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Policy Notification Change (effective 6/1/09)
You will be service charged $45.00 for a pre-employment Concentra physical required for certain job
assignments. If you self-terminate and/or get terminated within 365 days of employment, you can assume it will
be taken out of your last payroll check and/or sent to a collection agency to obtain the wrongful charges to
Ankeny Temporary Services account.
After (90) days of employment with Ankeny Temporary Services, you are eligible for advancement of Casey’s
gas cards of $25.00 with a $5.00 Misc service charge that can be taken out of your check. FYI: Need a 3 day
advance notification in order to purchase the card.
Anyone that is given uniforms in the event of working on a job assignment and you are terminated or you self
terminate. Ankeny Temporary Services will hold your last check until the items belonging to the client is
obtained. Your check will be cancelled and the uniform amount will be deleted from your gross payroll check,
once ATS receives this it will be certified mailed with a return receipt.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENTS
I certify that I have read, fully understand and accept all terms of the forgoing statements written above.
Signature of Employee:
________________________________________________________Date:_____________
___________________________
Street Address § Address 2 § Phone: 555.555.0125 § E-mail address