ICE Employment Application

New Hire Package
Employee Information
Name*

Last NameFirst Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
E-mail
Date Available
Desired Salary
Are you a Citizen of the United States?*

YesNo
If no, are you authorized to work in the U.S.?

YesNo
Have you ever worked for this Company?*

YesNo
Have you ever been convicted of a felony?*

YesNo

Education
High School
Please identify when attended, did you complete this level of education any degree(s) earned.
College
Please identify when attended, did you complete this level of education any degree(s) earned.
Other / Trade School
Please identify when attended, did you complete this level of education any degree(s) earned.

References

Please list three professional references
Professional Reference 1
You must include their Full Name, Relationship, Company, Phone Number, and Address
Professional Reference 2
You must include their Full Name, Relationship, Company, Phone Number, and Address
Professional Reference 3
You must include their Full Name, Relationship, Company, Phone Number, and Address

Previous Employment
Company
You must include the Company Name, Phone Number, Address, Supervisor's Name, Your Job Title, Starting Salary, Ending Salary, Start Date, End Date and Reason for Leaving
May we contact your previous supervisor for a reference?

YesNo
Company
You must include the Company Name, Phone Number, Address, Supervisor's Name, Your Job Title, Starting Salary, Ending Salary, Start Date, End Date and Reason for Leaving
May we contact your previous supervisor for a reference?

YesNo
Company
You must include the Company Name, Phone Number, Address, Supervisor's Name, Your Job Title, Starting Salary, Ending Salary, Start Date, End Date and Reason for Leaving
May we contact your previous supervisor for a reference?

YesNo

Military Service
Branch
From To
Rank at Discharge
Type of Discharge
If other than Honorable, explain

Disclaimer and Signature
I hereby certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature*

Clear

Please review the following IRS Form W-4 (2017) and provide the necessary information as itemized in the fields below.
1. Name*
First, Middle Initial, and Last Name
1. Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
2. Social Security Number*
3.*

SingleMarriedMarried, but withhold at higher Single rate.
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)
6.
Additional amount, if any, you want withheld from each paycheck
7.
I claim exemption from withholding for 2017, 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
Under 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*

Clear
Date*

Please review the following USCIS Form I-9 and provide the necessary information as itemized in the fields below.
Section 1. Employee Information and Attestation*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
Social Security Number*
E-Mail Address
Phone Number

Area CodePhone Number
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am (check one of the following boxes):
1. A citizen of the United States
2. A noncitizen national of the United States (see instructions)
3. A lawful permanent resident
Alien Registration Number / USCIS Number:
4. An alien authorized to work until
(expiration date, if applicable, mm/dd/yyy):
1. Alien Registration Number / USCIS Number:
2. Form I-94 Admission Number:
3. Foreign Passport Number:
Country of Issuance
List A - Documents that Establish Both Identity and Employment Authorization

Upload a File
Please upload a copy or photo of one of the following documents: 1. U.S. Passport or U.S. Passport Card, 2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551), 3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa, 4. Employment Authorization Document that contains a photograph (Form I-766), 5. For a nonimmigrant alien authorized to work for a specific employer because of his or her status: a. Foreign passport; and b. Form I-94 or Form I-94A that has the following: (1) The same name as the passport; and (2) An endorsement of the alien's nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form, 6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI Cancelof
OR
List B - Documents that Establish Identity

Upload a File
Please upload a copy or photo of one of the following documents: 1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address, 2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address, 3. School ID card with a photograph, 4. Voter's registration card, 5. U.S. Military card or draft record, 6. Military dependent's ID card, 7. U.S. Coast Guard Merchant Mariner Card, 8. Native American tribal document, 9. Driver's license issued by a Canadian government authority, Cancelof
AND
List C - Documents that Establish Employment Authorization

Upload a File
Please upload a copy or photo of one of the following documents: 1. A Social Security Account Number card, unless the card includes one of the following restrictions: (1) NOT VALID FOR EMPLOYMENT (2) VALID FOR WORK ONLY WITH INS AUTHORIZATION (3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION, 2. Certification of Birth Abroad issued by the Department of State (Form FS-545), 3. Certification of Report of Birth issued by the Department of State (Form DS-1350), 4. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal, 5. Native American tribal document, 6. U.S. Citizen ID Card (Form I-197), 7. Identification Card for Use of Resident Citizen in the United States (Form I-179), 8. Employment authorization document issued by the Department of Homeland Security Cancelof
Signature of Employee*

Clear
Date*

Inland Construction and Engineering, Inc. has the capability to email your pay stub each week.

The email supplied on your application can be used or you may provide an additional email address for your pay stub to be delivered.
Name
Email Address
Approval to Send Pay Stub by Email

Clear
If you provide your eamil address for your pay stubs, the following is your personal ID to open up the email and view your pay stub:

First Four alphabetic characters of your last name (in lowercase) followed by the Last Four digits of your Social Security Number.

