Employee Manual

830 W Main Street

Geneseo, IL 61254
Phone 309.944.5700 Office 309.944.5775
dan@dannyboysrestaurants.com
kris@dannyboysrestaurants.com
heidi@dannyboysrestaurants.com
Table of Contents

Welcome Letter ......................................................................... 1

Employee Confidenitality Agreement ........................................ 2
Employment Applications .......................................................... 3
Substance Abuse Policy............................................................ 3
Personal Property & Security .................................................... 3
Time Off / Sick Time / Personal Leave of Absence ................... 4
Bereavement Leave / Recording Time / Pay Periods .............. 4
Holidays / Working Hours / Overtime ........................................ 5
Parking / Code of Conduct ........................................................ 5
Behavior / Personal Appearance............................................... 6
COOP / Attendance Policy ........................................................ 6
Performance Evaluation ............................................................ 7
Safety / Sanitation / Company Property .................................... 7
Disciplinary Policy ..................................................................... 8
Termination ............................................................................... 9
Personnel File ........................................................................... 9
Internal Complaint Procedures................................................ 10
Social Security and Medicare.................................................. 10
Unemployment Insurance ....................................................... 10
Worker's Compensation .......................................................... 11
Equal Employment Opportunity Policty ................................... 11
Non-Discrimination & Anti-Harassment Policy ........................ 12
Americans With Disibilities Act Policy ..................................... 15
Emergency Procedures........................................................... 15
Employment Incident Report .................................................. 16
Employee Performance Evaluation ......................................... 17
Employee Warning Notice....................................................... 18
Employee Manual Receipt Acknowledgment .......................... 19
Index ....................................................................................... 20
 1
Chapter
D A N N Y B O Y S E M P L O Y E E M A N U A L

Welcome to Danny Boys Pizza & More, Inc. We are a family owned and
operated business and we pride ourselves in providing a superb product
and excellent customer service. The rules and regulations described in
this employee manual are for the safety and morale of our employees.
We encourage any questions or comments concerning the work
environment and practices.

1
 THE PURPOSE

This handbook is intended to provide employees with a general understanding of our employment
policies. Employees are encouraged to familiarize themselves with the contents of this handbook,
for it will answer many common questions concerning employment with Danny Boys Pizza &
More, Inc. (hereafter Danny Boys Pizza & More, Inc. or Company).

In order to retain necessary flexibility in the administration of policies and procedures, the
Company reserves the rights to change, revise, or eliminate any of the policies and/or benefits
described in this handbook without prior notice. This handbook and the policies and procedures
contained herein supersede any prior policies or practices written or unwritten, which may have
been in practice prior to this time. Any deviation, whether individual or universal, shall not
necessarily establish future precedent.

It is the responsibility of each employee to read and be familiar with the information in this
handbook. Questions should be referred to your supervisor.

EMPLOYEE CONFIDENTIALITY AGREEMENT

Employee agrees that any and all knowledge or information that may be obtained in the course of
the employment with respect to the conduct and details of the business and with respect to the secret
processes, formulas, machinery, etc. used by the employer in manufacturing its products will be
forever held inviolate and be concealed from any competitor and all other persons and that he or she
will not engage as employer, employee, principal, agent, or otherwise, directly or indirectly, at any
time in a similar business, and that he or she will not impart the knowledge acquired to anybody at
any time during his or her employment or thereafter. If he or she violates the confidentiality
agreement, the Company shall be entitled to an injunction by any competent court of equity
enjoining and restraining him or her and each and every other person concerned from continuance
of employment, services or other acts in aid of the business of the rival company or concern and
money damages. Any employee who discloses trade secrets or confidential business information
will be subject to disciplinary action, up to and including possible termination of employment and
legal action, even if he or she does not actually benefit from the disclosed information. Nothing
shall prevent him or her, upon the termination of the employment, in engaging in any occupation in
which the processes, formulas, and other secrets of the employer will not be directly or indirectly
involved.

2
 EMPLOYMENT APPLICATIONS

Danny Boys Pizza & More, Inc. relies upon the accuracy of information contained in the
employment application, as well as the accuracy of other data presented throughout the hiring
process and employment. Any misrepresentations, falsifications, or material omissions in any
of the information or data may result in the Companys exclusion of the individual from
further consideration for employment or, if the person had been hired, termination of
employment.

SUBSTANCE ABUSE POLICY

Our policy is to employ a work force free from alcohol abuse or the use of illegal drugs. Any
employee who violates this policy will be disciplined. This may include termination, even for
a first offense.

We strive to provide a safe and healthy work environment, free from the use of illegal drugs
and abuse of alcohol and set forth the following rules:

Employees may not consume alcoholic beverages or take illegal drugs on our premises.

Employees may not report to work under the influence of drugs or alcohol.

Legal drugs include prescribed and over-the-counter drugs which have been legally obtained
and used for the purpose for which they were intended. Illegal drugs include any drug which
is not legally obtainable, which may be obtainable but has not been legally obtained or which
is being used in a manner or for a purpose other than as prescribed.

PERSONAL PROPERTY AND SECURITY

The Company is not responsible for losses of or damage to personal property or for
automotive accidents on Company property or property leased by the Company. Please take
precautions to protect your safety and do not bring valuables to work with you. Employees are
forbidden from possessing any weapons or other unprofessional or improper items on the
premises. Employees may not take any company property off of the premises without
permission from a supervisor.

