New hire packet

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New hire packet

  1. 1. There are four basic steps to becoming a Convergence Marketing employee merchandiser: 1. Completely fill out the On-line Application at www.convergencemktg.com ƒ The application will ask you for contact information, previous work experience, skill sets, availability, whether you are seeking part time or full time opportunities, etc. 2. Have a successful employee interview with a Convergence Marketing Management member and/or a representative in our Recruiting Department ƒ You will be contacted for a personal interview after you complete your on-line application. ƒ If you are offered employment as a merchandiser with us, you will be given an employee/merchandiser identification number (MCID) and sent an employee paperwork packet. 3. If you are offered employment, complete and return the following new employee documentation: 1. Application and copy of government issued ID (such as.: driver’s license, passport, etc) 2. I-9 Form (Employment Eligibility) 3. W-4 Form (Tax withholding) You also will be required to successfully complete a background check and drug testing as a condition of employment. If you meet this requirement and submit these 3 completed documents are sent in, you will be activated in our system, invited to attend a new employee orientation call, and will be eligible to accept and perform assignments. a) Scan and email to: payrollfaxes@convergencemktg.com b) Fax to: (443) 688-5083 c) Mail to: Attn: New Employee Convergence Marketing 7361 Coca Cola Drive Suite A Hanover, MD 21076 4. Attend new hire orientation teleconference Once the new hire packet has been received, you will be invited via phone or email to attend a new employee orientation teleconference. During this teleconference we will provide instruction on how you learn and accept assignments in your web portal at www.convergencemktg.com , report your completed work in the portal, where to mail your recap and payment forms (timesheets) and review policies and procedures such as dress code, attendance, business conduct, etc. If you have any questions or need assistance, simply email us at payrollfaxes@convergencemktg.com 5. Begin Accepting Assignments Once you have completed these four steps, you are eligible to begin working for Convergence Marketing. As a Convergence Marketing Merchandiser, you will be able to access your personal web portal with your merchandiser identification number (MCID) and password. The web portal provides information about your scheduled assignments and available work, download necessary paperwork for assigned jobs, and report completed assignments. To learn about available assignments in your area, log into your Merchandiser Web Portal at a minimum of 2-3 times per week and contact your area manager by phone or email at least once each week. When contacting your area manager, please include your name and MCID.Thank you in advance for completing this process and we look forward to having you work as an important part of ourorganization.Best Regards,Dawn BlackDirector of Human ResourcesConvergence Marketing, Inc
  2. 2. Merchandiser ID Number __ __ __ __ __ __ An Equal Opportunity EmployerThis application shall be valid for only 30 days from the date completed. After that, you will need to reapply to be considered foremployment.)Convergence Marketing is an Equal Opportunity Employer and does not discriminate on the basis of race, color, creed, religion, sex,age, marital status, national origin, disability, sexual orientation, or other classification protected by applicable law.Applicant InformationNameAddressCity State Zip CodeTelephone CellEmail AddressSocial SecurityAre you eligible to work in the United States? Yes [ ] No [ ] ___________________________________Have you ever been convicted of a crime or received a disposition other than “not guilty” in any criminal investigation orproceeding? Yes _____ No _____If yes, describe when the conviction occurred, the facts and circumstances, and any facts pertaining to rehabilitation. (Do not list any arrests notresulting in conviction or criminal charges for which the records have been expunged. A criminal offense will not necessarily bar employment.):Work Availability Are you able to work during the weekday? [ ] Yes [ ] No How many hours are you available each week? [ ] Part Time [ ] Full Time What type of work are you available to complete? [ ] Short Term [ ] Long Term (M ark All that Apply) [ ] Resets [ ] InstallationsBusiness ReferencesNameCompany TelephoneNameCompany TelephoneEducation Information[ ] High School Diploma/GED[ ] College/Trade SchoolPrior Employment (use additional sheets if necessary)Name of employer Name of last Employment Pay or salary
  3. 3. Address supervisor datesCity, State, Zip Code From StartPhone number To Final Your last job titleReason for leaving (be specific)Name of employer Name of last Employment Pay or salaryAddress supervisor datesCity, State, Zip Code From StartPhone number To Final` Your last job titleReason for leaving (be specific)List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at thiscompany. Maryland Residents: UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. ____________________________ __________________________________________________________ Date Signature of Applicant
