new hire forms checklist

Last Updated 10/27/2020

NEW HIRE FORMS CHECKLIST

Welcome to Arizona Public Service. The following checklist is provided to guide you through your New Hire forms. Please follow the instructions below. Return this completed checklist

and all required forms to your Talent Acquisition representative.

Complete and return the following information and forms immediately:

Read and retain - no action required:

Name:

Voluntary Self ID

Notice of Wage Withholding – Child Support* (AZ Only)- Attached Separately

Voluntary Self ID of Disability

Voluntary Veteran Self ID

Applicant Information Page

Authorization to Release SSN- Attached Separately (Requires Wet Signature)

Contract Labor DocumentationAPS Non-Disclosure Agreement

If married, date of marriage:

Marital Status:

Signed Offer Letter- Attached Separately

FCRA Background Authorization- Attached Separately

I-9 Employment Eligibility Verification- Attached Separately

EEO/AA Policy Statement Employee Rights and Responsibilities under FMLA New Health Insurance Marketplace Coverage OptionsUSERRA The Fair Wages and Healthy Families Act

••••

•

In order to provide you with the correct benefit options, please identify your marital status:

DATE FROM TO COUNTY CITY STATE

APPLICANT INFORMATIONAN AFFIRMATIVE ACTION AND EQUAL OPPORTUNITY EMPLOYER

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color,

religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

APPLICANT: PLEASE FILL OUT THE APPLICATION COMPLETELY.

PROVIDE THE DATES (MONTH AND YEAR), COUNTIES, CITIES & STATES LIVED IN DURING THE PAST 7 YEARS

HIGHEST LEVEL OF EDUCATION COMPLETED (please select one of the below)

Not Indicated Less than HS Graduate HS Graduate or Equivalent Some College Technical School 2yr College degree

Bachelors Degree Some Graduate School Masters Degree Doctorate (Academic) Doctorate (Professional) Post Doctorate

SCHOOL NAME/CITY/STATE COURSE OF STUDY

DATES ATTENDED (TO/FROM)

YEAR GRADUATED

DEGREE, DIPLOMA, CERTIFICATION

High School or GED

College

College

Other

Have you ever worked for PNW or a subsidiary before? if YES, please list position and company and dates worked below.

Positions held:

Are you at least 18 years of age?

Have you ever been convicted of a felony or misdemeanor? You are not required to disclose expunged records.

If YES, explanation of conviction:

Do you have a valid Drivers License?

Email Address

First Name Middle Initial Last Name

Other name(s) used (i.e., maiden)

Home Address City

State Zip Code Cell Phone

Yes No

Yes No (Date)

Yes No Yes No

LIST ALL THE STATES YOU HAVE HELD A MOTOR VEHICLE OPERATORS LICENSE OR PERMIT DURING THE PAST 39 MONTHS LICENSE NUMBERSTATE EXPIRATION DATELICENSE NUMBER

LIST MOST RECENT EMPLOYER FIRST (NEED 3 YEARS EXPERIENCE)

May we contact your present employer?

JOB TITLE SUPERVISORS NAME/TITLE SUPERVISORS PHONE TO-FROM (MO/YR)

NAME & ADDRESS OF EMPLOYER

EXPLAIN ANY BREAK IN CONTINUITY OF WORK HISTORY.

IMPORTANT PLEASE READ BEFORE SIGNING

I certify that, to the best of my knowledge all information given herewith is true. I understand that any falsification or misrepresentation of fact or omissions may cause me to be disqualified from further consideration for employment with the Company or may be cause for dismissal if I am hired by the Company.

APPLICANT SIGNATURE DATE

Recruiting Coordinator: Keep a copy in the recruiting file (send copy of hired applicant to HR Services)


Yes No







CONTRACT LABOR DOCUMENTATION SUPPLEMENTAL UNION EMPLOYEE

All New Hires/Rehires of PNW/APS and its subsidiaries must complete this form:

Check one of the two boxes below and then follow the directions that apply to your response:

I have not worked at PNW/APS or one of its subsidiaries through a contract agency.