3
 TIME OFF / SICK TIME

Time off requests should be submitted at least two weeks in advance. If you need time off and
cannot comply with the two week notice requirement, you should find a substitute to replace you.
If you are unable to find a substitute you should contact your immediate supervisor. If your
substitute fails to work as promised, both you and the substitute may be disciplined. If you are sick
and cannot work please report it to your immediate supervisor as soon as possible and prior to the
beginning of your shift.

PERSONAL LEAVE OF ABSENCE

A personal leave of absence may be requested for personal reasons. The request must be completed
on the proper form far enough in advance in order to adjust work schedules. An extension may be
requested at the completion of the leave, if required.

BEREAVEMENT LEAVE

If an employee wishes to take time off due to the death of a family member or close friend, the
employee should notify the employees Supervisor or Manager immediately.

RECORDING TIME / PAY PERIODS / ACCEPTING EMPLOYMENT

There are two pay periods per month. Days 1-15 will be paid on the 20th of the same month
and days 16-31 to be paid on the 5th of the following month. Employees need to record time
using the time clock provided. Any time not recorded will not be paid. If an employee
believes a payroll error has been made, the employee may file an incident report. If the error
is confirmed, it will be corrected at the next pay cycle. Employees are required to submit W-4
statements, I-9 Form including required documentation, signed Employee Manual Receipt
Acknowledgment, and completed Employee Emergency Information Form when accepting
employment. All required forms are included in this manual. The employee is responsible to
submit any changes to a supervisor to ensure information is accurate at all times.

4
 HOLIDAYS / WORKING HOURS

Danny Boys Pizza & More, Inc. will close on the following holidays: Easter, Thanksgiving,
Christmas Eve, & Christmas. Normal business hours are Sunday through Thursday 4 pm 9 pm
and Friday and Saturday 4 pm 10 pm. Employees are required to arrive 5 minutes prior to
scheduled shift. Observed holidays and restaurant hours may be changed at any time.

OVERTIME

Overtime compensation is paid to all nonexempt employees in accordance with federal and state
wage and hour restrictions. As required by law, overtime pay is based on actual hours worked in
excess of 40 in a seven consecutive day workweek at the rate of one and one-half (1 ) times the
hourly rate.

PARKING

Employees should park in the area designated as employee parking for the safety and convenience
of customers.

CODE OF CONDUCT

Danny Boys Pizza & More, Inc.s reputation for integrity is its most valuable asset and is
determined by the conduct of its employees. Each employee must manage his or her personal
business affairs to avoid situations that may lead to a conflict between duty to the employer and its
customers. The employees position must never be used, directly or indirectly, for private gain, to
advance personal interests, or to obtain favors or benefits for self, family, or any other person.

Confidential information with respect to the Company and its customers, prospective customers,
and suppliers acquired in the course of employment shall be used solely for work purposes and
under no circumstances revealed to unauthorized persons.

5
 BEHAVIOR

Employees should behave in a manner which positively represents Danny Boys Pizza & More, Inc.
at all times. Smoking, cursing, illegal behavior, threats, violence, personal phone calls, unnecessary
fraternizing, rudeness to associates or customers is strictly forbidden and may result in termination
of employment.

PERSONAL APPEARANCE

Dress, grooming, and personal cleanliness standards contribute to the morale of all employees and
affect the business image presented to customers and visitors.

Employees are expected to present a clean and neat appearance and to dress according to the
requirements of their positions. Most employees must wear the company shirt. Clothing must not
be torn, unprofessional or dirty. Sandals and other open toed shoes are forbidden. Hair should be
completely restrained.

Jewelry such as rings, earrings, and necklaces may be dangerous in certain areas. The Company
restricts the wearing of jewelry or clothing that poses a safety hazard around the machinery.

COOP

All COOP employees should be available as soon as his or her school schedule is completed
regardless of normal business hours.

ATTENDANCE POLICY

Good attendance and punctuality are expected as part of the Danny Boys Pizza & More, Inc.
Team. As with any team effort, it takes cooperation and commitment from everyone to
operate effectively. Therefore, each employees attendance and punctuality is very important,
and greatly appreciated.

6
 PERFORMANCE EVALUATION

Employees may be evaluated on a quarterly basis. Employees are encouraged to review the
performance evaluation form and strive for excellence in their work performance. The evaluation
process allows the supervisor and the employee to discuss the job responsibilities, standards, and
performance requirements of the position. In addition to formal performance evaluations,
supervisors and employee are encouraged to discuss job performance and goals on an informal,
day-to-day, or as needed basis.

Evaluations are personal between the employee and his/her supervisor. Evaluations are signed
by the employee and the supervisor with an opportunity for the employee to comment on
his/her evaluation. Evaluations become a permanent part of the employees personnel file.

SAFETY / SANITATION

Safety and Sanitation standards are determined by the Department of Health and must be observed
by all employees.

COMPANY PROPERTY

It is expected that employees protect and care for all property, product, and equipment owned
or leased by the Company.

Failure to comply with this policy will result in disciplinary action, up to and including
termination. If your actions are thought to be illegal, criminal prosecution may be pursued.

7
 DISCIPLINARY POLICY

The purpose of the Danny Boys Pizza & More, Inc. disciplinary policy and procedure is to
provide a method of effectively dealing with inappropriate employee behavior. Disciplinary
action is not intended to punish, but rather a method to modify or change the behavior of an
employee whose performance or conduct does not meet standards.

The degree of discipline will vary depending upon the severity of the violation. Certain
offenses will warrant suspension or dismissal without previous offenses or warnings. Danny
Boys Pizza & More, Inc. reserves the right to terminate the employment of any employee
without warning and for any reason deemed to be in the best interest of the Company.

