" if you will file as head of household on your tax return (see conditions under Head of household above) E

Enter "1" if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit F

(Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)

Child Tax Credit (including additional child tax credit). See Pub. 972, Chlld Tax Crr-'dit, for more information.. lf your total income will be less than $70,000 ($1 00,000 if marrled), enter "2" for eiach eligible child; then less "1" if you

have two to four eligible children or less "2" if you have five or more eligible childrern.

. lf your total income will be between $70,000 and $84,000 ($100,000 and $1 1 9,000 if manied), enter "1 " for each eligible child G

H Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) > H

lf you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductionsand Adjustments Worksheet on page 2.

lf you are single and have more than one job or are married anrJ you and your spouse both work and the combinedearnings from all jobs exceed $50,000 ($20,000 if manied), see the Two-Earners/Multiple Jobs Worksheet on page 2to avoid having too little tax withheld.lf neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

A

B

A

B

c

I'.l.

G

For accuracy,complete allworksheetsthat apply.

---- Separate here and give Form W-4 to your employer. Keep thr: top part for your records.

Employee's Withholding Allowance Gertificate> Whether you are entilled to claim a certain number of allowances or exemption from withholding issubiect to review by the lRS. Your employer may be required to send a copy of this form to the lRS,

OMB No. 1545-0074

2@16Your flrst name and middle initial

Home address (number and street or rural route)

City or town, state, and ZIP code

2 Your social security number

s E Single [] Vanieo n vanleo, but withhold at higher Single rate

Note: lfmarried,bullegallyseparated,orspouseisanonresidenlalien,checklhe

4 lf your last name differs from that shown on your social security card,

check here. You must call1-8OO-772J|213tor a replacement card. > E

Date >

10 Employer identification number (ElN)

5

6

7

,",," lllf-4Department ol the Treasurylnternal Revenue Seruice

Under

Employee's signatureffhis form is not valid unless

8 Employer's name and address (Employer: Complete lines 8 and 10 only if sending to the lRS.)

Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2)

Additional amount, if any, you want withheld from each paycheck

I claim exemption from withholding for 2016, and I certify that I meet both of the following conditions for exemption.. Last year I had a right to a refund of all federal income tax withheld because I frad no tax liability, and. This year I expect a refund of all federal income tax withheld because I expect to have no taxtf meet both conditions. write "Exemot" here .

of periury, declare examined this certificate and, to the best of mV knowledge and belief, it is true, correct, and complete.

For Privacy Act and Paperwork Reduction Act Notice, see page 2. rorm W-4 1zoto1

MPT2016

Direct Deposit Agreement Form

ALL EMPLOYEES ARE REQUIRED TO HAVE DIRECT DEPOSIT

* This form needs to be filled out at time of hire *

I hereby authorize Premier Electrical Staffing, LLC to initiate automatic deposits to my account at the financial

institution named below. I also authorize Premier Electrical Staffing, LLC to make withdrawals from this account

in the event that a credit entry is made in error.

Further, I agree not to hold Premier Electrical Staffing, LLC responsible for any delay or loss of funds due to

incorrect or incomplete information supplied by me or by my financial institution or due to an error on the

part of my financial institution in depositing funds to my account.

This agreement will remain in effect until Premier Electrical Staffing, LLC receives a written notice of cancellation from

me or my financial institution, or until I submit a new direct deposit form to the Payroll Department. mation

Name of Financial Institution:

Authorized Signature (Primary): Date:

Authorized Signature (Joint) Date:

____Checking ____Global Cash Card

Account Number __________________________________________________

Routing Number ___________________________________________________

We only accept a voided check (NOT a deposit slip), attach and return this form to the

Payroll Department A bank direct deposit authorization letter can be faxed to us directly to

the below number. Employee name must appear on the account.

Fax: 919-420-7577

ASK your recruiter for additional information and documentation.

Other Options: For those of you who do not have a bank account a pay card will be issued through

Global Cash Card: Please see your Recruiter for details. We are a 100% direct deposit company.

*Please call the 919-420-7576 for any Payroll Questions*

MPT2016

Employee Handbook and Policy Acknowledgement Form

I acknowledge that I will review the Premier Electrical Staffing, LLC Employee Handbook and Safety Manual

located online at www.premierelectricalstaffing.com (under Employment Tab), and/or by contacting a

Premier Electrical Staffing representative, within five (5) days of signing this agreement for a written copy. I

agree to abide by the policies outlined there in. I agree to read it thoroughly, including all the policies and

procedures that are outlined in the Handbook. I agree that if there is any policy or provision in the Handbook

that I do not understand, I will seek clarification from the Human Resources Department.

I understand that Premier Electrical Staffing, LLC is an "at will" employer and, as such, employment with

Premier Electrical Staffing, LLC is not for a fixed term or definite period and may be terminated at any time at

the will of either party, with or without cause, and with or without prior notice. No supervisor or other

representative of the company has the authority to enter into any agreement for employment for any specified

period of time, or to make any agreement contrary to “at will” employment except for the CEO or President of

the Company and then only expressly in writing signed by one of them.

In addition, I understand that this Handbook includes Premier Electrical Staffing, LLC practices in effect on the

date of publication. I understand that nothing contained in the Handbook may be construed as creating a

promise of future benefits or a binding contract with Premier Electrical Staffing, LLC for benefits or for any

other purpose. I also understand that these policies and procedures are continually evaluated and may be

amended, modified or terminated by the Company at any time, without prior notification. I understand that I

can request an amended Handbook at any time.