I have previously worked at PNW/APS or one of its subsidiaries through a contract agency or through the IBEW Supplemental Workforce

SOCIAL SECURITY NUMBER AND/OR CONTRACTOR ID NUMBER:

Contract Agency Assignment Start Date Assignment Release DatePNW/APS Assignment Information

(i.e. Leader, Dept, Job Title)

Recruiting Coordinator: delivered to the Benefits Department at Mail Station 8467


Last Name First Name Hire Date

No (return form with new hire paperwork)

Yes (indicate all of your assignment(s) information below)

Signature Date

ACKNOWLEDGEMENT OF NON-DISCLOSURE, CONFIDENTIALITY, OWNERSHIP, AND LIMITED ACCESS OBLIGATION

This will confirm the agreement concerning non-disclosure, confidentiality, ownership, and limited access obligation (the “Agreement”) between Pinnacle West Capital Corporation and its affiliates (“Employer” or “Company”) and the undersigned employee (“Employee”).

1. Obligations Regarding Confidential Information.

Employee acknowledges that Employee’s work at the Company may involve access to, and creation, handling and safeguarding of confidential information regarding employees, customers, contractors and the business of the Company (“Confidential Information”). As a result of Employee’s commitment to the APS Code of Ethics and Business Practices, which is a term and condition of Employee’s employment, Employee hereby commits to maintain in strict confidence all Confidential Information which Employee receives, to which Employee has access or which Employee generates in connection with Employee’s employment with the Company. Employee agrees to protect the Confidential Information of the Company as follows:

a. Employee will not use or disclose (verbally or visually) Confidential Information for any purpose other than as required in connection with the performance of Employee’s assigned job duties.

b. Employee will take all precautions to prevent Confidential Information from being disclosed to any parties not authorized to receive such information.

c. Employee will not download, print, copy, reproduce, remove from the premises or distribute, in whole or in part, the Confidential Information unless specifically authorized or required to do so by the Company.

d. Employee will not use or view the Confidential Information except in the performance of Employee’s job-related responsibilities for the Company, and only to the extent that Employee is required to access or use the Confidential Information for job-related responsibilities.

e. Employee agrees that the Company’s disclosure of the Confidential Information to Employee is not a waiver of the Company’s intellectual property rights, nor is it a transfer of the Company’s intellectual property rights, or a license or other authorization for Employee to utilize the Confidential Information, except in a manner and for the purposes expressly authorized by the Company.

f. Employee will not commingle Confidential Information with other records or information that may result in the Confidential Information being made available to third parties, and Employee will maintain Confidential Information in secure locations that are not accessible to third parties who do not have a need to know.

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g. Employee will not use Confidential Information in providing services to third parties unless first authorized and consented to by the management of the Company in writing, which may be granted or withheld in the Company’s sole discretion.

h. If Employee is ordered by a court, government agency or regulatory authority to disclose Confidential Information, Employee will promptly advise the Company so the Company will have the opportunity to participate in the disclosure of the Confidential Information in question.

i. Employee understands that nothing in this Agreement is intended to or shall be construed to prohibit Employee from reporting or disclosing any suspected instance of illegal activity or interference with protected activity of any nature, any nuclear safety concerns, any workplace safety concerns, or any public safety concerns to the Nuclear Regulatory Commission (“ NRC”), Department of Labor (“ DOL”), U.S. Equal Employment Opportunity Commission (“ EEOC”), National Labor Relations Board (“ NLRB”), Securities and Exchange Commission (“ SEC”), or any other federal, state or local agencies with investigative and enforcement powers with whom Employee could file a charge. This Agreement shall not be construed to prohibit Employee from providing information to the NRC, DOL, EEOC, NLRB, SEC, Occupational Safety and Health Administration, or the Arizona or New Mexico Division of Occupational Safety and Health, or testifying in any civil or criminal proceedings, even if such information or testimony relates to the claims or matters covered by this Agreement. This Agreement shall not be construed as a waiver or withdrawal of any concerns that Employee has or may have reported to the NRC, DOL, or SEC, or withdrawal of Employee’s participation in any NRC, DOL, or SEC proceedings.

