Clean Slate Houston | Document Center

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🎖️ Veteran Candidate Portal 🏢 Employer Registration Portal

This document center is for Clean Slate Houston staff only. Enter your access PIN to continue.

Need access? Contact Deirdre · 832-488-5765

🔍

Background Check Authorization

Required · All Candidates

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Required by Law: This authorization is required under the Fair Credit Reporting Act (FCRA) before any background check may be conducted. A separate disclosure document will be provided.

Candidate Information

Full Legal Name

Date of Birth

Social Security Number (last 4)

Driver's License Number & State

Current Address

Previous Addresses (last 7 years)

Previous Address 1

Dates Lived There

Previous Address 2

Dates Lived There

Authorization

I hereby authorize Clean Slate Houston / D&D Maintenance, Inc. and its designated agents to obtain a consumer report and/or investigative consumer report for employment purposes including verification of education, employment history, criminal records, driving records, and references. This authorization shall remain on file and serve as authorization for future reports.

Candidate Signature

Date

⚙️

Candidate Skills Assessment

Completed by Clean Slate Staff

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Candidate Name

Assessment Date

Assessed By

Assessment Method

Skills Rating (1 = No Experience · 5 = Expert)

Skill Area	Rating (1–5)	Notes
General Maintenance
Painting & Finishing
Carpentry / Drywall
Janitorial / Cleaning
General Labor / Lifting
Tools & Equipment
Communication / Reliability

Overall Recommendation

Assessor Notes

Assessor Signature

Date

🏢

Employer Registration Form

Required · New Clients

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Company Information

Company Name

Industry / Trade

Primary Contact Name

Title / Role

Phone

Business Address

Federal EIN / Tax ID

Number of Employees

Staffing Needs

Typical Number of Workers Needed

Assignment Type

Describe Your Typical Job Duties

WOTC Tax Credit Interest

Yes — I want to learn about WOTC tax credits for hiring veterans (up to $9,600/hire)

My company already participates in WOTC

Authorized Signature

Date

📄

Staffing Services Agreement

Required · Before First Placement

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This agreement governs all placements between Clean Slate Houston (a division of D&D Maintenance, Inc.) and the employer client. Complete once and keep on file.

Client Company Name

Agreement Date

Bill Rate & Markup Structure

Trade / Position Type	Worker Pay Rate ($/hr)	Client Bill Rate ($/hr)
General Labor
Janitorial / Cleaning
Maintenance Technician
Painter / Finisher
Carpenter / Drywall

Key Terms

Client supervises all placed workers on-site (Model 1 staffing)

Clean Slate handles all payroll, taxes, and workers' comp

Client invoiced weekly based on hours worked

Minimum 4-hour billing per worker per day

Temp-to-hire conversion fee: 18% of first-year salary applies

Payment terms: Net 14 days from invoice date

Special Terms / Notes

Signatures

Clean Slate Houston / D&D Maintenance, Inc.

Deirdre Gilbert, Owner

Date

Client Company Authorized Representative

Name & Title

Date

📝

Job Order / Staffing Request

Submit Per Opening

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Company Name

Date Needed By

Contact Name

Contact Phone

Job Site Address

Number of Workers

Position / Trade Type

Shift / Hours

Assignment Duration

Agreed Bill Rate

Specific Requirements / Notes

✅

Placement Confirmation Sheet

Completed Per Placement

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Placement ID #

Placement Date

Placed By

Veteran Worker

Veteran Name

Phone

Trade / Position

Pay Rate ($/hr)

Employer Client

Company Name

Site Supervisor

Job Site Address

Bill Rate ($/hr)

Assignment Start Date

Expected End Date

Shift Hours

Assignment Type

Veteran Acknowledgment

I understand the terms of this assignment including the work site, hours, pay rate, and expected conduct. I agree to notify Clean Slate Houston immediately if there are any issues at the job site.

Veteran Signature

Date

🕐

Weekly Timesheet

Submitted Weekly by Worker

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Worker Name

Week Ending

Client Company

Job Site

Day	Date	Time In	Time Out	Lunch (hrs)	Total Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
TOTAL

Signatures

Worker Signature

Date

Client Supervisor Signature

Date

📞

30-Day Placement Follow-Up

Completed by Clean Slate Staff

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Veteran Name

Client Company

Follow-Up Date

Contacted By

Veteran Check-In

Still Active on Assignment?

Veteran Satisfaction (1–5)

Veteran Comments / Issues Noted

Employer Check-In

Employer Satisfaction (1–5)

Likelihood of Continued Use

Employer Comments

Staff Action Items

📊

Weekly Placement Activity Log

Internal Tracking

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Week Of

Prepared By

Veteran Name	Employer	Trade	Hours This Week	Bill Rate	Revenue	Status

Total Active Placements

Total Hours Billed

Total Weekly Revenue

📑

W-4 Federal Tax Withholding

Required · All New Hires · Federal

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Note: The official IRS W-4 form must also be completed. This is a collection record only. Direct employees to irs.gov/pub/irs-pdf/fw4.pdf for the official form.