Some offenses may not be serious enough to result in immediate termination but may warrant
other disciplinary action. The following is a general outline of disciplinary action. Although
it may be generally viewed as progressive in nature, it may be accelerated, adjusted, modified,
repeated, or intensified as needed in relation to the severity or misconduct and/or multiple or
combination of incidents involved.

Verbal Warning Verbal reprimand or counseling is normally applicable in cases of minor

first time offenses.

Written Warning Written warnings are normally applicable in the event of offenses more
serous than would be treated with a verbal warning, or where a verbal warning or warnings
proved insufficient.

Dismissal Warning with Suspension Suspension from work without pay is effective in
cases where a second or third offense occurs within a reasonable period from the date of the
first verbal or written warning, or for more serous offenses. The length of the suspension will
depend upon the seriousness of the offense or offenses.

Discharge Termination or discharge is warranted in the event of a serious offense or

repeated offenses within a reasonable period of time or if by their serious nature of their
related concurrent or recent combination of offenses are determined to be intolerable.
Employment may be terminated at the discretion of the Company.

8
 TERMINATION

All employees are employees at will and may resign at any time and may be terminated at
any time at the desire of the employee or Danny Boys Pizza & More, Inc. Employees are
asked to submit a written resignation at least two weeks in advance. Time of final payment
shall be no later than the next regularly scheduled payday covering the pay period in which
termination occurs.

All Danny Boys Pizza & More, Inc. owned property in possession of the employee (i.e. keys,
equipment, etc.) must be returned at the time employment ends.

PERSONNEL FILE

A confidential employment history file will be prepared and maintained for each employee
and permanently retained in the business office. This file shall include the employment
application, performance evaluations, counseling reports, and other records reflecting
significant job related events that occur during employment with Danny Boys Pizza & More,
Inc. No confidential employment history information will be provided to outside inquiries
without prior written approval.

Upon request, employees may examine the contents of their personnel files. Within a
reasonable time after the receipt of a request, the employee will be notified of a time (outside
working hours) when the inspection may be made. The file, or any of its contents, may not be
removed from the place of the inspection; however, the employee may make notes, or may
receive copies of any part of the file. Employees who disagree with material contained in the
file should bring the matter to the attention of their supervisor. If a satisfactory resolution
cannot be achieved, the employee may insert a statement of position into the file. Such
statements will be a permanent part of the personnel file and will accompany contested
documents at all times thereafter.

9
 INTERNAL COMPLAINT PROCEDURES

To foster sound employee-employer relations through communication and reconciliation of

work-related problems, Danny Boys Pizza & More, Inc. provide employees with an
established procedure for expressing employment related concerns.

In a situation where employees feel a complaint is in order, the following steps should be
taken:

1. Talk with your Shift Supervisor;

2. If your supervisor cannot help resolve the matter, then speak to the HR Manager, Heidi
Gazay, who will give your problem or complaint prompt consideration;
3. If the HR Manager feels that the situation warrants further review, then the HR
Manager should seek assistance from the President or Secretary.

Our goal is to maintain a comfortable working environment for everybody by maintaining

direct communication with all employees and ensuring that each and every employee may
speak directly and openly with our management team.

SOCIAL SECURITY AND MEDICARE

The cost of Social Security and Medicare is shared between the employee and Danny Boys
Pizza & More, Inc. For every dollar the employee contributes to Social Security and
Medicare, Danny Boys Pizza & More, Inc. contributes an additional dollar. This tax provides
for employees and their families as specified by law in the event of retirement, total and
permanent disability, or a death. Details about Social Security and Medicare can be acquired
at your local Social Security office.

UNEMPLOYMENT INSURANCE

Unemployment insurance is paid entirely by Danny Boys Pizza & More, Inc. An employee
may be eligible for benefits when a loss of income occurs resulting from unemployment
beyond their control.

10
 WORKERS COMPENSATION INSURANCE

Danny Boys Pizza & More, Inc. provides comprehensive Workers Compensation Insurance
at no cost to all employees. This program covers any injury or illness sustained in the course
of employment that requires medical, surgical or hospital treatment.

An employee who sustains a work-related injury or illness should inform his or her supervisor
and the Human Resources Department immediately. No matter how minor an on-the-job
injury may appear, it is important that it be reported immediately in the event that unforeseen
ramifications or impairments result. This will enable an eligible employee to qualify for
coverage as quickly as possible.

Neither the employer nor the insurance carrier will be liable for the payment of Workers
Compensation benefits for injuries that occur during an employees voluntary participation in
an off-duty recreational, social, or athletic activity sponsored by the Company.

EQUAL EMPLOYMENT OPPORTUNITY POLICY

Equal Employment Opportunity has been, and will continue to be, a fundamental principle at
Danny Boys Pizza & More, Inc., where employment is based upon personal capabilities and
qualifications without discrimination because of race, color, religion, sex, age, national origin,
disability, sexual orientation, or any other protected characteristic as established by law.

This policy of Equal Employment Opportunity applies to all policies and procedures relating
to recruitment and hiring, compensation, benefits, termination and all other terms and
conditions of employment.

Appropriate disciplinary action may be taken against any employee willfully violating this
policy.

LOST/REPRINTED DOCUMENTS

A $30 fee will be collected before any document (ie paycheck) reprints will be issued.