j. Notwithstanding the foregoing nondisclosure obligations, pursuant to 18 USC Section 1833(b), Employee shall not be held criminally or civilly liable under any federal or state trade secret law for the disclosure of a trade secret that is made: (1) in confidence to a federal, state, or local government official (either directly or indirectly) or to an attorney, if the disclosure is made solely for the purpose of reporting or investigating a suspected violation of law; or (2) in a complaint or other document filed in a lawsuit or an administrative proceeding, if such filing is made under seal.

k. Employee agrees to comply with all corporate policies and procedures, including but not limited to those Company policies and procedures applicable to classifying and handling information, information privacy, cyber security, export control, records retention, and legal holds.

2. Examples of Confidential Information.

a. For purposes of this Agreement, “Confidential Information” includes non-public business, customer, technical and scientific information, as well as other similar sensitive business information disclosed by the Company to Employee or which Employee has learned, observed, created, or otherwise obtained during Employee’s employment with the Company or

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from work performed by Employee for the Company. Examples of Confidential Information include, without limitation, information relating to attorney-client privileged communications, vendor contract and pricing information, business-related discoveries, ideas, inventions, methods, “know-how,” “show-how,” and similar business concepts or knowledge, computer programs and databases, software in various states of development, security and other information regarding the Company’s infrastructure or operations that is subject to state or federal regulation or could be useful to a person planning to damage facilities, disrupt operations, steal information, or harm individuals, patent claims, non-public Company financial information, all customer information, and customer, employee and contractor banking information, credit card information, social security numbers, and health related information. Confidential Information shall include information constituting a “trade secret” as defined by Arizona law. Confidential Information shall also include any information described above which the Company obtains from another party and which the Company treats as proprietary or designates as Confidential Information, whether or not owned or developed by the Company. Nothing in this Agreement prohibits employees from discussing wages, hours, and other terms and conditions of employment.

b. Confidential Information is limited to that information and to those materials that derive actual or potential economic value from not being generally known or readily ascertainable to the public or to the Company’s competitors. “Confidential Information” does not include the following:

(i) matters of public knowledge; (ii) information lawfully known to Employee prior to the time of Company’s

disclosure; or (iii) information independently developed from other sources available to

Employee which are not then subject to an obligation to the Company to preserve the confidentiality of such information.

3. Intellectual Property Ownership.

Employee agrees that all Intellectual Property, as defined herein, that is in whole or in part conceived, reduced to practice or made by Employee during or after the term of Employee’s employment with the Company, and that is conceived or made through the use of or containing any Confidential Information as defined in this Agreement, including Company trade secrets or other Intellectual Property protectable by law, or that results in any way from work performed by the Employee for the Company is the sole and exclusive property of the Company. Employee agrees to assign and hereby assigns all such Intellectual Property to the Company. “Intellectual Property” includes, without limitation, all subject matter of, and all United States and foreign rights to, all patents, patent applications, inventions, improvements, ideas, methods and techniques, know-how, show-how, discoveries, trademarks, service marks, trade dress, copyrights, forms of expression in any medium, computer programs, databases, and trade secrets. Employee agrees to promptly execute any documents as may be requested by the Company to vest in the Company any United States or foreign rights to all such Intellectual

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Property, and to otherwise cooperate with the Company in securing all such rights during and after the term of employment.

Employee further agrees that all copyrightable work product, as listed in the above paragraph, shall be deemed to be “works made for hire” and that the Company shall be deemed the author under the U.S. Copyright Act (Title 12 of the U.S. Code), and if for any reason any of such copyrightable work product is deemed not a work for hire, Employee agrees to assign all rights in such works to Company. The Company shall own no rights to original works of authorship or other work product reduced to tangible form by Employee prior to Employee’s employment with Company, provided that Employee has identified such works (if any) in writing prior to signing this Agreement, and the listing is attached to this Agreement. Nothing in this Agreement prohibits employees from discussing wages, hours, and other terms and conditions of employment.