Employee Information

Full Legal Name

Social Security Number (last 4)

Address

Filing Status

Additional Withholding Per Pay Period

Claim Exemption from Withholding?

Employee Certification: Under penalties of perjury, I declare that this certificate is correct and accurate to the best of my knowledge.

Employee Signature

Date

🤠

Texas New Hire Report

Required · Texas Law · Within 20 Days of Hire

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Texas Requirement: Texas employers must report all new hires to the Texas Employer New Hire Reporting Operations Center within 20 calendar days of the hire date. Report online at newhire.twc.state.tx.us or use this record to prepare the report.

Employer Information

Employer Name

Federal EIN

Employer Address

Employer Phone

Employee (New Hire) Information

Employee First Name

Employee Last Name

Social Security Number

Date of Birth

Employee Address

First Day of Work (Hire Date)

State of Hire

Salary / Wage

🪪

I-9 Employment Eligibility Verification

Required · Federal Law · All New Hires

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Federal Requirement: All U.S. employers must verify identity and employment authorization for every new hire. The official USCIS Form I-9 must be completed — this is a tracking record. Official form: uscis.gov/i-9

Section 1 — Employee Information (Completed by Employee on First Day)

Last Name

First Name

Middle Initial

Date of Birth

Social Security Number

Email Address

Address (Street, City, State, ZIP)

Attestation — I am (select one)

Employee Signature

Date

Section 2 — Employer Review (Completed by Employer Within 3 Business Days)

Document Title (List A)

Issuing Authority

Document Number

Expiration Date

— OR — Document Title (List B)

Document Title (List C)

First Day of Employment

Employer / Authorized Rep Name

Employer / Authorized Rep Signature

Date

🏦

Direct Deposit Authorization

Recommended · Payroll Setup

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Employee Information

Employee Full Name

Start Date

Banking Information

Bank Name

Account Type

Routing Number (9 digits)

Account Number

I authorize D&D Maintenance, Inc. / Clean Slate Houston to initiate credit entries to my account. I understand this authorization will remain in effect until I notify payroll in writing to cancel.

Employee Signature

Date

🚨

Emergency Contact & Personal Information

Required · All New Hires

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Employee Information

Full Name

Phone

Address

Date of Birth

Emergency Contact 1

Name

Relationship

Phone (Primary)

Phone (Secondary)

Emergency Contact 2

Name

Relationship

Phone

Address

📖

Employee Policies Acknowledgment

Required · All New Hires

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Employee Name

Position / Trade

Start Date

Assigned Client / Job Site

I Acknowledge and Agree to the Following

I have received and reviewed the Clean Slate Houston employee policies

I understand my pay rate, pay schedule, and that D&D Maintenance is my employer of record

I understand I am supervised by the client employer on-site but employed by D&D Maintenance

I will submit accurate weekly timesheets signed by my site supervisor

I will notify Clean Slate Houston immediately of any workplace injury or safety concern

I understand that falsifying timesheets is grounds for immediate termination

I will conduct myself professionally and represent D&D Maintenance with integrity at all times

I understand that workers' compensation coverage is provided and I must report any injury same day

At-Will Employment (Texas): Employment with D&D Maintenance, Inc. is at-will, meaning either party may end the employment relationship at any time, with or without cause, and with or without notice, consistent with Texas law.

Employee Signature

Date

D&D Representative Signature

Date

💰

Employer Invoice

Generate Per Billing Period

▼

Bill From

Clean Slate Houston
A Division of D&D Maintenance, Inc.
Houston, TX
Phone: 832-488-5765
Email: ddmaintenance1988@gmail.com
Website: danddmaintenance.org

Invoice Details

Invoice #

Invoice Date

Billing Period Start

Billing Period End

Payment Due Date

Bill To (Client Employer)

Company Name

Attention / Contact Name

Address

Services Rendered

Worker Name	Trade / Position	Hours	Bill Rate ($/hr)	Subtotal
				$0.00
				$0.00
				$0.00
				$0.00
				$0.00

Subtotal$0.00

Tax (0% — services)$0.00

Total Due$0.00

Payment Instructions

Payment Terms: Net 14 Days
Make checks payable to: D&D Maintenance, Inc.
Questions: 832-488-5765 · ddmaintenance1988@gmail.com
Late payments may be subject to a 1.5% monthly service charge.

Notes / Additional Information

Staff Access Only

Staffing Division Document Center