Thanks,

Finance Manager

icefinance@hotmail.com

To All Inland Employees:

All Inland Construction and Engineering employees are required to have thier check direct deposited or mailed via regular USPS. If you choose to have your check mailed, it will be sent to the address provided that is printed on your check or check stub. If you need that address changed, you must do so 3 business days prior to the work week (Monday). It is against policy to pick up checks here at the office, and please remeber pay day is Wednesday.

Thanks,

Office Administration
Please choose your method of receipt*

Inland Construction and Engineering, Inc.

DIRECT DEPOSIT AUTHORIZATION

This authorizes Inland Construction and Engineering, Inc. (the "Company") to send credit entires (and) appropriate debit and adjustment entries, electronically or by any other commercially accepted method, to my (our) account(s) indicated below and to other accounts I (we) identify in the future (the "Account"). This authorizes the financial institution holding the Account to post all such entries.
Account Type
(Checking or Savings)
Employee Bank Name
Account Number
Routing Number
This authorization will be in effect until the Company receives a written termination notice from myself and has a reasonable opportunity to act on thee request for termination.
Employee Name

First NameLast Name
Employee Signature*

Clear
Date*

INLAND CONSTRUCTION AND ENGINEERING, INC.

DRUG-FREE-WORKPLACE POLICY ACKNOWLEDGEMENT

I hereby acknowledge that I have rec ived and read this Drug-Free Workplace Policy, a summary of the drugs which may alter or affect a drug test and a list oflocal Employee Assistance Programs and drug and alcohol treatment programs. I have had an opportunity to have all aspects of this material fully explained. I also understand that I must abide by the policy as a condition of initial and/or continued employment, and any violation may result in disciplinary action up to an including discharge.

Further, I understand that during my employment I may be required to submit to testing for the presence of drugs or alcohol. I understand that submission to such testing is a condition of employment with the Company and disciplinary action up to and including discharge-may result if:

1) I refuse to consent to such testing

2) I refuse to execute all forms of consent and release of liability as are usually and reasonably attendant to such examinations

3) I refuse to authorize release of the test.results to the Company

4) The tests establish a violation of the Company's Drug-Free Workplace Policy

5) I otherwise violate the policy.

I also understand that if I am injured in the course and scope of my employment and test positive or refuse to be tested, I forfeit my eligibility for medical and indemnity benefits und r the Workers' Compensation Act upon exhaustion of the remedies provided in Florida Statute 440.102(5).

I ALSO UNDERSTAND THAT THE DRUG-FREE WORKPLACE POLICY AND RELATED DOCUMENTS ARE NOT INTENDED TO CONSTITUTE A CONTRACT BETWEEN THE COMPANY AND ME.

THE UNDERSIGNED FURTHER STATES THAT HE OR SHE HAS READ THE FOREGOING ACKNOWLEDGEMENT AND KNOWS THE CONTENTS THEREOF AND SIGNS THE SAME OF HIS OR HER OWN FREE WILL.
Signature*

Clear
Date*

INLAND CONSTRUCTION AND ENGINEERING, INC.

Team Member Emergency Contact Form

In the event of an emergency, it is very important that we contact the right person. Please fill out the following information and return to your direct supervisor as soon as possible. All information will be kept confidential by our Personnel Management Team.
Employee Name:

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number

Area CodePhone Number
Mobile (Cell) Phone Number

Area CodePhone Number
ICE Supervisor
IN CASE OF EMERGENCY PLEASE CONTACT:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number

Area CodePhone Number
Mobile (Cell) Phone Number

Area CodePhone Number
Relationship to Employee

INLAND CONSTRUCTION AND ENGINEERING, INC.

NOTICE OF INTENT TO OBTAIN A DRIVING RECORD

In connection with your employment/ application for employment (circle one), we would like to procure certain background information concerning your driving record.

Before we proceed, we ask for your authorization in writing. You have a right to decline authorization, but you cannot drive any company vehicle on company business unless your record is checked and approved.

RELEASE TO OBTAIN A DRIVING RECORD

I have read the "Notice of lntent to Obtain a Driving Record" above.

I understand that I have the right to decline authorization for Inland Construction & Equipment, Inc., to obtain my driving record.

I understand that this authorization will remain in effect for the entire length of my employment.
Understanding my rights,*

I authorize Inland Construction & Engineering, Inc. to obtain my driving record.I do not authorize Inland Construction & Engineering, Inc. to obtain my driving record.
Name:*
Signature*

Clear
Date:*
Attach a Copy of Driver's License

Upload a File
Please upload a copy or photo of your driver's license Cancelof

This completes the New Hire Package.

Please review the following check list and ensure that all required information has been provided.
Application completely filled and signedApplicant Social Security Card and Color copy of Driver's LicenseW-4 Form filled out and signedI-9 Form filled out and signedAuthorization for Direct Deposit filled out and signedDrug Policy Statement read, signed, and datedTeam member Emergency Contact Form filled outUse of Company Vehicle Disclaimer / Policy read and signed
Please provide any additional information that was not disclosed in the New Hire Package
Please provide any additional documents that were not disclosed in the New Hire Package

Upload a File

Cancelof
Should be Empty:

New Hire Package

Employee Information

Education

References

Previous Employment

Military Service

Disclaimer and Signature