Employee’s Signature (required)

Employee’s Name (Print) (required)

Date (required)

MPT2016

Safety Manual Sign Sheet

This is to certify that I have received a copy of the Premier Electrical Staffing Safety Manual. This manual is also available on our Website at www.premierelectricalstaffing.com in both English and Spanish. I have read these instructions, understand them, and will comply with them while working for the company. I understand that failure to abide by these rules may result in disciplinary action and possible termination of my employment with the company. In addition, I certify that in case I am injured while in the course of my work, I will report the injury to my supervisor immediately and will obtain medical treatment from a Medical Provider authorized by Premier Electrical Staffing before seeking treatment. I also agree to obtain first aid for every injury, no matter how slight, to preclude further injury or avoid infection. I also understand that it is company policy that the employee’s medical information must be delivered to the Branch office no later than 12 hours after treatment. I also understand that I am to report any injury to my Supervisor or Manager immediately and report all safety hazards. I further understand that I have the following rights. * I am not required to work in any area I feel is not safe. * I am entitled to information on any hazardous material or chemical I am exposed to while working. * I am entitled to see a copy of the Safety Manual and Injury and Illness Prevention program. * I will not be discriminated against for reporting safety concerns Employees Name (Print) (required) Employees Signature (required) Date (required) Copy: Employee File

TRM All other editions invalid—02/18/16

Welcome to Premier Electrical Staffing, LLC. The following is a list of rules, regulations and guidelines that we require all employees comply with

throughout their career with PES. Please read each item carefully and initial where indicated to show that you understand what is expected. If you

do not understand, please do not hesitate to ask for clarification.

(Initial Each Statement and Sign and Date the bottom of the Form.)

You are required to IMMEDIATELY report personal accidents and/or job related injuries by notifying your foreman and calling Branch or corporate our office: 919.420.7576. Failure to report injury/accident within eight (8) hours of the incident can result in your claim being denied. If medical treatment is necessary, you are to go to the nearest URGENT CARE FACILITY. If you are involved in an accident or job related injury, you will be required to take a post-accident drug and alcohol test. If test results are positive, we will contest claims and you may be solely responsible for all damages and your employment may be terminated. All PES employees are subject to random drug testing.

You are required to follow the rules and regulations of our Clients when on their jobs.

Payday is each week on Friday. Direct deposit is mandatory. It is your responsibility to inform our payroll team of any changes to your account information.

If we send you to a job and you do not report as instructed to the jobsite without notification (No Call/No Show), you may be immediately terminated and may NOT be eligible for rehire.

You are eligible to enroll in Health Insurance benefits offered by PES within your first 30 days of employment. The enrollment form MUST be completed. Your health insurance will become active within 2-3 weeks of your first paycheck. The enrollment in this period is YOUR responsibility. You will NOT be reminded. “Open Enrollment” period is each December during this time, you can either upgrade your benefits, or sign up for benefits for the following year.

You are required to call and inform us of your availability IMMEDIATELY if there is a reduction in force on your present assignment and on a continual weekly basis if you are unassigned or if you become available for work. It is your responsibility to make sure we can contact you for work. FAILURE TO NOTIFY THE BRANCH OFFICE OF YOUR AVAILABILITY AND/OR CONTACT INFORMATION WILL RESULT IN YOUR UNEMPLOYMENT BEING CONTESTED BY PES AND POSSIBLY DENIED.

You are required to call the job foreman and your branch office if you will be absent or late to work. Every attempt should be made to report to work unless notified otherwise.

You are expected to dress appropriately for your position and work environment (i.e. boots, safety equipment, practice effective personal hygiene, etc.). Please refrain from wearing clothing with offensive remarks or pictures to work. No shorts, flip flops, cut-off shirts or pants or ripped clothing, piercings allowed on jobsites for safety reasons. We are 100% PPE (hardhat, safety glasses, gloves, vest/shirt).

All company and client tools, equipment, and/or vehicles must be returned in the same manner received. Failure to return any equipment will be subject to being deducted from your pay and/or reported to the sheriff’s office for prosecution. Any per diem paid in advance shall also be returned to the office if not used. Any payroll deductions/overpayments/per diems owed to PES will be deducted from your final check. If you leave our employ at any time with a balance owed, we reserve the right to seek legal representation to recover lost funds to the fullest extent of the law.

Approved payroll advances will be subject to administrative fees.

Falsifying timecards is FRAUD and is immediate grounds for termination. Engaging in this behavior will be reported to the sheriff’s office and PES will prosecute to the fullest extent of the law.

By placing my signature below, I acknowledge that I have read and understand all of the above statements.

Employee Signature PES Witness Signature

Employee Print PES Witness Print

Date Date MPT2016

NEW HIRE CHECKLIST/TERMS OF EMPLOYMENT

PREMIER ELECTRICAL STAFFING, LLC

MPT2016

As of June 1, 2015, the Hazard Communication Standard (HCS) will require pictograms on labels to alert users of the Chemical hazards to which they may be exposed. Each pictogram consist of ta symbol on a white background framed within a red border and represents a distinct hazard(s). The pictogram on the label is determined by the chemical hazard classification

HCS Pictograms and Hazards

Health Hazard

Carcinogen

Mutagenicity

Reproductive Toxicity

Respiratory Sensitizer

Target Organ Toxicity

Aspiration Toxicity

Flame

Flammables

Pyrophorics

Self-Heating

Emits Flammable Gas

Self-Reactives

Organic Peroxides

Exclamation Mark

Irritant (skin and eye)

Skin Sensitizer

Acute Toxicity

Narcotic Effects

Respiratory Tract Irritant

Hazardous to Ozone Layer (Non-Mandatory)

