Employee Check Sign Off – Provide Staff

Name*

First Last

Phone*

Last 4 of Social Security Number*

Do you have a gate card?*

Never had one
No, I returned it
Still have one

Do you have a vest?*

Never had one
No, I returned it
Still have one

Do you have any company property?*

YES
NO

Yes, I have company property

If yes was selected, please list what you have.

Are you available for work?*

YES
NO

No, I'm not available for work

If no, please list why in this field.

Authorization

By signing below, you are saying that all of the above information is accurate and you are picking up YOUR check.

Also, you are aware that you have 14 days to make Provide Staffing Services, LLC, aware that there are any corrections that need to be made to the check or direct deposit stub you are receiving on today's date.

Signature*

Date*

Comments

This field is for validation purposes and should be left unchanged.