  4. 4. OMB No. 1615-0047; Expires 08/31/12Department of Homeland Security Form I-9, EmploymentU.S. Citizenship and Immigration Services Eligibility Verification Instructions Read all instructions carefully before completing this form. Anti-Discrimination Notice. It is illegal to discriminate against in Section 2 evidence of employment authorization that any individual (other than an alien not authorized to work in the contains an expiration date (e.g., Employment Authorization United States) in hiring, discharging, or recruiting or referring for a Document (Form I-766)). fee because of that individuals national origin or citizenship status. It is illegal to discriminate against work-authorized individuals. Preparer/Translator Certification Employers CANNOT specify which document(s) they will accept The Preparer/Translator Certification must be completed if from an employee. The refusal to hire an individual because the Section 1 is prepared by a person other than the employee. A documents presented have a future expiration date may also preparer/translator may be used only when the employee is constitute illegal discrimination. For more information, call the Office of Special Counsel for Immigration Related Unfair unable to complete Section 1 on his or her own. However, the Employment Practices at 1-800-255-8155. employee must still sign Section 1 personally. Section 2, Employer What Is the Purpose of This Form? For the purpose of completing this form, the term "employer" means all employers including those recruiters and referrersThe purpose of this form is to document that each new for a fee who are agricultural associations, agriculturalemployee (both citizen and noncitizen) hired after November employers, or farm labor contractors. Employers must6, 1986, is authorized to work in the United States. complete Section 2 by examining evidence of identity and employment authorization within three business days of the date employment begins. However, if an employer hires an When Should Form I-9 Be Used? individual for less than three business days, Section 2 must beAll employees (citizens and noncitizens) hired after November completed at the time employment begins. Employers cannot6, 1986, and working in the United States must complete specify which document(s) listed on the last page of Form I-9Form I-9. employees present to establish identity and employment authorization. Employees may present any List A document Filling Out Form I-9 OR a combination of a List B and a List C document. If an employee is unable to present a required document (orSection 1, Employee documents), the employee must present an acceptable receiptThis part of the form must be completed no later than the time in lieu of a document listed on the last page of this form.of hire, which is the actual beginning of employment. Receipts showing that a person has applied for an initial grantProviding the Social Security Number is voluntary, except for of employment authorization, or for renewal of employmentemployees hired by employers participating in the USCIS authorization, are not acceptable. Employees must presentElectronic Employment Eligibility Verification Program (E- receipts within three business days of the date employmentVerify). The employer is responsible for ensuring that begins and must present valid replacement documents withinSection 1 is timely and properly completed. 90 days or other specified time.Noncitizen nationals of the United States are persons born in Employers must record in Section 2:American Samoa, certain former citizens of the former TrustTerritory of the Pacific Islands, and certain children of 1. Document title;noncitizen nationals born abroad. 2. Issuing authority; 3. Document number;Employers should note the work authorization expiration 4. Expiration date, if any; anddate (if any) shown in Section 1. For employees who indicate 5. The date employment begins.an employment authorization expiration date in Section 1,employers are required to reverify employment authorization Employers must sign and date the certification in Section 2.for employment on or before the date shown. Note that some Employees must present original documents. Employers may,employees may leave the expiration date blank if they are but are not required to, photocopy the document(s) presented.aliens whose work authorization does not expire (e.g., asylees, If photocopies are made, they must be made for all new hires.refugees, certain citizens of the Federated States of Micronesia Photocopies may only be used for the verification process andor the Republic of the Marshall Islands). For such employees, must be retained with Form I-9. Employers are stillreverification does not apply unless they choose to present responsible for completing and retaining Form I-9. Form I-9 (Rev. 08/07/09) Y