Gas Cylinder

Gases Under Pressure

Corrosion

Skin Corrosion/Burns

Eye Damage

Corrosive to Metals

Exploding Bomb

Explosives

Self-Reactives

Organic Peroxides

Flame Over Circle

Oxidizers

Environment

(Non-Mandatory)

Aquatic Toxicity

Skull and Crossbones

Acute Toxicity (fatal or toxic

OSHA-US Department of Labor www.osha.gov

800-321-6724

Employee Name: _____________________________________(required)

Date: ______________________________________________(required)

MPT2016

Hot Work Policy for Electrical Equipment and Systems

PREMIER ELECTRICAL STAFFING HOT WORK POLICY

Premier Electric Staffing, LLC policies and procedures regarding electrical equipment and systems have been implemented to protect the employees of Premier Electric Staffing, LLC as well as our customers and those trades that work with us. As an employee of Premier Electrical Staffing, LLC you shall treat all electrical equipment and systems as energized until tested or otherwise proven to be de-energized.

Work shall NOT be performed on any exposed energized parts of equipment or systems.

**If you are ever asked to work on energized equipment you are to immediately stop and contact your local Premier branch office or contact the corporate 0ffice at 919-420-7576.

I have carefully read the foregoing policy statement and I acknowledge that I will not work on energized systems. Employee’s Name (Print) (required) Employee Signature (required) Date (required) Company Witness

Copy: Employee File

MPT2016

Equal Employment Opportunity Information

Employees are treated during employment without regard to race, color, religion, sex (including pregnancy, national origin, age, material or veteran status, medical condition of handicap, or any other legally protected status. PREMIER Electrical Staffing is required by the United States Equal Employment Opportunity Commission to collect and maintain the information requested below for E.E.O statistical reporting purposes. The information that you provide will be kept in a Confidential File and is not part of your Application for employment or personnel file.

Name:

DATE:

SOCIAL SECURITY:

SEX: FEMALE MALE

DATE OF BIRTH:

RACE/ETHNIC CATEGORIES

(Check One)

White (Not Hispanic origin) - All persons having origins in any of the original peoples of

Europe, North Africa, or the Middle East.

Black OR African (Not OF Hispanic origin) - All persons having origins in any of the Black

racial groups of Africa.

American Indian or Alaska Native - All persons having origins in any of the original

peoples of North America, and who maintain cultural identification through tribal

affiliation or community recognition.

Hispanic OR Latino - All persons of Mexican, Puerto Rican, Cuban, Central or South

American, or Spanish culture or origin, regardless of race.

Native Hawaiian OR Pacific Islander - All persons having origins in any of the original

peoples of the Pacific Islands. This area includes, for example, the Philippine Islands,

Micronesia and Samoa.

Asian – All persons having origins in any of the original peoples of the Far East,

Southeast Asia, and the Indian Subcontinent. This area includes, for example, China,

Japan, or Korea.

Two or more races.

I do not want to disclose this information

Safety Video Ouiz Premier Electrical Staffins. LLC

1. Employees with a safety attitude have the right attitude. True or False

2. Employer safety programs should provide for frequent and regular inspections ofthe job sites, materials andequipment. True or False

3 ' Any employee can operate equipment and machinery at the worksite ifthey have some idea of how it works. Trueor False

4. Guardrails, covers, personal fall arrest systems and safbty ropes ar€ all types of fall protection. True orFalse

5 ' Rerouting or properly covering exposed cableVcords that cross pathways is one way to prevent slips, trips andfalls. True or False

6. Employees must always wear hard hats to protect themselves from falling objects. True or False7. Fall protection is required any time you use a ladder. True or False

8. When lifting heavy objects it is always a good idea to get help or use special equipment. True or False

9 ' Employees should always assur-ne that al l overhead power l ines are energized. True or False

10. MSDSs are recluired for most chemicals used at the worksite and should be kept locked up in the supervisor'soffice for safety. True or False

I 1 . Trenches and excavations must be inspected daily fbr evidence of possible cave-ins, hazardous atmospheres.failure of protective systems. or other unsafb conditions. True or Farse

12. Guardrai ls should be instal led along al l operr s ides aud ends of plat fbrn-rs. ' l ' rue or False

13. Power tools must be f i t ted wit l r guards and saf 'ety switches. True or l ralse

14.Fatal electrocut ion is the only real r isk when working near overhead power l ines. ' f rue

or False

15. Ladders with structural def-ects can be used i f the employee thinks i t is st i l l safe. True or False

16. Employees should never enter into a confined or enclosed space unless properly trained and instructed by theiremployer. True or False

17. PPE must fit properly, be worn properly and be maintained properly to be effective. True or False

I 8. Smoking is prohibited at most construi:tion sites or is pennitted in designated areas only. True orFalse

19. You should know the locations of rlll frst aid kits and who is certified in first-aid at the worksite.True or False

20. Employees should take personal responsibility for their safety, their co-workem and others on theiobsite. True or Iralse

Premier Electrical Staffing, LLCSafety Orientation Quiz 2013

Name of Employee:

Date:

Employment Eligibitity VerificationDepartment of Homeland Security

U.S. Citizenship and Immigration S(3rvices

USCISForm I-9

OMll No l6l5-0047Expires 08/31/2019

:":r::::::':T:]:::1"::-": .*ullv berore completing this rorm. rhe instructions must be avaitabte, either in paper or etectronicaly,during completion of this form. Employers are liable for errors in the completion of this form.ANTI-DISCRIMINATIoN NOTICE: lt is illegal to discriminate against work-authorized individuals Employers cANNoT specify which

::::ff:i1:l il331"1:"I1Jjl"^::lll"_::l1b]:1?Tprovment authorization and identity rhe rerusat to hire or continu,e ro emproyan individual because the documentation presented has a future exprration date may also constitute illegal discriminatior.