4. Obligations Regarding Export-Control Compliance.

Employee recognizes and acknowledges that any access to and/or use of information subject to control under the U.S. Department of Energy’s Part 810 Regulations (10 CFR Part 810), the U.S. Nuclear Regulatory Commission’s Part 110 Regulations (10 CFR Part 110), the Export Administration Regulations (15 CFR Parts 730 through 774), the U.S. Department of Treasury’s Office of Foreign Assets Control Regulations (31 CFR Parts 500 through 599), or the International Traffic in Arms Regulations (22 CFR Parts 120 through 130) (collectively, “U.S. Export Control Laws”) may be limited to U.S. persons only. U.S. Person is defined as a U.S. Citizen, a U.S. Lawful Permanent Resident ( i.e. “Green Card Holder”), a Political Asylee, or a Refugee under the U.S. Export Control Laws. All employees are required to confirm their U.S. person or non-U.S. person status. All information collected in this regard will only be used to ensure compliance with U.S. Export Control Laws, and will be used in full compliance with all applicable laws prohibiting discrimination on the basis of national origin and other factors. Employees at Palo Verde Nuclear Generating Station are required to be U.S. persons.

5. No Breach of Contract.

Employee represents and warrants that Employee has no obligations or commitments to any third party that would interfere with the full and faithful performance of Employee’s duties for Company, or that would subject Employer to any claims or lawsuits from such parties. Employee both recognizes and agrees that safeguarding Confidential Information is material to the continuing successful conduct of Employer’s business, and any breach of the terms of this paragraph is therefore material.

6. Understanding of Employer’s Policy.

Employee represents and warrants that Employee understands Employer’s policy to respect the rights of Employee’s previous employers in their proprietary or confidential information. Employee acknowledges that Employer does not expect Employee to disclose, and requests that Employee not disclose any confidential or proprietary information Employee may

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have acquired as a result of previous employment. Employee further acknowledges that Employer is not allowed to use for its own purpose, any confidential or proprietary information that Employee may have acquired as a result of previous employment.

7. Term.

The obligations described in this Agreement shall apply both during and after Employee’s employment with the Company.

8. Execution.

By signing below, Employee acknowledges and agrees to the terms of this Non-Disclosure, Confidentiality, Ownership, and Limited Access Obligation Agreement.

EMPLOYEE:

_________________________________ (Employee’s Signature)

_________________________________ (Employee’s Printed Name)

Date

Emp ID #

VOLUNTARY VETERAN SELF IDENTIFICATION

1. Do you currently serve in the Armed Forces of the United States, or have you ever served in the Armed Forces of the United States?

This includes: United States Army United States Army National GuardUnited States Army Reserve United States Marine Corps United States Marine Corps Forces ReserveUnited States NavyUnited States Navy Reserve United States Air ForceUnited States Air National GuardUnited States Air Force ReserveUnited States Coast GuardUnited States Coast Guard Reserve

Yes No I do not wish to disclose this information

2. Are you a protected veteran?

Yes I am a protected veteran

I am a protected veteran, but I choose not to self-identify the classifications to which I belong.

I am NOT a protected veteran

3. I belong to the following classifications of protected veterans (choose all the apply): Disabled Veteran

Disabled Veteran is one of the following:

-a veteran of the U.S. military, ground, naval, or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs.

-a person who was discharged or released from active duty because of a service-connected disability. Last updated 3/7/14

Last Name First Name Date

The information requested below is used by Arizona Public Service only to maintain records required of employers doing business with the federal government. Arizona Public Service is a government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. Arizona Public Service is an equal employment opportunity employer.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended.