  5. 5. For more detailed information, you may refer to the Information about E-Verify, a free and voluntary program thatUSCIS Handbook for Employers (Form M-274). You may allows participating employers to electronically verify theobtain the handbook using the contact information found employment eligibility of their newly hired employees, can beunder the header "USCIS Forms and Information." obtained from our website at www.uscis.gov/e-verify or by calling 1-888-464-4218.Section 3, Updating and Reverification General information on immigration laws, regulations, andEmployers must complete Section 3 when updating and/or procedures can be obtained by telephoning our Nationalreverifying Form I-9. Employers must reverify employment Customer Service Center at 1-800-375-5283 or visiting ourauthorization of their employees on or before the work Internet website at www.uscis.gov.authorization expiration date recorded in Section 1 (if any).Employers CANNOT specify which document(s) they willaccept from an employee. Photocopying and Retaining Form I-9A. If an employees name has changed at the time this form is being updated/reverified, complete Block A. A blank Form I-9 may be reproduced, provided both sides are copied. The Instructions must be available to all employeesB. If an employee is rehired within three years of the date completing this form. Employers must retain completed Form this form was originally completed and the employee is I-9s for three years after the date of hire or one year after the still authorized to be employed on the same basis as date employment ends, whichever is later. previously indicated on this form (updating), complete Block B and the signature block. Form I-9 may be signed and retained electronically, as authorized in Department of Homeland Security regulationsC. If an employee is rehired within three years of the date at 8 CFR 274a.2. this form was originally completed and the employees work authorization has expired or if a current employees work authorization is about to expire Privacy Act Notice (reverification), complete Block B; and: The authority for collecting this information is the 1. Examine any document that reflects the employee Immigration Reform and Control Act of 1986, Pub. L. 99-603 is authorized to work in the United States (see List (8 USC 1324a). A or C); This information is for employers to verify the eligibility of 2. Record the document title, document number, and individuals for employment to preclude the unlawful hiring, or expiration date (if any) in Block C; and recruiting or referring for a fee, of aliens who are not 3. Complete the signature block. authorized to work in the United States.Note that for reverification purposes, employers have theoption of completing a new Form I-9 instead of completing This information will be used by employers as a record ofSection 3. their basis for determining eligibility of an employee to work in the United States. The form will be kept by the employer and made available for inspection by authorized officials of What Is the Filing Fee? the Department of Homeland Security, Department of Labor,There is no associated filing fee for completing Form I-9. This and Office of Special Counsel for Immigration-Related Unfairform is not filed with USCIS or any government agency. Form Employment Practices.I-9 must be retained by the employer and made available for Submission of the information required in this form isinspection by U.S. Government officials as specified in the voluntary. However, an individual may not begin employmentPrivacy Act Notice below. unless this form is completed, since employers are subject to civil or criminal penalties if they do not comply with the USCIS Forms and Information Immigration Reform and Control Act of 1986.To order USCIS forms, you can download them from ourwebsite at www.uscis.gov/forms or call our toll-free number at1-800-870-3676. You can obtain information about Form I-9from our website at www.uscis.gov or by calling1-888-464-4218. EMPLOYERS MUST RETAIN COMPLETED FORM I-9 Form I-9 (Rev. 08/07/09) Y Page 2 DO NOT MAIL COMPLETED FORM I-9 TO ICE OR USCIS
  6. 6. Paperwork Reduction ActAn agency may not conduct or sponsor an informationcollection and a person is not required to respond to acollection of information unless it displays a currently validOMB control number. The public reporting burden for thiscollection of information is estimated at 12 minutes perresponse, including the time for reviewing instructions andcompleting and submitting the form. Send commentsregarding this burden estimate or any other aspect of thiscollection of information, including suggestions for reducingthis burden, to: U.S. Citizenship and Immigration Services,Regulatory Management Division, 111 MassachusettsAvenue, N.W., 3rd Floor, Suite 3008, Washington, DC20529-2210. OMB No. 1615-0047. Do not mail yourcompleted Form I-9 to this address. Form I-9 (Rev. 08/07/09) Y Page 3
  7. 7. OMB No. 1615-0047; Expires 08/31/12Department of Homeland Security Form I-9, EmploymentU.S. Citizenship and Immigration Services Eligibility VerificationRead instructions carefully before completing this form. The instructions must be available during completion of this form.