11
 NON-DISCRIMINATION & ANTI-HARASSMENT POLICY

Danny Boys Pizza & More, Inc. is committed to a work environment in which all individuals are
treated with respect and dignity. Each individual has the right to work in a professional atmosphere
that promotes equal employment opportunities and prohibits discriminatory practices, including
harassment. Therefore Danny Boys Pizza & More, Inc. expects that all relationships among
persons in the workplace will be business-like and free of bias, prejudice and harassment. Danny
Boys Pizza & More, Inc. prohibits and will not tolerate any such discrimination or
harassment.

Definitions of Harassment

a. Sexual harassment constitutes discrimination and is illegal under federal, state,

and local laws. For the purposes of this policy, sexual harassment is defined by the Illinois
Human Rights Act, as unwelcome sexual advances or requests for sexual favors or any
conduct of a sexual nature when (i) submission to such conduct is made either explicitly or
implicitly a term or condition or any individuals employment; ii) submission to or rejection
of such conduct by an individual is used as the basis for employment decisions affecting such
individual; or (iii) such conduct has the purpose or effect of unreasonably interfering with an
individuals work performance or creating an intimidating, hostile or offensive working
environment.

Sexual harassment may include a range of subtle and not so subtle behaviors and may involve
individuals of the same or different gender. Depending on the circumstances, these behaviors
may include, but are not limited to: unwanted sexual advances or requests for sexual favors;
sexual jokes and innuendo; verbal abuse of a sexual nature; commentary about an individuals
body, sexual prowess or sexual deficiencies; leering, catcalls or touching; insulting or obscene
comments or gestures; display or circulation in the workplace of sexually suggestive objects or
pictures (including through e-mail); and other physical (touching, unwelcome hugging or
kissing, pinching, brushing the body, coerced sexual intercourse, or actual assault), verbal or
visual conduct of a sexual nature. Some sexual harassment is subtle, such as the use of
endearments such as honey, darling, and sweetheart and is objectionable to many
women who believe that these terms undermine their authority and their ability to deal with
men on an equal and professional level. Sex-based harassment, that is, harassment not
involving sexual activity or language (e.g., male manager yells only at female employees and
not males) may also constitute discrimination if it is severe or pervasive and directed at
employees because of their sex.

b. Harassment on the basis of any other protected characteristic is also strictly

prohibited. Under this policy, harassment is verbal or physical conduct that denigrates or
shows hostility or aversion toward an individual because of his/her race, color, religion,
national origin, age, disability, sexual orientation or any other characteristic protected by law
or that of his/her relatives, friends or associates and that: (i) has the purpose or effect of
creating an intimidating, hostile or offensive work environment; (ii) has the purpose of effect

12
of unreasonably interfering with an individuals work performance; or (iii) otherwise
adversely affects an individuals employment opportunities.

Harassing conduct includes, but is not limited to: epithets, slurs or negative stereotyping;
threatening, intimidating or hostile acts; denigrating jokes and display or circulation in the
workplace of written or graphic material that denigrates or shows hostility or aversion toward
an individual or group (including through e-mail).

Individuals and Conduct Covered

These policies apply to all applicants and employees, and prohibit harassment, discrimination
and retaliation whether engaged in by fellow employees, by a supervisor or manager or by
someone not directly connected to Danny Boys Pizza & More, Inc. (e.g., an outside vendor,
consultant or customer).

Conduct prohibited by these policies is unacceptable in the workplace or any work-related

setting outside the workplace, such as during business trips, business meetings and business-
related social events.

Retaliation Is Prohibited

Danny Boys Pizza & More, Inc. prohibits retaliation against any individual who reports
discrimination or harassment or participates in an investigation of such reports. Retaliation
against an individual for reporting harassment or discrimination or for participating in an
investigation of a claim or harassment or discrimination is a serious violation of this policy
and, like harassment or discrimination itself, will be subject to disciplinary action.

Complaint Procedure

Danny Boys Pizza & More, Inc. strongly urges the reporting of all incidents of
discrimination, harassment or retaliation, regardless of the offenders identity or position.
Individuals who believe they have experienced conduct that they believe is contrary to the
Companys policy or who have concerns about such matters should file their complaints with
their Shift Manager, or Supervisor. If the employee believes it would be inappropriate to
contact these individuals, the employee should immediately contact the HR Manager,
President or Secretary before the conduct becomes severe or pervasive. Individuals should not
feel obligated to file their complaints with their immediate supervisor first before bringing the
matter to the attention of one of the other Danny Boys Pizza & More, Inc. designated
representatives identified above.

Important Notice to All Employees: Employees who have experienced conduct they
believe is contrary to this policy have an obligation to take advantage of the complaint
procedure. An employees failure to fulfill this obligation could affect his or her rights in
pursuing legal action. Also, please note, federal, state and local discrimination laws
establish specific time frames for initiating a legal proceeding pursuant to those laws.

13
Early reporting and intervention have proven to be the most effective method of resolving
actual or perceived incidents of harassment. Therefore, Danny Boys Pizza & More, Inc.,
strongly urges the prompt reporting of complaints or concerns so that rapid and constructive
action can be taken. Danny Boys Pizza & More, Inc. will make every effort to stop alleged
harassment before it becomes severe or pervasive, but can only do so with the cooperation of
its staff and employees.

The availability of this complaint procedure does not preclude individuals who believe they
are being subjected to harassing conduct from promptly advising the offender that his or her
behavior is unwelcome and requesting that it be discontinued.