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents inconnection with the completion of this form.I attest, under penalty of perjury, that I am (check one of the following boxes):

L__l 1 A citizen of the United States

l_J2 A noncitizen national of the United States (See instructions)

I o n lawful permanent resident (Alien Registration Number/Uscts ttumoer)

! a nn alien authorized to work until (expiratio

Some aliens may write "N/A" in the expiration date field (see instructions)

Aliens authorized to work must provide only one of the following document numbers to ccmplete Form l-g:An Alien Registration Number/uSClS Number oR Form t-94 Admission Number oR Foreign passpott Number.

1. AIien Registration Number/USCIS Number:

OR2. Form l-94 Admission Numoer:

OR3. Foreign Passport Number:

Country of lssuance:

QR Code - liection 1

Do Not Write In Thrs Space

section 1. Empf oyee Information inE AEestatio,n Erptry"^;;tia4"t" "rd "isn

s"cti*than the first day of emproyment, but not before accepting a job offer.)

1 of Fctnn i-S nc' Iater

Lasr Name (ramily Name) First Name (Given Name) Middle Initial Other Last Names Used (lf any,)

Address (Street Number and Name) Apt Number City or Town State ZIP Cc,de

Date of Birth (mm/dd/yyyy) U S Social Security Number

l-T-ft-t-l_rrrttttlEmployee's E-mail Adclress Employee's Telephorre Number

Signature of Employee

Preparer and/or Translator Certific€rtion Grreparer ano/or I ranstator certific€ttion (cherck one):!toionotuseapreparerortranslator' f-l Apreparer(s) arrd/ort|anslator(s) assls;tedtheernploveeincomptetingsectionl.(Fields below must be completed and signed when preparers and/or transiators,?ssisl an emplolr:e in comltletino Sec:firrrr

L:T:1,111",',T::]lI ?lpelju.rv, thatr havi ectio{11 ffisrk the information is true and correct.Signature of Preparer or Translator Today's Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name)

A0dress (Street Number and Name) City or Town State ZP

my

Form I-9 I l/14/2016 N

Ernployer Completes |Vert lDo;qe

Page I of 3

Employment Eligibility Verifi cationDepartment of Homeland Security

U.S. Citizenship and lmmigration Services

USCISForm I-9

OMB No. l615-0()47Expires 08/3 I /20 I 9

Employee Info from Section 1Last Name (Family Name) First Namer (Given Name) M Citizenship/lmnrig ration Status

List A OR List B

Document Title Document Title Document Title

lssuing Authority lssuing Authority

Document Number

lssuing Authority

Document NumberDocument Number

Expiration Date (if any) (mm/dd/yyyy) Expiration Date (if any)(nm/dd/yyyy) Expiration Date (if any)(mm/ddtyyyy)

Document Title

lssuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Document Title

lssuing Authority

Document Number

Expiration Date (if any)(mm/dd/yyyy)

ldentity and Employment Authorization ldentityList C;

Employment A uthorization

Certification: lattest, under penalty of perjury, that (1)l have examined the document(s) presented by the above-named employee,(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge theemployee is authorized to work in the United States.The empfoyee's first day of employment (mm/dd/yyyy): (See instructions for exemptions)

Signature of Employer or Authorized Representative Today's Date(m m/dd/y yyy) Title of Employer or Authorized Repr

Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative Employeis Business or O

Employer's Business or Organization Address (Street Number and Name) City or Town State ZIP Coder

the employee's previous grant of employment autho has expired, provide the for the document or that r:sl.erblisl'resurng employment authorization in the space rrrovided below

Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United St,ates, anO itthe employee presented document(s), the document(s) | have examined appear to be genuine and to relate to the individual.

u"fI

I

Section 3. Reverification and Rehires (To be completetd and signed by ,t mpllyu;*thoized rup;usenatirr)A. New Name (if applicable) B. Date of Rehire (if applicableLast Name (Family Name) First Name (Given Name) Midclle Initial Date (mn/dd/yyyy)

Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy)

Form I-9 I l/14/2016 N Page 2 of3

LISTS OF ACCEPTABLE DOCUMENTSAll documents must be UlrtEXplRED

Employees may present one selection from List Aor a combination of one selection from List B arrd one selection from List c

ldentification Card for Use ofResident Citizen in the UnitedStates (Form l-179)

Employment authorizationdocument issued by the,Department of Homelarrd Securitv

Examples of many of these documents appear in Part 8 of the Handbook for Employers (lr/l-274).

7.

8.

LIST A

Documents that EstablishBoth ldentity and

Employment Authorization

LIST B

Documents that Estalblishldentity

LIST C

Documents thati EstablishEmployment Authorization

U S. Passport or U.S passport Card

Permanent Resident Card or AlienRegistration Receipt Card (Form l-551)

'1. Driver's license or lD card i:;sued by aState or outlying possession of theUnited States provided it cc,ntains aphotograph or information s,uch asname, date of birth, gender height, eyecolor, and address

1. A Social Security Accc,unt Numbercard, unless the card includes one ofthe followin g restrictions;:

(1) NOr VALTD FOR ETVIPLOYMENT

(2) VALTD FOR WORK ONLY W|THINS AUTHORIZATION

(3) VALTD FOR WORK ONLY WITHDHS AUTHORIZATION

2. Certification of Birth Ab road issuedby the Department of S;tate (FormFS-545)

3. Foreign passport that contains atemporary l-551 stamp or temporaryl-551 printed notation on a machine-readable immigrant visa

2. lD card issued by federal, state or localgovernment agencies or entities,provided it contains a photograph orinformation such as name, date of birth,gender, height, eye color, arrd address

4. EmploymentAuthorization Documentthat contains a photograph (Formt_766)

3. School lD card with a photograph5. For a nonimmigrant alien authorizedto work for a specific employerbecause of his or her status:

a. Foreign passport; and

b. Form l-94 or Form l-94A that hasthe following:

(1) The same name as the passport;ano

(2) An endorsement of the alien'snonimmigrant status as long asthat period of endorsement hasnot yet expired and theproposed employment is not inconflict with any restrictions orlimitations identified on the form.