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOTspecify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have afuture expiration date may also constitute illegal discrimination.Section 1. Employee Information and Verification (To be completed and signed by employee at the time employment begins.)Print Name: Last First Middle Initial Maiden NameAddress (Street Name and Number) Apt. # Date of Birth (month/day/year)City State Zip Code Social Security # I attest, under penalty of perjury, that I am (check one of the following):I am aware that federal law provides for A citizen of the United Statesimprisonment and/or fines for false statements oruse of false documents in connection with the A noncitizen national of the United States (see instructions)completion of this form. A lawful permanent resident (Alien #) An alien authorized to work (Alien # or Admission #) until (expiration date, if applicable - month/day/year)Employees Signature Date (month/day/year)Preparer and/or Translator Certification (To be completed and signed if Section 1 is prepared by a person other than the employee.) I attest, underpenalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct. Preparers/Translators Signature Print Name Address (Street Name and Number, City, State, Zip Code) Date (month/day/year)Section 2. Employer Review and Verification (To be completed and signed by employer. Examine one document from List A ORexamine one document from List B and one from List C, as listed on the reverse of this form, and record the title, number, andexpiration date, if any, of the document(s).) List A OR List B AND List CDocument title:Issuing authority:Document #: Expiration Date (if any):Document #: Expiration Date (if any):CERTIFICATION: I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, thatthe above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on(month/day/year) and that to the best of my knowledge the employee is authorized to work in the United States. (Stateemployment agencies may omit the date the employee began employment.)Signature of Employer or Authorized Representative Print Name TitleBusiness or Organization Name and Address (Street Name and Number, City, State, Zip Code) Date (month/day/year)Section 3. Updating and Reverification (To be completed and signed by employer.)A. New Name (if applicable) B. Date of Rehire (month/day/year) (if applicable)C. If employees previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization. Document Title: Document #: Expiration Date (if any):l attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presenteddocument(s), the document(s) l have examined appear to be genuine and to relate to the individual.Signature of Employer or Authorized Representative Date (month/day/year) Form I-9 (Rev. 08/07/09) Y Page 4
  8. 8. LISTS OF ACCEPTABLE DOCUMENTS All documents must be unexpired LIST A LIST B LIST C Documents that Establish Both Documents that Establish Documents that Establish Identity and Employment Identity Employment Authorization Authorization OR AND1. U.S. Passport or U.S. Passport Card 1. Drivers license or ID card issued by 1. Social Security Account Number a State or outlying possession of the card other than one that specifies United States provided it contains a on the face that the issuance of the photograph or information such as card does not authorize2. Permanent Resident Card or Alien name, date of birth, gender, height, employment in the United States Registration Receipt Card (Form eye color, and address I-551) 2. Certification of Birth Abroad 2. ID card issued by federal, state or issued by the Department of State3. Foreign passport that contains a local government agencies or (Form FS-545) temporary I-551 stamp or temporary entities, provided it contains a I-551 printed notation on a machine- photograph or information such as readable immigrant visa name, date of birth, gender, height, eye color, and address 3. Certification of Report of Birth issued by the Department of State (Form DS-1350)4. Employment Authorization Document 3. School ID card with a photograph that contains a photograph (Form I-766) 4. Voters registration card 4. Original or certified copy of birth certificate issued by a State,5. In the case of a nonimmigrant alien 5. U.S. Military card or draft record county, municipal authority, or authorized to work for a specific territory of the United States employer incident to status, a foreign bearing an official seal 6. Military dependents ID card passport with Form I-94 or Form I-94A bearing the same name as the 7. U.S. Coast Guard Merchant Mariner passport and containing an 5. Native American tribal document Card endorsement of the aliens nonimmigrant status, as long as the 8. Native American tribal document period of endorsement has not yet expired and the proposed 6. U.S. Citizen ID Card (Form I-197) 9. Drivers license issued by a Canadian employment is not in conflict with government authority any restrictions or limitations identified on the form For persons under age 18 who 7. Identification Card for Use of are unable to present a Resident Citizen in the United document listed above: States (Form I-179)6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with 10. School record or report card 8. Employment authorization Form I-94 or Form I-94A indicating document issued by the nonimmigrant admission under the 11. Clinic, doctor, or hospital record Department of Homeland Security Compact of Free Association Between the United States and the FSM or RMI 12. Day-care or nursery school record Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274) Form I-9 (Rev. 08/07/09) Y Page 5