The Investigation

Any reported allegations of harassment, discrimination or retaliation will be investigated

promptly, thoroughly and impartially. The investigation may include individual interviews
with the parties involved and, where necessary, with individuals who may have observed the
alleged conduct or may have other relevant knowledge.

Confidentiality will be maintained throughout the investigatory process to the extent consistent
with adequate investigation and appropriate corrective action.

Responsive Action

Misconduct constituting harassment, discrimination or retaliation will be dealt with promptly

and appropriately. Responsive action may include, for example, training, referral to
counseling, monitoring of the offender and/or disciplinary action such as warning, reprimand,
withholding of a promotion or pay increase, reduction of wages, demotion, reassignment,
temporary suspension without pay or termination, as Danny Boys Pizza & More, Inc. believes
appropriate under the circumstances.

If an employee making a complaint does not agree with its resolution, the employee may
appeal to the Companys President or Secretary.

Individuals who have questions or concerns about these policies should talk to the Human
Resources Manager.

Finally, these policies should not, and may not, be used as a basis for excluding or separating
individuals of a particular gender, or any other protected characteristic, from participating in
business or work-related social activities or discussion in order to avoid allegations of
harassment. The law and the policies of Danny Boys Pizza & More, Inc. prohibit disparate
treatment on the basis of sex or any other protected characteristic, with regard to terms,
conditions, privileges and prerequisites of employment. The prohibitions against harassment,
discrimination and retaliation are intended to complement and further these policies, not to
form the basis of an exception to them.

14
 AMERICANS WITH DISABILITIES ACT POLICY

Danny Boys Pizza & More, Inc. is committed to complying with all applicable provisions of
the Americans With Disabilities Act (ADA). Danny Boys Pizza & More, Inc. will not
discriminate against any qualified employee or applicant with respect to any terms, privileges,
or conditions of employment because of a persons physical or mental disability or perceived
disability or a persons disease such as AIDS or AIDS-related virus, or other life-threatening
illnesses or diseases so long as the employee can perform the essential functions of the job.
Consistent with this policy of nondiscrimination, the Company will provide reasonable
accommodations to a qualified individual with a disability, as defined by the ADA, who has
made the Company aware of his or her disability, provided that such accommodation does not
constitute an undue hardship on the Company.

Employees with a disability who believe they need a reasonable accommodation to perform
the essential functions of the job should contact the Shift Manager, or Supervisor, or President.
Danny Boys Pizza & More, Inc. encourages individuals with disabilities to come forward and
request reasonable accommodation.

EMERGENCY PROCEDURES

Call 911, the emergency phone number, if required. If a minor injury occurs while you are on
the job, the first aid kit is located near the sink in the kitchen. If the injury is serious, someone
will take you to the hospital emergency room.

If an accident or illness should occur, no matter how slight, notify your shift Supervisor
immediately so that appropriate medical treatment may be administered. The transfer of any
body fluid (blood, saliva, urine, etc.) may pass on AIDS or other viruses. Please use extreme
caution to avoid contact with these body fluids. The first aid kit contains plastic gloves.
Please be sure to use them. Use a strong disinfectant, such as Lysol or liquid bleach, to clean
up afterwards.

On the job injuries will be handled in accordance with the Workers Compensation laws. Any
employee who is injured while on the job must notify the HR Department immediately to be
eligible for coverage provided under the Workers Compensation Act. As part of our
Substance Abuse Policy, you may also be required to submit to drug testing if you are injured
on the job.

15
 2
Chapter

Employee Incident Report

Date of report ______________

Report filled out by _______________________________________________

1. Workers name ____________________________________________

2. Workers address __________________________________________

City __________________________________________

3. Date of incident Time of incident

4. Address/place where incident happened __________________________________

5. Description of incident: _______________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

6. Signature of worker _________________________________________

Injury
Harassment / Discrimination
Payroll

16
 Employee Performance Evaluation
Employee Information
Employee Name: Review Period:

Job Title: Date:

Manager:

Ratings

(5) = Poor (4) = Fair (3) = Satisfactory (2) = Good (1) = Excellent
Job Knowledge
Comments:

Work Quality
Comments:

Attendance/Punctuality
Comments:

Initiative
Comments:

Communication/Listening Skills
Comments

Dependability
Comments:

Overall Rating (average the rating numbers above):

Evaluation
Additional Comments:

Goals (as agreed upon by employee and manager):

Verification of Review

By signing this form, you confirm that you have discussed this review in detail with your supervisor. Signing this form
does not necessarily indicate that you agree with this evaluation.

Employee Signature Date

Manager Signature Date

17
 Employee Warning Notice
Employee Information
Employee Name: Date:

Manager: Department:

Type of Warning
First Warning Second Warning Final Warning

Type of Offense
Tardiness/Leaving Early Absenteeism Violation of Company Policies

Substandard Work Violation of Safety Rules Rudeness to Customers/Coworkers

Other:

Details
Description of Infraction:

Plan for Improvement:

Consequences of Further Infractions:

Acknowledgement of Receipt of Warning

By signing this form, you confirm that you understand the information in this warning. You also confirm that you and your
manager have discussed the warning and a plan for improvement. Signing this form does not necessarily indicate that you
agree with this warning.

Employee Signature Date

Manager Signature Date

Witness Signature (if employee understands warning but refuses to sign) Date

18
 EMPLOYEE MANUAL RECEIPT ACKNOWLEDGMENT

I have received my copy of the Danny Boys Pizza & More, Inc. Employment Manual. It is my
responsibility to read and understand the matters set forth in this Manual. It is a guide to
company policies and procedures.