3. Certification of Report of Birthissued by the Departmr_.nt of State(Form DS-1350)

4. Original or certified copy of birthcertificate issued by a {itate,county, municipal authority, orterritory of the United Statesbearing an official seal

5. Native American tribal <iocument

6. U S. Citizen lD Card (F:rm l-197)

4. Voter's registration card

5. U.S. Military card or draft rer:ord

6. Military dependent's lD card

7. U.S. Coast Guard Merchant MarinerCard

8. Native American tribal docurnenl

9. Drivels license issued by a r3anadiangovernment authority

For persons under age 18 who areunable to present a document

listed above:6. Passport from the Federated States of

Micronesia (FSM) or the Republic ofthe Marshall lslands (RMl) with Forml-94 or Form l-94A indicatingnonimmigrant admission under theCompact of Free Association Betweenthe United States and the FSM or RMI

10. School record or report carrj

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

Form I-9 I l/14/2016 N

Refer to the instructions for more information about acceptabte receipts.

Page 3 of3

Limited Benefi t & Self-Funded Minimum Essential Coverage (MEC) Enrollment Guide

Complete the Enrollment Form to Elect or Decline Coverage

1. You MUST complete the Enrollment Form as part of your New Hire Process.2. Elect or decline all benefi ts on the Enrollment Form.3. You MUST Sign and Date the bottom of the form, even if you decline coverage.4. Return the Enrollment Form to your Branch Manager.5. Keep the Benefi ts at a Glance page for your records.

The Essential StaffCARE Fixed Indemnity Medical, Prescription Drug, and Dental Plans are underwritten by BCS Insurance Company, Oakbrook Terrace, Illinois under Policy Series Numbers 25.1204, 26.1801, 26.212, and 26.213. The Term Life, Accidental Death and Dismemberment and Short-Term Disability Plans are underwritten by 4 Ever Life Insurance Company, Oakbrook Terrace, Illinois under Policy Series Number 62.200.

For questions or assistance, please call Essential StaffCARE Customer Service at 1-866-798-0803.

Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.

The MEC Wellness/Preventive Plan is an employer-sponsored, self-funded plan that has been deemed to be in compliance with ACA rules and regulations. More information about Preventive Services may be found on the government website at: https://www.healthcare.gov/what-are-my-preventive-care-benefi ts/. For questions or assistance, please call Essential StaffCARE Customer Service at 1-866-798-0803.

Availability of Summary Health Information for MEC/Wellness Preventive PlanYour plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefi ts and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options.The SBC is available on the web at: essentialstaffcare.com/sbcmec. A paper copy is also available, free of charge, by calling Essential StaffCARE Customer Service 1-866-798-0803.

Advantages of the Fixed Indemnity Medical Plan

Covers Day to Day Medical Expenses

Satisfi es the Individual Mandate

You may still be eligible to receive a subsidy from the health insurance exchange

Offers Dental, Term Life and STD

IMPORTANT PLAN INFORMATION: You have two medical plan options. You may enroll in one or both. Additional benefi ts are available to add if you enroll in the Fixed Indemnity Medical Plan.

Advantages of the MEC Wellness/Preventive Plan

Covers Day to Day Medical Expenses

Satisfi es the Individual Mandate

You may still be eligible to receive a subsidy from the health insurance exchange

Offers Dental, Term Life and STD

THE FIXED INDEMNITY MEDICAL PLAN IS A SUPPLEMENT TO HEALTH INSURANCE. IT IS NOT A SUBSTITUTE FOR ESSENTIAL HEALTH BENEFITS OR MINIMUM ESSENTIAL COVERAGE AS DEFINED UNDER THE AFFORDABLE CARE ACT (ACA).

PME ESC/MEC 4NAVCL PVM v18.2

This is an Essential StaffCARE Enrollment Form.

ENROLLMENT FORM ESC/MEC 4NAVCL PVM v18.2

VSI OFFICE USE ONLY LOCATION ____________ Rehire Date __ __ /__ __ /__ __ __ __

A. REQUIRED EMPLOYEE INFORMATION B. MEDICARE INFORMATIONPRINT USING BLACK or BLUE INK (Must Be Filled Out) Do you or any of your dependents receive

Medicare benefi ts? Yes No. If Yes:

Name Home Phone

Social Security # Date of Birth

/ /

Sex M F

Medicare Health Insurance Claim Number (HICN)

Address Apt. # Medicare Effective Date

City Zip State Name of Covered Person(s):1. 2.

C. LIMITED BENEFIT PLAN SELECTION You MUST enroll in the Fixed Indemnity Medical Insurance Plan before adding any additional benefi ts in Section C. Your coverage level for the additional benefi ts in Section C will be identical to your fi xed indemnity medical plan selection. This plan is underwritten by BCS Insurance Company.