  9. 9. Form W-4 (2011) Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For Form 1040-ES, Estimated Tax for Individuals. Otherwise, you may owe additional tax. If you regular wages, withholding must be based on have pension or annuity income, see Pub. 919 toPurpose. Complete Form W-4 so that your allowances you claimed and may not be a flat find out if you should adjust your withholding onemployer can withhold the correct federal amount or percentage of wages. Form W-4 or W-4P.income tax from your pay. Consider completing a Head of household. Generally, you may claim Two earners or multiple jobs. If you have anew Form W-4 each year and when your head of household filing status on your tax return working spouse or more than one job, figure thepersonal or financial situation changes. only if you are unmarried and pay more than total number of allowances you are entitled toExemption from withholding. If you are exempt, 50% of the costs of keeping up a home for claim on all jobs using worksheets from only onecomplete only lines 1, 2, 3, 4, and 7 and sign yourself and your dependent(s) or other Form W-4. Your withholding usually will be mostthe form to validate it. Your exemption for 2011 qualifying individuals. See Pub. 501, Exemptions, accurate when all allowances are claimed on theexpires February 16, 2012. See Pub. 505, Tax Standard Deduction, and Filing Information, for Form W-4 for the highest paying job and zeroWithholding and Estimated Tax. information. allowances are claimed on the others. See Pub. Tax credits. You can take projected tax credits 919 for details.Note. If another person can claim you as adependent on his or her tax return, you cannot into account in figuring your allowable number of Nonresident alien. If you are a nonresident alien,claim exemption from withholding if your income withholding allowances. Credits for child or see Notice 1392, Supplemental Form W-4exceeds $950 and includes more than $300 of dependent care expenses and the child tax Instructions for Nonresident Aliens, beforeunearned income (for example, interest and credit may be claimed using the Personal completing this form.dividends). Allowances Worksheet below. See Pub. 919, Check your withholding. After your Form W-4 How Do I Adjust My Tax Withholding, for takes effect, use Pub. 919 to see how theBasic instructions. If you are not exempt, information on converting your other credits into amount you are having withheld compares tocomplete the Personal Allowances Worksheet withholding allowances. your projected total tax for 2011. See Pub. 919,below. The worksheets on page 2 further adjustyour withholding allowances based on itemized Nonwage income. If you have a large amount of especially if your earnings exceed $130,000deductions, certain credits, adjustments to nonwage income, such as interest or dividends, (Single) or $180,000 (Married).income, or two-earners/multiple jobs situations. consider making estimated tax payments using Personal Allowances Worksheet (Keep for your records.)A Enter “1” for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . AB Enter “1” if: { • You are single and have only one job; or • You are married, have only one job, and your spouse does not work; or • Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less. . . .} BC 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.) . . . . . . . . . . . . . . CD Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . DE Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . . EF Enter “1” if you have at least $1,900 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.)G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information. • If your total income will be less than $61,000 ($90,000 if married), enter “2” for each eligible child; then less “1” if you have three or more eligible children. • If your total income will be between $61,000 and $84,000 ($90,000 and $119,000 if married), enter “1” for each eligible child plus “1” additional if you have six or more eligible children . . . . . . . . . . . . . . . . . . GH 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 { For accuracy, • If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions complete all and Adjustments Worksheet on page 2. worksheets • If you have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed that apply. $40,000 ($10,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to avoid having too little tax withheld. • If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below. Cut here and give Form W-4 to your employer. Keep the top part for your records. W-4 Employees Withholding Allowance Certificate OMB No. 1545-2159 2011Form ▶ Whether you are entitled to claim a certain number of allowances or exemption from withholding isDepartment of the TreasuryInternal Revenue Service subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS. 1 Type or print your first name and middle initial. Last name 2 Your social security number Home address (number and street or rural route) 3 Single Married Married, but withhold at higher Single rate. Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box. City or town, state, and ZIP code 4 If your last name differs from that shown on your social security card, check here. You must call 1-800-772-1213 for a replacement card. ▶ 5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5 6 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . . 6 $ 7 I claim exemption from withholding for 2011, 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 had no tax liability and • This year I expect a refund of all federal income tax withheld because I expect to have no tax liability. If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . . ▶ 7Under penalties of perjury, I declare that I have examined this certificate and to the best of my knowledge and belief, it is true, correct, and complete.Employee’s signature(This form is not valid unless you sign it.) ▶ Date ▶ 8 Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) 9 Office code (optional) 10 Employer identification number (EIN)For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 10220Q Form W-4 (2011)