I understand that no statement contained in this Manual creates any guarantee of continued
employment or creates any obligation, contractual or otherwise, on the part of Danny Boys
Pizza & More, Inc. I will rely on any promises, statements or representations to the contrary
only if they are in writing and signed by an authorized member of the Companys
management.

I understand and acknowledge that the company has the right, without prior notice, to modify,
amend or terminate policies, practices, and other institutional programs within the limits and
requirements imposed by law.

Dated: ______________ Signature _______________________________________

19
Index
Accepting Employment, 4
Americans with Disabilities Act Policy, 15
Attendance Policy, 6
Behavior, 6
Bereavement Leave, 4
Code of Conduct, 5
Company Property, 7
COOP, 6
Disciplinary Policy, 8
Emergency Procedures, 15
Employee Confidentiality Agreement, 2
Employee Incident Report, 16
Employee Manual Receipt Acknowledgment, 19
Employee Performance Evaluation, 17
Empoyee Warning Notice, 18
Employment Applications, 3
Equal Employment Opportunity Policy, 11
Holidays, 5
Internal Complaint Procedures, 10
Medicare, 10
Non-Discrimnation & Anti-Harassment Policy, 12 14
Overtime, 5
Pay Periods, 4
Parking, 5
Performance Evaluation, 7
Personal Appearance, 6
Personal Leave of Absence, 4
Personal Property and Security, 3
Personnel File, 9
The Purpose, 2
Recording Time, 4
Safety, 7
Sanitation, 7
Sick Time, 4
Social Security, 10
Substance Abuse Policy, 3
Termination, 9
Time Clock, 4
Time Off, 4
Unemployment Insurance, 10
Welcome Letter, 1
Workers Compensation, 11
Working Hours, 5

20
 EMPLOYEE MANUAL RECEIPT ACKNOWLEDGMENT

I have received my copy of the Danny Boys Pizza & More, Inc. Employment Manual. It is my
responsibility to read and understand the matters set forth in this Manual. It is a guide to
company policies and procedures.

I understand that no statement contained in this Manual creates any guarantee of continued
employment or creates any obligation, contractual or otherwise, on the part of Danny Boys
Pizza & More, Inc. I will rely on any promises, statements or representations to the contrary
only if they are in writing and signed by an authorized member of the Companys
management.

I understand and acknowledge that the company has the right, without prior notice, to modify,
amend or terminate policies, practices, and other institutional programs within the limits and
requirements imposed by law.

Dated: ______________ Signature _______________________________________

21
Employee Emergency Information Form
Personal Information
First name

Middle name

Last name

Nickname

Gender

Citizenship

Home address

Home phone

Cellular phone

E-mail address

Birth date

Medical Information
Doctors name & Address

Phone number

Medical conditions for purposes of

determining whether reasonable
accommodations are necessary

Allergies

Current medications

Emergency Information
Emergency contacts name

Relationship

Address

Phone number(s)

22
Danny Boys Pizza & More, Inc.

New Team Member Checklist

EMPLOYEE INFORMATION
Name: Start date:

Position: Manager:

FIRST DAY
Provide employee with Employee Manual
Assign "buddy" employee(s) to answer general questions
Provide employee with team shirt
POLICIES
Review key policies. Time Cards Submit W-4
Sick Time / Time Off Submit Illinois W-4
Uniform / Shoes Submit Emergency Info Form
Working hours Submit Photo Identification
ADMINISTRATIVE PROCEDURES
Review general administrative Work Stations Telephones
procedures. Keys Office supplies
Mail
INTRODUCTIONS AND TOURS
Give introductions to department staff and key personnel during tour.
Tour of facility, including: Restrooms
Parking
Supplies
POSITION INFORMATION
Introductions to team.
Review initial job assignments and training plans.
Review job description and performance expectations and standards.
Review job schedule and hours.
Review payroll timing, time cards and policies and procedures.

