Personal Information

First name

Last name

Address

SSN or Gov ID

Phone

Marital Status

Married

Single

Divorced

Emergency Contact

First Name

Last Name

Address

Contact Number

Relationship

Federal Tax Information

Are you a non resident alien?

Yes

Selecting Yes will result in selecting a marital status of Single or Married filing separately regardless of actual marital status.

Notice: Nonresident aliens may be exempt from wage withholding on part or all of their compensation for dependent personal services under

an income tax treaty. If you are claiming a tax treaty withholding exemption, do not complete Form W-4. Instead, complete Form 8233,

“Exemption from Withholding on Compensation for Independent (and Certain Dependent) Personal Services of a Nonresident Alien Individual”

https://www.irs.gov/pub/irs-pdf/f8233.pdf , and give it to each withholding agent from whom amounts will be received.

Are you Exempt from 2024 withholding?

Yes, I am exempt from 2024 withholding.

No, I am NOT exempt from 2024 withholding and want to complete the below 2024 Form W-4.

To be exempt, you must meet the following requirements:

• For 2023, you had no federal income tax liability; AND

• For 2024, you expect to have no federal income tax liability.

If you claim exemption, you will have no income tax withheld from your paycheck and may owe taxes and penalties when you file your tax

Select a filing status:

Single or Married filing separately

Married filing jointly or qualifying surviving spouse.

Head of Household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual)

Additional Applicant Information

Do you have any relatives/friends that work here? If Yes, please list their name below.

What date would you like to start?

If hired, are you able to prove legal eligibility for employment in the US without restriction?

Yes

Will you now or in the future require Leading Edge Scaffold to file a petition or application for employment-based visa status on your behalf to begin or continue employment with our company?

Yes

Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?

Yes

List any skills that may be useful for the job you are seeking. Enter the number of years of experience.

Employment History

Employer

Supervisor

Address

Duties

Reason for Leaving

Employment Dates

Employer

Supervisor

Address

Duties

Employment Dates

Equal Employment Opportunity Questionnaire

Were an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

lease note that answering these questions is voluntary:

Disability:

I have a disability and would like to be considered under the affirmative action program.

I do not have a disability or would not like to be considered under the affirmative action program.

Decline to Specify

Ethnicity

Hispanic or Latino

Other

Decline to Specify

Applicant Certification

I certify that the information provided on this application is truthful and accurate. I understand that

providing false or misleading information will be the basis for rejection of my application, or ifemployment commences, immediate termination

If an employment relationship is created, I understand that unless I am offered a specific writtencontract of employment signed on behalf of the organization by its President, the employment

relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature,and either I or my employer will be able to terminate the employment relationship at any time and

without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will

have the right. Moreover, no agent, representative, or employee of Leading Edge Scaffold, Inc., except in a specific written contract of employment signed on behalf of the organization by its

President, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

Signature

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Date