  10. 10. Form W-4 (2011) Page 2 Deductions and Adjustments Worksheet Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income. 1 Enter an estimate of your 2011 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state and local taxes, medical expenses in excess of 7.5% of your income, and miscellaneous deductions . . . . . . . . . . . . . . . . . . . . . . . . . 1 $ 2 Enter: {$11,600 if married filing jointly or qualifying widow(er) $8,500 if head of household $5,800 if single or married filing separately } . . . . . . . . . . . 2 $ 3 Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . 3 $ 4 Enter an estimate of your 2011 adjustments to income and any additional standard deduction (see Pub. 919) 4 $ 5 Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to Withholding Allowances for 2011 Form W-4 Worksheet in Pub. 919.) . . . . . . . . . . . 5 $ 6 Enter an estimate of your 2011 nonwage income (such as dividends or interest) . . . . . . . . 6 $ 7 Subtract line 6 from line 5. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . 7 $ 8 Divide the amount on line 7 by $3,700 and enter the result here. Drop any fraction . . . . . . . 8 9 Enter the number from the Personal Allowances Worksheet, line H, page 1 . . . . . . . . . 9 10 Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1 10 Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.) Note. Use this worksheet only if the instructions under line H on page 1 direct you here. 1 Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet) 1 2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than “3” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter “-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . . 3 Note. If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill. 4 Enter the number from line 2 of this worksheet . . . . . . . . . . 4 5 Enter the number from line 1 of this worksheet . . . . . . . . . . 5 6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . . 7 $ 8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . . 8 $ 9 Divide line 8 by the number of pay periods remaining in 2011. For example, divide by 26 if you are paid every two weeks and you complete this form in December 2010. Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck . . . . . . . . 9 $ Table 1 Table 2 Married Filing Jointly All Others Married Filing Jointly All Others If wages from LOWEST Enter on If wages from LOWEST Enter on If wages from HIGHEST Enter on If wages from HIGHEST Enter on paying job are— line 2 above paying job are— line 2 above paying job are— line 7 above paying job are— line 7 above $0 - $5,000 - 0 $0 - $8,000 - 0 $0 - $65,000 $560 $0 - $35,000 $560 5,001 - 12,000 - 1 8,001 - 15,000 - 1 65,001 - 125,000 930 35,001 - 90,000 930 12,001 - 22,000 - 2 15,001 - 25,000 - 2 125,001 - 185,000 1,040 90,001 - 165,000 1,040 22,001 - 25,000 - 3 25,001 - 30,000 - 3 185,001 - 335,000 1,220 165,001 - 370,000 1,220 25,001 - 30,000 - 4 30,001 - 40,000 - 4 335,001 and over 1,300 370,001 and over 1,300 30,001 - 40,000 - 5 40,001 - 50,000 - 5 40,001 - 48,000 - 6 50,001 - 65,000 - 6 48,001 - 55,000 - 7 65,001 - 80,000 - 7 55,001 - 65,000 - 8 80,001 - 95,000 - 8 65,001 - 72,000 - 9 95,001 -120,000 - 9 72,001 - 85,000 - 10 120,001 and over 10 85,001 - 97,000 - 11 97,001 -110,000 - 12 110,001 -120,000 - 13 120,001 -135,000 - 14 135,001 and over 15Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to You are not required to provide the information requested on a form that iscarry out the Internal Revenue laws of the United States. Internal Revenue Code sections subject to the Paperwork Reduction Act unless the form displays a valid OMB3402(f)(2) and 6109 and their regulations require you to provide this information; your employer control number. Books or records relating to a form or its instructions must beuses it to determine your federal income tax withholding. Failure to provide a properly retained as long as their contents may become material in the administration ofcompleted form will result in your being treated as a single person who claims no withholding any Internal Revenue law. Generally, tax returns and return information areallowances; providing fraudulent information may subject you to penalties. Routine uses of this confidential, as required by Code section 6103.information include giving it to the Department of Justice for civil and criminal litigation, to The average time and expenses required to complete and file this form will varycities, states, the District of Columbia, and U.S. commonwealths and possessions for use in depending on individual circumstances. For estimated averages, see theadministering their tax laws; and to the Department of Health and Human Services for use in instructions for your income tax return.the National Directory of New Hires. We may also disclose this information to other countriesunder a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to If you have suggestions for making this form simpler, we would be happy to hearfederal law enforcement and intelligence agencies to combat terrorism. from you. See the instructions for your income tax return.