23
Form W-4 (2014)
Purpose. Complete Form W-4 so that your employer
can withhold the correct federal income tax from your
pay. Consider completing a new Form W-4 each year
and when your personal or financial situation changes.
Exemption from withholding. If you are exempt,
complete only lines 1, 2, 3, 4, and 7 and sign the form
to validate it. Your exemption for 2014 expires
February 17, 2015. See Pub. 505, Tax Withholding
and Estimated Tax.
Note. If another person can claim you as a dependent
on his or her tax return, you cannot claim exemption
from withholding if your income exceeds $1,000 and
includes more than $350 of unearned income (for
example, interest and dividends).
Exceptions. An employee may be able to claim
exemption from withholding even if the employee is a
dependent, if the employee:
Is age 65 or older,
Is blind, or
Will claim adjustments to income; tax credits; or
itemized deductions, on his or her tax return.
Personal Allowances Worksheet (Keep for your records.)
A Enter 1 for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . .
The exceptions do not apply to supplemental wages
greater than $1,000,000.
Basic instructions. If you are not exempt, complete
the Personal Allowances Worksheet below. The
worksheets on page 2 further adjust your
withholding allowances based on itemized
deductions, certain credits, adjustments to income,
or two-earners/multiple jobs situations.
Complete all worksheets that apply. However, you
may claim fewer (or zero) allowances. For regular
wages, withholding must be based on allowances
you claimed and may not be a flat amount or
percentage of wages.
Head of household. Generally, you can claim head
of household filing status on your tax return only if
you are unmarried and pay more than 50% of the
costs of keeping up a home for yourself and your
dependent(s) or other qualifying individuals. See
Pub. 501, Exemptions, Standard Deduction, and
Filing Information, for information.
Tax credits. You can take projected tax credits into account
in figuring your allowable number of withholding allowances.
Credits for child or dependent care expenses and the child
tax credit may be claimed using the Personal Allowances
Worksheet below. See Pub. 505 for information on
converting your other credits into withholding allowances.
Nonwage income. If you have a large amount of
nonwage income, such as interest or dividends,
consider making estimated tax payments using Form
1040-ES, Estimated Tax for Individuals. Otherwise, you
may owe additional tax. If you have pension or annuity
iincome, see Pub. 505 to find out if you should adjust
your withholding on Form W-4 or W-4P.
Two earners or multiple jobs. If you have a
working spouse or more than one job, figure the
total number of allowances you are entitled to claim
on all jobs using worksheets from only one Form
W-4. Your withholding usually will be most accurate
when all allowances are claimed on the Form W-4
for the highest paying job and zero allowances are
claimed on the others. See Pub. 505 for details.
Nonresident alien. If you are a nonresident alien,
see Notice 1392, Supplemental Form W-4
Instructions for Nonresident Aliens, before
completing this form.
Check your withholding. After your Form W-4 takes
effect, use Pub. 505 to see how the amount you are
having withheld compares to your projected total tax
for 2014. See Pub. 505, especially if your earnings
exceed $130,000 (Single) or $180,000 (Married).
Future developments. Information about any future
developments affecting Form W-4 (such as legislation
enacted after we release it) will be posted at www.irs.gov/w4.
A

B Enter 1 if: { You are single and have only one job; or
You are married, have only one job, and your spouse does not work; or
Your wages from a second job or your spouses wages (or the total of both) are $1,500 or less.
. . . B }
C Enter 1 for your spouse. But, you may choose to enter -0- if you are married and have either a working spouse or more
than one job. (Entering -0- may help you avoid having too little tax withheld.) . . . . . . . . . . . . . . C
D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . D
E Enter 1 if you will file as head of household on your tax return (see conditions under Head of household above) . . E
F Enter 1 if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit . . . F
(Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)
G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.
If your total income will be less than $65,000 ($95,000 if married), enter 2 for each eligible child; then less 1 if you
have three to six eligible children or less 2 if you have seven or more eligible children.
If your total income will be between $65,000 and $84,000 ($95,000 and $119,000 if married), enter 1 for each eligible child . . . G

{
H Add lines A through G and enter total here. (Note. This may be different from the number of exemptions you claim on your tax return.) a H
If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions
For accuracy, and Adjustments Worksheet on page 2.
complete all If you are single and have more than one job or are married and you and your spouse both work and the combined
worksheets earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to
that apply. avoid having too little tax withheld.
If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

Separate here and give Form W-4 to your employer. Keep the top part for your records.

Form W-4
Department of the Treasury
Employee's Withholding Allowance Certificate
a Whether you are entitled to claim a certain number of allowances or exemption from withholding is
OMB No. 1545-0074

2014
Internal Revenue Service subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.
1 Your first name and middle initial Last name 2 Your social security number

Home address (number and street or rural route)

3 Single Married Married, but withhold at higher Single rate.
Note. If married, but legally separated, or spouse is a nonresident alien, check the Single box.
City or town, state, and ZIP code
4 If your last name differs from that shown on your social security card,
check here. You must call 1-800-772-1213 for a replacement card. a
5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5
6 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . . 6 $
7 I claim exemption from withholding for 2014, and I certify that I meet both of the following conditions for exemption.
Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and
This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.
If you meet both conditions, write Exempt here . . . . . . . . . . . . . . . a 7
Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.
Employees signature
(This form is not valid unless you sign it.) a Date a
8 Employers name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) 9 Office code (optional) 10 Employer identification number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 10220Q Form W-4 (2014)
Form W-4 (2014) Page 2

Deductions and Adjustments Worksheet

Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.
1 Enter an estimate of your 2014 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state
and local taxes, medical expenses in excess of 10% (7.5% if either you or your spouse was born before January 2, 1950) of your
income, and miscellaneous deductions. For 2014, you may have to reduce your itemized deductions if your income is over $305,050
and you are married filing jointly or are a qualifying widow(er); $279,650 if you are head of household; $254,200 if you are single and not
head of household or a qualifying widow(er); or $152,525 if you are married filing separately. See Pub. 505 for details . . . . 1 $

2 Enter: {
$12,400 if married filing jointly or qualifying widow(er)
$9,100 if head of household
$6,200 if single or married filing separately
}
. . . . . . . . . . . 2 $