FIXED INDEMNITYMEDICAL 1 DENTAL TERM LIFE SHORT-TERM

DISABILITY 2

Employee Only $15.98 $5.40 $0.60 $4.20Employee +

Child(ren) $26.54 $14.58 $0.90

Employee + Spouse $30.36 $10.80 $0.90

Employee + Family $40.44 $20.52 $1.80

NO to ALL Benefi ts Yes No Yes No Yes No1 This coverage is not available to residents of NH, HI, or PR. 2 STD is not available to persons who work in CA, HI, NJ, NY, or RI.

For Term Life / Accidental Death & Dismemberment please write in your benefi ciary information. Accidental Death & Dismemberment is part of the Term Life Benefi t.Name Relationship

D. REQUIRED DEPENDENT INFORMATIONName Social Security # Date of Birth

/ /Sex M F

Relationship Spouse Child Domestic Partner

Name Social Security # Date of Birth / /

Sex M F

Relationship Spouse Child Domestic Partner

Name Social Security # Date of Birth / /

Sex M F

Relationship Spouse Child Domestic Partner

E. OPTIONAL MEC WELLNESS/PREVENTIVE BENEFIT SELECTION List Bill Monthly RatesEnrolling in the Optional MEC Wellness/Preventive Benefi t may DISQUALIFY you from receiving a subsidy from the health insurance exchange. This plan satisfi es the federal healthcare reform Individual Mandate. This is an offer of ACA compliant coverage and by purchasing this plan, you will not be taxed for failing to purchase insurance required by the Affordable Care Act. The MEC Wellness/Preventive Benefi t is NOT underwritten by BCS Insurance Company. It is a benefi t offered and provided by your employer. Rates for the MEC Wellness/Preventive Benefi t are billed monthly.

$60.00 Employee Only $79.80 Employee + Child(ren) $87.00 Employee + Spouse $105.90 Employee + Family

NO to MEC Wellness/Preventive

F. REQUIRED SIGNATURE YOU MUST SIGN AND DATE EVEN IF YOU DECLINE COVERAGEI have read the Benefi ts Summary and the Limitations and Exclusions for the Fixed Indemnity Medical Plan. I understand that I have been offered ACA compliant coverage (MEC Wellness/Preventive), and open enrollment is only available for a limited time. I understand that making no benefi t selection is a declination of coverage.

DATE __ __ /__ __ /__ __ __ __ SIGNATURE

2914400-PME

82914400-M-PME

This is an Essential StaffCARE Enrollment Form.

Policy Number

WEEKLY LIMITED BENEFITS PREMIUM Medical Dental Term Life STDEmployee Only $15.98 $5.40 $0.60 $4.20

Employee + Child(ren) $26.54 $14.58 $0.90 -

Employee + Spouse $30.36 $10.80 $0.90 -

Employee + Family $40.44 $20.52 $1.80 -

OPTIONAL MEC WELLNESS/PREVENTIVE BENEFIT 1

The optional MEC Wellness/Preventive Benefi t DOES NOT cover medical services. This plan provides coverage for preventive services such as immunization and routine health screening. It does not cover conditions caused by accident or illness.

Benefi t In-Network Non-Network MONTHLY MEC PREMIUM MEC15 Preventive Services for Adults 100% 40% Employee Only $60.00

22 Preventive Services for Women 100% 40% Employee + Child(ren) $79.80

26 Covered Preventive Services for Children 100% 40% Employee + Spouse $87.001 For more information about preventive services, please visit www.healthcare.gov. Employee + Family $105.90

LIMITED BENEFITS SUMMARY

SHORT-TERM DISABILITY BENEFITBenefi t Amount 60% of Salary up to $150 per week

Waiting Period/Maximum Benefi t Period 7 days, up to 26 weeks

DENTAL BENEFIT Waiting Period/Coinsurance Annual Maximum Benefi t $750 Deductible $50

Coverage A None / 80% Exams, Cleanings, Intraoral Films and Bitewings

Coverage B 3 Months / 60% Fillings, Oral Surgery, and Repairs for Crowns, Bridges and Dentures

Coverage C 12 Months / 50% Periodontics, Crowns, Bridges, Endodontics and Dentures

Policy Number

FIXED INDEMNITY MEDICAL BENEFITThe Fixed Indemnity Medical Plan pays a flat amount for a covered event caused by an accident or illness. If the covered event costs more, you pay the difference. But if the covered event costs less, you keep the difference.

Outpatient Benefi ts 1 Inpatient Benefi tsPhysician Offi ce Visit $55 per day Standard Care $300 per day

Diagnostic (Lab) $75 per day Intensive Care Unit Maximum 2 $400 per day

Diagnostic (X-Ray) $150 per day Inpatient Surgery $2,000 per day

Ambulance Services $300 per day Anesthesiology $400 per day

Physical, Speech, or Occupational Therapy $50 per day Skilled Nursing 3 $100 per day

Emergency Room Benefi t - Sickness $100 per day Annual Inpatient Maximum 4 No Limit

Emergency Room Benefi t - Accident $300 per day Prescription Drugs (via reimbursement) 5,6

Outpatient Surgery $500 per day Annual Maximum $600

Anesthesiology $200 per day Per Day $30

Annual Outpatient Maximum $2,000

Wellness CareWellness Care (one per year) $1001 all outpatient benefi ts are subject to the outpatient maximum 2 pays in addition to standard care benefi t 3 for stays in a skilled nursing facility after a hospital stay 4 Subject to internal limits of plan 5 not subject to outpatient maximum 6 To fi le a claim for reimbursement, save your receipt and remit to Planned Administrators, Inc.

