iat c lamer Company name: Prone ea (apeeabey —_ Fa Sire TRADjEN Oy. Stare, 2p. Website: ‘Workers Comp (WC) Provider WC Policy We agree to provide proof of worker's compensation insurance (or exemption from requirement) and busines icense as part of the vetting and approval process. Soc ee _toevs onan fo Dy go ersng gong none at eeereekeae Worksite address #ameerttromaboe) Street iy — State: Zp Nearest majr city Distance to nearest major Cty. “Tora numberof international students a this location: Total number ofa emplayees at this locaton: “Wich other J sponsor companies are you using 1 provide seasonal help? (Offer made to Guser rare _ (ates of employment (Soni: Mamremf aw) mont Frome Te ‘DiWe have previously employed this Exchange Visor. Name of Previous Spenser peeeatenns et a Supervisors phone: Supersisor§ ema (Of-season phone: WOBINFORMATION woe Li ‘Student job ite - ‘tsa seasonal postion? yes CINe Please describe the seasonal racure ofthis position: Estates weekly wage chide toe: Ian endotseason bonus avaiable? Clver CINo “yes please provide deta i “Overtime require? ves CNa Overtine awatabe? Ces CINo ‘Overtime wage pet hove rage per hour ct peter tan Feder) Wage pay schedule; Clweekly CBrweeidy CiMonhiy. “are meas provided ding shit? (les CINo Cost to student for mea? Cives CINo Estimated cost of meal: ‘Additional Wage Provisions/Deductions: Kenly ary training costs, equipment or uniform fees, or addional paycheck deductions. ‘Supplies required: Ident any uniforms, supplies or equipment the student must supply. ‘What opportunities wil the participant have to experience US. culture local or through the workpiace? eel Who Provides Housing? CJEmpleyer_ClParicpant 7 ieerrtional Representative (Rep nas: Housing address Cost of housing per weelc ‘Estimated cont of vblities Housing deposit Ishousing urisnec ves ONO How many people share a room? Distance from job ste ‘Cos of transportation Estimated comme tore Whoveng rot prone, wil yeu ist particpant in fecng howe? Clves No (Other housng recommendations: Destancefromjooste Estenaced cost of Rousing Estimated Cort of trniportation: Parc COUN, Knocjer (ab aon panes 208WORK & TRAVEL USA Clee ays. OTH nla a wae Mintee 2019 ‘The understad tmployer agrees tothe fllewing conditions: + Laman authored, ey named on Ieransterzed armen fe company named on docament wth hor > Yt peed ua omer ofthe CEE Wor rae UA US Bparmet of Stare makers or Program nah re popes o> oe poger ures te alavea oreprarucent tnd sarang [unk Spiny gant of Re ones Boe _ ~ ee 23 We understand hat the 41 Exchange Vitor Progr tended o provide educational iepdcuturaleachanges and nase ro promt least Oe coturd ectonge soporte ‘ayo participants Stour canon ts each np set, he vaadnersto a iors that govern “4 Wen avers to apc ceptor erovtor that Rover tha prog anda 55 We warrant thatthe relation vp between the employer and student wi comply with Federal State ard acl ama repr erg ergioyner and @copaterss Peat and ae 1 Lunaersand tht fecal sattes soc 2 TeV ofthe Cha Rights Act ovo, te Ivvmigration etorm Act ef be andthe forngraion ard Maton Ace exe a4 Uigerurir ote seauces provtn acrminitin Marne forgn ntonas "THE ears ttn tly exerts legal or a employer a fra agonson sch GREE To engage naschmvnaton fated on Matera np Eender rae, reopon ee 17. The salary and ether terms of employment medto exceed sl federa ate, and oes igen wage and over egurements an omy romeo, arcane ththore oPaur US empiyees 18 Tha partiipant wilbe ‘s Insurance or were Prazargegn io comely verter Conpeaton cere ‘9 Ths participant ill bean empoyee, not anindependent contractor. Ye tuncestand tat undertae a period! of no more ran tps artcioares may period o!erhoymert Be ee eee are Lou acento eee satis summa aecanrana merrier a 1. Lundertane that hong lor ntieaoralpestions incoreatent wath he 15 Were uty esned ie terms employment andjeb dette ots parcpant 16 Lunde Departrert of Sate reuies CEE to veto potent © reer hl cvogaros the 2 SStmar woe isee agra PT 17 We understand that hig ob ofr eno ut vetted nd appre JOE, andthe chou wet oppor mn een awa ga meee eee emer " flere ine buses tse se put evetne oe wepre poem nine er ete nacre we roe nee pote oe ” hac tee tee act ete ee RCT LS woe See reer im acters yw tn och cat of He ae aoe Harem ea eecens meee y Gecuctonser changes nSeducbons a 1 een on ce eyo none srecie ions a sleet fe ts er ee Mier ountios cgittiarem plspehieon neat cbyiee acon, naps orl tt peter ha ee ce re acters ed ec etna ny suaon tat impacts the were of par pane 24 The ob re are offerings ntlited as probted by CEE in ve ok deta elow-— Tipline ie orfounner epioreryworttraveonarepetiors 2% We andrea ta the det al apy oan cts Sc Seiya {htmoy nor be nae te art Sergoyrere: Te DSor9 Ferman 94 card {opethet il ur ot pa! of thor nico Sor re trom tere gene er ean pee beet eccrine ee ee nee es re ene aetna ae fajemiar renee oll ee 1 derstand ta ware otro empl J Sure Wok Teta Fee toe eae a fknarcceerlsnmonctiares Gragteccearamts, Werlarralyenf ia ete remap oy cee ome iy nat eee een eee ema prea ae Se Se streetscene onan pty nae ete Name of person completing this form: Title: Date Gone: ONSS525C eee Man LE Heme: Olga Yelania Sanchez. Chawe> ‘tas ID: Email addre — yelasanchaves:N@ginailom CIEE Representative: “TERMS AND CONDITIONS Desert rid dagen Os eo 2 Racy nemnaeuneit orsyeenrea RE sare ep ce iicactcertes eat onlecsaegintats Suc eetocpopee a yer cel ng Terra nd bc ye re rpereepagionote ott rniycotot > tecee coe cere ce OSS eater rey pen + aang re aA rare open pep repent aoe ee eC TE nse may be terminated a ny tera above Ihave rene a fornston retest th Ose ee .eS mat oe erpoyer cee ade CHE Repesetabe understand tha: nether the erp ror CIEE can guarantee te term oft agree ye “nent and that my hours, duties, and housing are subject to change. Participants vst: €lee.orgfin-the-usa/work/work-travelusa Participants cal, 1+889-COUNCIL Brone: AS0u) BIAGGF76 Country of residence: Costa Ri ll reper tothe employer ated ove win five ds mart inthe Une 9 Vn workout of he dates ted ony BS-2019 form. ‘o.twlladere tal CEE and OE Represenatve res seep. uricpstion casing the fervs ond Cones fan reg ionarscbar ee Fo part fy this place of enpioynent for rank reccea peo or 12, Should | change obs without cecening rig ae such termina recveghire hone erminaton may prevent me rem recov ne US. i {ermiration may prevet me fom retevang ture US vase eee ore eccaeena Frere fate oaeecsenprmera ars pee at eee Ucenaaceatraedtia et egret noe Signature: eh Employers vst: daw.org/partner/employers/worketravebusa, Employers cal: 1-066-609-CIEE Updated: 25/18 20f2