  11. 11. **PLEASE RETURN TO CONVERGENCE **Name Merchandiser ID NumberEmployment Eligibility Verification SEE I9 FOR COMPLIANT DOCUMENTS TO DEMONSTRATE IDENTIFICATION Compliant I9 Document Compliant I9 Document FORM 1 FORM 2 PLACE HERE PLACE HEREDirect Deposit Information (Optional)I hereby authorize Convergence Marketing to initiate automatic deposits to my account at the financial institution namedbelow. I also authorize Convergence Marketing to make withdrawals from this account in the event that a credit entry ismade in error.Further, I agree not to hold Convergence Marketing responsible for any delay or loss of funds due to incorrect orincomplete information supplied by me or by my financial institution or due to an error on the part of my financialinstitution in depositing funds to my account.This agreement will remain in effect until Convergence Marketing receives a written notice of cancellation of directdeposit for this account. If a new account is to be opened or an existing account reopened, I will submit new directdeposit documentation.Financial Institution Type of AccountRouting Transit Number [ ] CheckingAccount Number [ ] SavingsAuthorized Signature (Primary) Date Please Attach Voided Check or Bank Document Here Direct Deposits will not be complete without a Voided Check or Bank Letter reflecting both the routing an account number. Note: DEPOSIT SLIPS ARE NOT ACCEPTED
  12. 12. **PLEASE RETURN TO CONVERGENCE **Employment Inquiry Release for Background Check and Consumer ReportsIN CONNECTION WITH MY APPLICATION FOR EMPLOYMENT (INCLUDING CONTRACT SERVICES) WITH YOU, I UNDERSTAND THAT INVESTIGATIVEBACKGROUND INQUIRIES ARE TO BE MADE CONCERNING BUT NOT LIMITED TO MY CHARACTER, WORK HABITS, PERFORMANCE, AND EXPERIENCE.I ALSO UNDERSTAND THAT YOU WILL BE REQUESTING THIS INFORMATION FROM FEDERAL, STATE, LOCAL AND PRIVATE AGENCIES. I UNDERSTAND THATTHE INFORMATION REQUESTED WILL INCLUDE BUT NOT BE LIMITED TO MY CRIMINAL HISTORY, DRUG SCREENING, CIVIL COURT HISTORY, MOTOR VEHICLERECORDS, PROFESSIONAL LICENSE CHECK, EDUCATIONAL HISTORY, PREVIOUS EMPLOYMENT, WORKERS COMPENSATION HISTORY, AS WELL AS OTHERREPORTS AND/OR REFERENCES. (BOTH PUBLIC AND PRIVATE).I AUTHORIZE WITHOUT RESERVATION, ANY PARTY, AGENCY OR AGENCY REPRESENTATIVE CONTACTED BY THE BELOW NAMED EMPLOYER TO OBTAIN THEABOVE INFORMATION AND REPORTS.I AUTHORIZE WITHOUT RESERVATION, ANY PARTY, AGENCY OR AGENCY REPRESENTATIVE CONTACTED BY THE BELOW NAMED EMPLOYER, HIS AGENT ORAGENCY REPRESENTATIVE TO FURNISH THE ABOVE MENTIONED INFORMATION AND REPORTS.I HEREBY CONSENT TO YOUR OBTAINING THE ABOVE MENTIONED INFORMATION AND REPORTS THROUGH YOUR AGENT, ACCURATE INFORMATIONSYSTEMS, INC. AND AGREE TO INDEMIFY AND HOLD HARMLESS, YOU OR YOUR AGENT, ACCURATE INFORMATION SYSTEMS, INC., THEIR AGENT OR THEIRAGENCY REPRESENTATIVE FOR RECORD CONTACT, ERRORS OR OMISSIONS[FOR CALIFORNIA EMPLOYEES OR APPLICANTS ONLY: (1) YOUR EMPLOYER SHALL PROVIDE YOU WITH A WRITTEN NOTICE OF THE NATURE AND SCOPE OFANY INVESTIGATIVE CONSUMER REPORT SOUGHT AND A COPY OF CALIFORNIA CIVIL CODE 1786.22; AND (2) IF YOU WOULD LIKE TO RECEIVE A COPY OF ANYREPORT, IF ONE IS OBTAINED, PLEASE CHECK THE BOX AND THE C.R.A. OR YOUR EMPLOYER, WHERE REQUIRED BY STATE LAW, WILL PROVIDE YOU WITH ACOPY OF THE REPORT] ___ [FOR MINNESOTA OR OKLAHOMA APPLICANTS OR EMPLOYEES ONLY, IF YOU WOULD LIKE TO RECEIVE A COPY OF ANY REPORT,IF ONE IS OBTAINED, PLEASE CHECK THIS BOX]___NameOther/Former NamesCurrent Address How Long? Years/MonthsCity State Zip CodePrevious Address How Long? YearsCity State Zip CodeTelephoneSocial Security Date of BirthDrivers License: Province or State NumberProspective Employer Convergence MarketingApplicants Signature DatePerson Requesting Reports (Print) Sign DateDisclaimer and SignatureI certify that my answers are true and complete to the best of my knowledge.I have been informed and understand that Convergence Marketing conduct random background checks for new employees. If thisapplication leads to employment, I understand that false or misleading information in my application or interview may result in myrelease.AT WILL EMPLOYMENT CLAUSE: Employment contract provision indicating that employer or employee may terminate theemployment relationship at any time with or without cause.In consideration of employer entering into this agreement, employee agrees to conform to the policies and rules of employer in effectfrom time to time. Each party to this agreement also agrees that employees employment and compensation can be terminated, withor without cause, and without prior notice, at any time, at the option of either employee or employer.Signature Date
