SALTAIRE SEASONAL EMPLOYEE ANNUAL UPDATE FORM

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Employee Name*

First Last

Primary Department*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Emergency Contact(s)

Please list the names and telephone numbers of up to two individuals you would like us to contact in the event of an emergency:

First Emergency Contact Name*

First Last

First Emergency Contact Cell Phone*

First Emergency Contact Email*

Would you like to add a second emergency contact?

Yes

Second Emergency Contact Name*

First Last

Second Emergency Contact Cell Phone*

Second Emergency Contact Email*

Consent*

By checking this box, employee certifies and affirms that the information provided is accurate and complete, and that I have read and agree to the below employee conditions:

Your employment with the Village of Saltaire is for seasonal/temporary employment only. The start, duration and amount of hours for your seasonal employment is at the discretion of the Department Supervisor based on his/her determination of the best allocation of the available staff to meet the seasonal or temporary needs of the Department; but in no case shall the start date of your employment commence before (i) all annually required applications forms have been submitted and approved by Village Administration, (ii) completion of all annually required PESH training (for which you will be paid 1.5 hours pay for completion regardless of whether you are offered employment) and employee training as approved by Village Administration, and (iii) you have received a confirmed date to start from your Department Supervisor. It is not expected that your seasonal employment will extend beyond September 15 of this year, and your employment could end sooner based on the Department Supervisor’s discretion. Your start of employment this year does not in any way guarantee your employment throughout this season or in any future year.

The Village of Saltaire is committed to a policy of protecting and safeguarding the rights and opportunities of all people to seek, obtain and hold employment without being subjected to harassment or discrimination in the workplace. It is the Village of Saltaire’s policy to provide a workplace environment free from harassment and discriminatory practices.

The Village of Saltaire has adopted and disseminated a Policy Against Discrimination and Harassment, as part of the Handbook. Please sign the below acknowledgement that you have a copy of the Policy, have reviewed it, and have been afforded an opportunity to ask a Municipality Compliance Officer any questions you may have regarding the Policy. If you have any further questions regarding this Policy, feel free to contact the Village Administrator.

Your employment with the Village is predicated on your compliance with the policies in the Saltaire Employee Handbook. You may request a hard copy of these documents at any time from your Department Supervisor or the Village Administration. Read them carefully and completely. Policies included in this Handbook and SOGs are subject to unilateral change by the Village from time to time. Such changes will be in writing issued by the Village.

ACKNOWLEDGEMENTS OF RECEIPT OF MUNICIPALITY’S POLICY AGAINST DISCRIMINATION AND HARASSMENT AND RECEIPT OF THE SALTAIRE EMPLOYEE HANDBOOK

I have received the Municipality’s Policy Against Discrimination and Harassment. I have reviewed this Policy, and I have had the opportunity to ask questions regarding the Policy.

By signing below, I acknowledge and attest that I have successfully opened the link to the Employee Handbook herein, or have received a hard copy. I also acknowledge that I have been advised that I have the opportunity to join the NY State Retirement System at any time, even if I have previously declined, by contacting the Village office.

If the potential employee is under the age of 18 at the time of execution of this document, a parent or legal guardian MUST also sign the Acknowledgment in addition to the Applicant.

Initials*

Date*

Signature*

Is the employee under the age of 18?*

Yes

Please select one of the following:

The employee is a New York State Resident (please upload current NY State Working Papers below).

The employee is Not a New York State resident, and understands that they cannot work until they submit current working papers from New York State.

Please upload current NY State Working Papers.*

Accepted file types: jpg, gif, png, pdf, jpeg, doc, docx, Max. file size: 50 MB.

Parent / Guardian Initials*

Date*

Signature of Parent / Guardian*

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Comments

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Saltaire Seasonal Employee Annual Update Form

Emergency Contact(s)

Contact
Village of Saltaire

Village Office:

Public Safety:

Fax:

Email:

Address: