ࡱ> 574 bjbjo>o> 6' T T """""WYYYYYY$}}""!!!"""W!W!!:,"`\"  C0 8.88$!}}.8 : Sample F a r m W o r k A g r e e m e n t A. 1. Employer: ____________________________ 2. Address: ____________________________ ____________________________ - A N D - _________________________________ Town & County ____________________________ Telephone No. ____________________________ Name of Employee 3. Name of Owner, ____________________________ & Title ____________________________ ___________________________ ________ ________________________________ ____________ Employer Signature Date Employee Signature Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B. 1. Work Location: ___________________________ 3. Hours for Standard Work Day: ______ 2. Type of Work: ____________________________ _______ a.m. to ______ p.m. ____________________________ Hours for Standard Work Week: _______ Other scheduled hours: ________ List strikes, work stoppage, slowdown or interruption of operation by employees at the place where workers will work: ____________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Describe Housing Arrangements:____________________________________________________________________ Telephone number at Seasonal Employee Housing: ( )__________ Location of telephone for local and emergency calls: ____________________________________________________ D. 1. NO allowances will be deducted from wages for: meals, lodging or payments in kind. WORKERS LIVING IN FARM HOUSING ARE EXPECTED TO KEEP LIVING QUARTERS, TOILET & SHOWER FACILITIES AND GROUNDS SURROUNDING HOUSING CLEAN ENOUGH TO MEET NYS HEALTH DEPARTMENT INSPECTIONS. Contact ____________________concerning housing problems or repairs needed immediately. D. 2. Sales Made to Workers: List arrangements made with establishment owners or agents for the payment of commissions or benefits for sales made to workers: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E. Benefits Provided: Unemployment Insurance: _____ Health Insurance: _____ Sick Leave: _____ Vacation: _______ Workers Comp: Yes, through the ______________________Policy Holder: ____________________To file a claim please notify: _____________________________NOTIFY _________ON THE DAY OF THE INJURY! Deadline for filing a claim is within _______ days of the day the accident occurred. Disability Ins. ______ Paid Holidays: ____________ Other: _____________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F. 1. Wage Rates to be Paid: Check those which apply and include rate(s). Piece Rates ______ per tree pruned Rate: $_____ to $ _______ ________Hourly: Rate: ________ ______ per flat of 12 pts raspberries Rate: $ _______ ______ per 20- 1 1/8 bu. bin Rate: $ _____ to $______ _______Bonus Rate: $_____ per bin picked: IF YOU STAY UNTIL THE END OF APPLE HARVEST F. 2. Wages are paid WEEKLY on _______(day). Other: _________________________________________________________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G. Approximate Period of Employment: From: ________________________ To:_______________ _____________ or end of apple harvest (dormant pruning, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H. Other Planned Payroll Deductions: State and Federal Taxes will be withheld Social Security: 7.65% of total Earnings ______________________________________________________________________________________________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. Non-Economic Terms and Conditions of Employment: Workers must arrange for transportation, medical transportation will be provided. HOUSING IS PROVIDED ONLY FOR THE TERM OF EMPLOYMENT. Nearest facilities: MEDICAL -____________________________________ SCHOOL: _____________________________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J. Will OVERTIME WILL BE PAID? _______ Courtesy of: Lake Ontario Fruit Program 2 !  j!q" !BP1i(=[`.abɻh0h(=6>*CJaJh06CJaJh0 h(=5>* h(=>* h(=5h(= h(=>*CJ h(=CJ h(=5CJB12a q v 1 m " # 5 b & F ^gd3h^h & F ^gd3$a$bj{|ab"$.i#$d%d&d'dNOPQ hZ^h`Z(scd$a$gd0gd0 4hxhxxhxhxxhxhxx.........P&P1 @!"#$v% 8$Dp^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH L`L Normal5$7$8$9DH$_HmH nHsH tHDA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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DeMarree Sears, Ashley  Oh+'0|   , 8 D P\dlt(F a r m W o r k A g r e e m e n tAlison M. DeMarree Normal.dotmSears, Ashley2Microsoft Office Word@@ f/@be"@be"!՜.+,0 hp  user&  (F a r m W o r k A g r e e m e n t Title  !"#%&'()*+-./01236Root Entry Fl"81TableLWordDocument6'SummaryInformation($DocumentSummaryInformation8,CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q