  13. 13. **PLEASE RETURN TO CONVERGENCE** Code of Business ConductName: Merchandiser ID #:All Convergence Marketing employees are expected to perform their jobs to the best of their ability as well as perform them in a safemanner. We each share a common goal to provide merchandising services always on time and with quality. As a ConvergenceMarketing employee, I agree to the following statements as they relate to my work as a Merchandiser.Dress Code: x My appearance will always be clean and professional. x I will always wear closed-toed, rubber-soled shoes. x I will not wear jeans, sweats, or hats while on the job. x I willl always wear appropriate clothing as directed in the dress code.Conduct x I must complete assignments on time. x I must arrive at assigned locations on time. x I will always be courteous and respectful of store employees and customers. x I will never shop while on company time.Reporting Obligations: x It is my responsibility to report assignments online as required within 24 hours of completing an assignment. x It is my responsibility to submit my original recap and payment forms to the Payroll Department the week following in order to be paid for work completed on time and with quality.Harassment Policy x Harassment, including sexual harassment, is a form of discrimination that is specifically prohibited in our harassment policy. Harassment means any conduct, comment, gesture, or conduct related to the prohibited grounds of discrimination: o That is likely to cause offense or humiliation or unfair treatment to any employee or customer; or, o That might reasonably be perceived as placing a “discriminatory” condition on services provided, employment or employment opportunities, such as training or promotions. x Convergence has a zero-tolerance policy for employee harassment. x Professionalism is expected and required at all times.Disciplinary Policy x Merchandiser accounts may be temporarily disabled or an issue may be placed against a merchandiser for unprofessional conduct or failure to follow company policies. x Any issue placed against a merchandiser must first be resolved with the manager or supervisor before completing additional work for Convergence Marketing. x Convergence Marketing is an at-will employer and operates under the provision that employees have the right to resign their position at any time, with or without notice, and with or without cause. We, the employer, have similar rights to terminate the employment relationship at any time, with or without notice or cause.Safety x I should practice good safe work habits and follow all safety mandates, company expectations, and regulations. x I should report all injuries and incidents to my supervisor immediately. If medical attention is necessary, I will go to the doctor first and then contact my supervisor.I have read and understand Convergence Marketing’s Code of Business Conduct.I confirm that I will abide by this Code of Conduct with respect to all matters related to my employment with ConvergenceMarketing.I recognize that while signing this acknowledgment is a condition of continued employment, it does not guarantee my futureemployment or constitute an employment contract. My employment with the Company remains as an “employee at will.”Signature Date
  14. 14. **KEEP FOR YOUR RECORDS **7361A Coca Cola DriveHanover, MD 21076866-249-6128 ext. 5443-688-5083 (fax)Dear Merchandiser,Attached are a Wachovia New Account Form and Wachovia Direct Pay Card Form.If you do not currently have a bank account and would still like to have your check direct deposited, please fill outthe enclosed form and directly send it to Wachovia Bank via fax at 410-576-0695. Please note that this is onlyan application to apply for a bank account or a direct pay card if you do not currently have a bank or would like tochange institutions.Once you have completed the appropriate forms and the process is complete, you will be notified in the mail byWachovia Bank. In this notification you will be provided your new account number and account guidelines. It isthen your responsibility to notify Convergence Marketing of the new account information by completing theappropriate Direct Deposit activation form which can be obtained from your portal and faxing along with a voidedcheck or bank document from your banking facility.Once the Direct Deposit Activation Form and additional documentation has been received by Convergence yourpaycheck would then be transmitted in the form of an electronic transfer to your account beginning the followingpay cycle. Please understand that prior to the completion of activation your wages will be paid in the form of alive check that is directly mailed to your address on record.If you currently have a bank account and would like to use your existing account as a means of direct deposit,please complete the direct deposit section of the application and attach a voided check or bank document fromyour banking facility.If you have any questions, please feel free to contact the Convergence Marketing Payroll Department at (866) 249-6128 extension 5.Thank you,Dawn M. BlackDirector Of Human Resources
  15. 15. **PLEASE RETURN TO WACHOVIA Do Not Return to Convergence Marketing**

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