As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified "protected veteran" category. If you believe you belong to any of the categories of protected veterans listed below, please indicate by checking the appropriate box.

Recently Separated Veteran

*Required for recently separated veterans.

Active Duty Wartime or Campaign Badge Veteran

Armed Forces Service Medal Veteran

An Armed Forces Service Medal Veteran means a veteran who, while serving on active duty in the U.S. military ,ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

If you are a disabled veteran it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changed in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability.

Do you require a reasonable accommodation?

If yes please list below:

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

Protected veterans may have additional rights under USERRA -- the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS) toll free at 1(866)4-USA-DOL.

Last Updated 3/7/14

A Recently Separated Veteran means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

Date of Separation (MM/DD/YYYY)

An Active Duty Wartime or Campaign Badge Veteran means a veteran who served on active duty in the U.S. military, ground, naval, or air service during a war, or in a campaign, or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

Yes No

Arizona Public Service advocates for employee participation in the military and fully supports of the Uniformed Services Employment and Reemployment Rights Act (USERRA). We recognize that supportive employers are critical to maintaining the strength and readiness of the nation's Guard and Reserve units. To demonstrate our advocacy and support, APS has partnered with the Employer Support of the Guard and Reserve (ESGR), a Department of Defense office established in 1972, by signing a Statement of Support. APS pledges the following:

1. We fully recognize, honor and enforce the Uniformed Services Employment and Reemployment Rights Act (USERRA).

2. We will provide our managers and supervisors with the tools they need to effectively manage those employees who serve in the Guard and Reserve.

3. We appreciate the values, leadership and unique skills Service members bring to the workforce and will encourage opportunities to employ Guardsmen, Reservists, and Veterans.

4. We will continually recognize and support our country's Service members and their families in peace, in crisis, and in war.

4. Are you an active member in either of the following?

Last Updated 3/7/14

Armed Forces Reserve

National Guard

I do not wish to disclose this information

Not applicable

VOLUNTARY SELF IDENTIFICATION

The information requested below is used by Arizona Public Service only to maintain records required of employers doing business with the federal government. YOU DO NOT HAVE TO ANSWER THESE QUESTIONS. If you do choose to answer these questions, any information supplied by you on this voluntary self-identification form will not affect your employment opportunities with Arizona Public Service, which is an equal opportunity employer. All information regarding your disability status will be kept confidential and will be kept confidential and will be used only in ways consistent with federal reporting requirements, except that (1) supervisors and managers may be informed regarding restrictions on the work or duties of individuals with disabilities, and regarding necessary accommodations; (2) first-aid and safety personnel may be informed, when and to the extent appropriate, if a condition might require emergency treatment; and (3) government officials engaged in enforcing the Americans with Disabilities Act and laws regulating government contractors may be informed.

RACE/ETHNICITYAre you Hispanic or Latino

If you answered "no" above, please identify your ethnicity below:

GENDER


Last Name First Name

Position Hired For

Yes No

White

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native

Two or More Races


Female


Male

Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005

Page 1 of 1 Expires 05/31/2023

(if applicable)

Why are you being asked to complete this form?

We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years. Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:

Please check one of the boxes below:

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

• Autism • Autoimmune disorder, for example,

lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS

• Blind or low vision • Cancer • Cardiovascular or heart disease • Celiac disease • Cerebral palsy

• Deaf or hard of hearing • Depression or anxiety • Diabetes • Epilepsy • Gastrointestinal disorders, for

example, Crohn's Disease, or irritable bowel syndrome

• Intellectual disability

• Missing limbs or partially missing limbs

• Nervous system condition for example, migraine headaches, Parkinson's disease, or Multiple sclerosis (MS)

• Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression

Name: Date:

Employee ID:

Yes, I Have A Disability, Or Have A History/Record Of Having A Disability

No, I Don't Have A Disability, Or A History/Record Of Having A Disability

I Don't Wish To Answer

https://www.dol.gov/agencies/ofccp\hich\af1\dbch\af37\loch\f1

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