TERM LIFE BENEFITEmployee Amount $10,000 (reduces to $7,500 at 65; $5,000 at 70) Child Amount (6 mos to 26 yrs old) $5,000

Spouse Amount $5,000 (terminates at age 70) Infant Amount (15 days to 6 mos) $1,000

ACCIDENTAL DEATH & DISMEMBERMENT (AD&D is part of the Term Life Benefi t.)Employee Amount $20,000 Child Amount (6 mos to 26 yrs old) $5,000

Spouse Amount $20,000 Infant Amount (15 days to 6 mos) $2,500

2914400-PME

82914400-M-PME

LIMITED BENEFIT EXCLUSIONS AND LIMITATIONSThese are the standard limitations and exclusions. As they may vary by state, please see your summary plan description (SPD) for a more detailed listing.FIXED INDEMNITY MEDICALNo benefi ts will be paid for loss caused by or resulting from:• Intentionally self-infl icted injuries, suicide or any attempt while

sane or insane• Declared or undeclared war• Serving on full-time active duty in the armed forces• The covered person’s commission of a felony• Work-related injury or sickness, whether or not benefi ts are

payable under workers’ compensation or similar lawNo benefi ts will be paid for:• Eye examinations for glasses, any kind of eye glasses, or vision

prescriptions• Hearing examinations or hearing aids• Dental care or treatment other than care of sound, natural

teeth and gums required on account of injury to the covered person resulting from an accident that happens while such person is covered under the policy, and rendered within 6 months of the accident

• Services rendered in connection with cosmetic surgery, except cosmetic surgery that the covered person needs for breast reconstruction following a mastectomy or as a result of an accident that happens while such person is covered under the policy. Cosmetic surgery for an accidental injury must be performed within 90 days of the accident causing the injury and while such person’s coverage is in force

• Services provided by a member of the covered person’s immediate family.

The fi xed indemnity medical plan is not available to residents of Hawaii, New Hampshire or Puerto Rico.PRESCRIPTION DRUGSNo benefi ts will be paid for over-the-counter products or medications or for drugs and medications dispensed while you are in a hospital.DENTAL The plan will pay only for procedures specifi ed on the Schedule of Covered Procedures in the group policy. Many procedures covered under the plan have waiting periods and limitations on how often the plan will pay for them within a certain time frame. For more detailed information on covered procedures or limitations, please see your summary plan description.

SHORT-TERM DISABILITYNo benefi ts are payable under this coverage in the following instances: • Attempted suicide or intentionally self-infl icted injury• Voluntary taking of poison; voluntary inhalation of gas;

voluntary taking of a drug or chemical. This does not apply to the extent administered by a licensed physician. The physician must not be you or your spouse, you or your spouse’s child, sibling or parent, or a person who resides in your home

• Declared or undeclared war or act of war• Your commission of or attempt to commit a felony, or any loss

sustained while incarcerated for the felony• Your participation in a riot• If you engage in an illegal occupation • Release of nuclear energy• Operating, riding in, or descending from any aircraft (including

a hang glider). This does not apply while you are a passenger on a licensed, commercial, nonmilitary aircraft; or

• Work-related injury or sickness. Short-Term Disability benefi ts are not available to persons who work in California, Hawaii, New Jersey, New York, or Rhode Island. TERM LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT No Life Insurance benefi ts will be payable under the policy for death caused by suicide or self-destruction, or any attempt at it within 24 months after the person’s coverage under the policy became effective. For Accidental Death and Dismemberment benefi ts will not be payable for any loss caused in whole or in part by, or resulting in whole or in part from, the following:Attempted suicide or intentionally self infl icted injury; bodily or mental infi rmity; disease of any kind; or medical or surgical treatment for that infi rmity or disease. This does not include bacterial infections resulting from an accidental cut or wound or accidental ingestion of poisonous food substance; voluntary taking of poison; voluntary inhalation of gas; voluntary taking of a drug or chemical. This does not apply to the extent administered by a licensed physician. The physician must not be you, your spouse or domestic partner; you, your spouse’s or domestic partner’s child; sibling or parent; or a person who resides in your home; declared or undeclared war or act of war; your commission of or attempt to commit a felony, or any loss sustained while incarcerated for the felony; your participation in a riot; if you engage in an illegal occupation; release of nuclear energy; operating, riding in, or descending from any aircraft (including a hang glider). This does not apply while you are a passenger on a licensed, commercial, nonmilitary aircraft; work-related injury or sickness.

Member Services:

For frequently asked questions and network information for the the Fixed Indemnity Medical Plan, please go to www.essentialstaffcare.com/FAQVSI. For frequently ask questions regarding the MEC Wellness Preventive Benefi t, as well as a full list of preventive services covered, please go to www.essentialstaffcare.com/FAQMECL. PLEASE NOTE: To make changes or cancel coverage by telephone call (800) 269-7783. Your pin code for enrolling/making changes is + _ _ _ _ (last four digits of your SSN). Your Company has chosen to take your payroll deductions on a Post-Tax basis.

Essential StaffCARE Customer Service: 1-866-798-0803• Once enrolled, members can call this number for questions regarding plan coverage, ID card, claim status, and policy booklets and

to add, change, or cancel coverage.• Customer Service Call Center hours are M - F, 8:30 a.m. to 8 p.m. Eastern Standard Time.

Bilingual representatives are available.• Members can also visit www.paisc.com and click on “Your Plan” and enter your group number.

The MEC SBC is available on the web at: essentialstaffcare.com/sbcmec. A paper copy is also available, free of charge, by calling Essential StaffCARE Customer Service 1-866-798-0803.

400

This is an Essential StaffCARE Enrollment Form.

www.premierelectricalstaffing.com MPT2016

Handbook and Safety Policy Employee Acknowledgment EMPLOYEE COPY

I acknowledge that I will review the Premier Electrical Staffing, LLC Employee Handbook, and Safety Manual located online at www.premierelectricalstaffing.com (under Employment tab), and/or by contacting a Premier Electrical Staffing representative, within five (5) days to receive a printed copy. I agree to abide by the policies outlined there in. I agree to read it thoroughly, including all the policies and procedures that are outlined in the Handbooks. I agree that if there is any policy or provision in the Handbooks that I do not understand, I will seek clarification from the Human Resources Department.

EMPLOYEE SAFETY VIDEO As an employee of Premier you are required to watch the safety video on avoidance of workplace injuries. When you are hired you have 24 hours to complete the 15 minute video and take a short test; unless you viewed the video and took the test when you applied. If you do not complete this your pay stubs will be held in the office until completed. Contact your recruiter for access to take the Safety Video.

EMPLOYEE RESPONSIBILITES I certify that in the event that I am injured while in the course of my work, I will report the injury to my supervisor immediately and will obtain medical treatment at a facility authorized by Premier Electrical Staffing before seeking treatment. I also agree to obtain first aid for every injury, no matter how slight, to prevent further injury and to avoid infection. I also understand the company policy of returning all medical information related to my treatment to the Raleigh office no later than 12 hours after treatment. (May be faxed to HR Director at 919-420-7577.)

Report all accidents and injuries, no matter how minor, to your supervisor immediately

We require on all jobs all PPE Hardhats, Glasses, Boots, Gloves, Safety Glasses

WE DO NOT WORK ON HOT OR ENERGIZED EQUIPMENT

SUMMARY OF SAFE PRACTICES

Every employee is responsible for working safely, both for self-protection and for protection of fellow workers. Employees must also support all company safety efforts.

If you are unsure how to do any task safely, ask your supervisor. Read and abide by all requirements of the Safety Manual. Know and follow the Code of Safe Practices and all company safety policies and rules. Wear all required personal protective equipment. Do not operate any equipment you have not been trained and authorized to use. Report any safety hazards or defective equipment immediately to your supervisor. Do not remove, tamper with or defeat any guard, safety device or interlock. Never use any equipment with inoperative or missing guards, safety devices or interlocks. Never possess, or be under the influence of, alcohol or controlled substances while on the

premises. Never engage in horseplay or fighting. Participate in, and actively support, the company safety program.

Contact your Home office or 919-420-7576 for additional Information

Accessing your paystub and W-2 online

SETTING UP AN ONLINE ACCOUNT:

1. STEP 1: Go to www.PremierElectricalStaffing.com 2. STEP 2: Go to the bottom right of the home page and click “View Paystubs” 3. STEP 3: Click on “Sign up now!” 4. STEP 4: If you have use a Global Cash Card issued by Premier Electrical Staffing you will click “YES”

under do you have a card with us. If you do not have a Global Cash Card issued by Premier Electrical Staffing you will click “NO”.

5. STEP 5: If you clicked “YES”, please enter your Global Cash Card number. If you clicked “NO” please fill out the information requested.

a. Unique ID: This is your Social Security Number b. User Name: When asked to enter a user name, it is recommended to use your Last Name and

Last 4 digits of your social security number. For example; John Doe 111-11-1234 would use Doe1234 as their user name.

Call Global Customer Service with questions or issues accessing your paystub at:

*** 949-751-0360 ***

To Set Up Options of Delivery ● Once you log into your account and select the “paystub” tab at the top of the screen you will be directed to the list of paystubs. On the left side of the screen you can setup to receive your paystub by e-mail. Just simply check “yes” and each time your paystub is loaded you will be notified by e-mail. ● Your paystub can also be set up with different options of delivery by clicking on a paystub link once the paystub comes up scroll to the bottom of the page where you will see the different options of delivery by entering an e-mail address, fax number or cell phone number.

To Access the Global Cash Card Mobile Web from your Smart Phone

●Cardholders simply log on to www.globalcashcard.com from a mobile device and are automatically directed to the user-friendly mobile site, which is tailored to their specific device. Log-in with your username and password to view their paystub information right from your phone.

Call Global Customer Service with questions or issues accessing your paystub at:

*** 949-751-0360 ***

www.premierelectricalstaffing.com

Required Tool List

Helper/Top Helper

Wire Stripper 1

Voltage Tester 1

Roto Splitter 1

Hacksaw 1

Claw Hammer 1

Knife 1

9” Side Cutters 1

10” Channel Locks or Water Pump Pliers 2

25’ Tape Measure 1

Straight slot screw driver (1 small, 1 large) 2

Phillips screw driver (1 small, 1 large) 2

Cordless 3/8” or larger Drill motor w/ battery 1

Pencil 2

6” pair of Work boots (check if job requires steel toe) 1

Belt and tool bag/pouches 1

Electrician

Flashlight 1

Torpedo level 1

8” diagonal pliers 1

8” needle nosed pliers 1

Center punch 1

Awl 1

Stubby straight slot screwdriver 1

Stubby Phillips screwdriver 1

Set of Allen wrenches (1/16” – 3/8”) 1

Set of open end wrenches (1/4” – ¾”) 1

Set of socket wrenches (1/4” - ¾”) 1

Adjustable end wrenches (1 small, 1 large) 2

Tin snips 1

Set of spin Tights or Nut Drivers (3/16” – 9/16”) 1

National Code Book 1