3 Subtract line 2 from line 1. If zero or less, enter -0- . . . . . . . . . . . . . . . . 3 $

4 Enter an estimate of your 2014 adjustments to income and any additional standard deduction (see Pub. 505) 4 $
5 Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to
Withholding Allowances for 2014 Form W-4 worksheet in Pub. 505.) . . . . . . . . . . . . 5 $
6 Enter an estimate of your 2014 nonwage income (such as dividends or interest) . . . . . . . . 6 $
7 Subtract line 6 from line 5. If zero or less, enter -0- . . . . . . . . . . . . . . . . 7 $
8 Divide the amount on line 7 by $3,950 and enter the result here. Drop any fraction . . . . . . . 8
9 Enter the number from the Personal Allowances Worksheet, line H, page 1 . . . . . . . . . 9
10 Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet,
also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1 10
Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)
Note. Use this worksheet only if the instructions under line H on page 1 direct you here.
1 Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet) 1
2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if
you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more
than 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter
-0-) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . . 3
Note. If line 1 is less than line 2, enter -0- on Form W-4, line 5, page 1. Complete lines 4 through 9 below to
figure the additional withholding amount necessary to avoid a year-end tax bill.
4 Enter the number from line 2 of this worksheet . . . . . . . . . . 4
5 Enter the number from line 1 of this worksheet . . . . . . . . . . 5
6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . . 7 $
8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . . 8 $
9 Divide line 8 by the number of pay periods remaining in 2014. For example, divide by 25 if you are paid every two
weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2014. Enter
the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck 9 $
Table 1 Table 2
Married Filing Jointly All Others Married Filing Jointly All Others
If wages from LOWEST Enter on If wages from LOWEST Enter on If wages from HIGHEST Enter on If wages from HIGHEST Enter on
paying job are line 2 above paying job are line 2 above paying job are line 7 above paying job are line 7 above
$0 - $6,000 0 $0 - $6,000 0 $0 - $74,000 $590 $0 - $37,000 $590
6,001 - 13,000 1 6,001 - 16,000 1 74,001 - 130,000 990 37,001 - 80,000 990
13,001 - 24,000 2 16,001 - 25,000 2 130,001 - 200,000 1,110 80,001 - 175,000 1,110
24,001 - 26,000 3 25,001 - 34,000 3 200,001 - 355,000 1,300 175,001 - 385,000 1,300
26,001 - 33,000 4 34,001 - 43,000 4 355,001 - 400,000 1,380 385,001 and over 1,560
33,001 - 43,000 5 43,001 - 70,000 5 400,001 and over 1,560
43,001 - 49,000 6 70,001 - 85,000 6
49,001 - 60,000 7 85,001 - 110,000 7
60,001 - 75,000 8 110,001 - 125,000 8
75,001 - 80,000 9 125,001 - 140,000 9
80,001 - 100,000 10 140,001 and over 10
100,001 - 115,000 11
115,001 - 130,000 12
130,001 - 140,000 13
140,001 - 150,000 14
150,001 and over 15
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this You are not required to provide the information requested on a form that is subject to the
form to carry out the Internal Revenue laws of the United States. Internal Revenue Code Paperwork Reduction Act unless the form displays a valid OMB control number. Books or
sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your records relating to a form or its instructions must be retained as long as their contents may
employer uses it to determine your federal income tax withholding. Failure to provide a become material in the administration of any Internal Revenue law. Generally, tax returns and
properly completed form will result in your being treated as a single person who claims no return information are confidential, as required by Code section 6103.
withholding allowances; providing fraudulent information may subject you to penalties. Routine The average time and expenses required to complete and file this form will vary depending
uses of this information include giving it to the Department of Justice for civil and criminal on individual circumstances. For estimated averages, see the instructions for your income tax
litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions return.
for use in administering their tax laws; and to the Department of Health and Human Services
for use in the National Directory of New Hires. We may also disclose this information to other If you have suggestions for making this form simpler, we would be happy to hear from you.
countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal See the instructions for your income tax return.
laws, or to federal law enforcement and intelligence agencies to combat terrorism.
 Illinois Department of Revenue
Form IL-W-4
Who must complete this form?
If you are an employee, you must com-
plete this form so your employer can with-
hold the correct amount of Illinois Income
Tax from your pay. The amount withheld
from your pay depends, in part, on the
number of allowances you claim on this
form.
Even if you claimed exemption from
withholding on your federal Form W-4,
U.S. Employees Withholding Allowance
Certificate, because you do not expect
to owe any federal income tax, you may
be required to have Illinois Income Tax
withheld from your pay. If you are claiming
exempt status (see Publication 131, With-
holding Income Tax Filing and Payment
Requirements) from Illinois withholding,
you must check the exempt status box on
the IL-W-4.
If you do not file a completed Form
IL-W-4 with your employer, if you fail to
sign the form or to include all necessary
information, or if you alter the form, your
employer must withhold Illinois Income Tax
on the entire amount of your compensa-
tion, without allowing any exemptions.
When must I file?
Y ou must file Form IL-W-4 when Illinois
Income Tax is required to be withheld from
compensation that you receive as an em-
ployee. Y ou should complete this form and
give it to your employer on or before the
date you start working for your employer.
Y ou may file a new Form IL-W-4 any time
your withholding allowances increase. If
the number of your previously claimed al-
lowances decreases, you must file a new
Form IL-W-4 within 10 days. However, the
death of a spouse or a dependent does
not affect your withholding allowances until
the next tax year.
When does my Form IL-W-4
take effect?
If you do not already have a Form IL-W-4
on file with your employer, this form will be
effective for the first payment of compen-
sation made to you after this form is filed.
If you already have a Form IL-W-4 on file
with this employer, your employer may
allow any change you file on this form to
become effective immediately, but is not
required by law to change your withhold-
ing until the first payment of compensation
is made to you after the first day of the
next calendar quarter (that is, J anuary 1,
April 1, J uly 1, or October 1) that falls at
least 30 days after the date you file the
change with your employer.
IL-W-4 (R-12/07)
Employees Illinois Withholding Allowance
Certificate and Instructions
Example: If you have a baby and file a
new Form IL-W-4 with your employer to
claim an additional exemption for the baby,
your employer may immediately change
the withholding for all future payments of
compensation. However, if you file the new
form on September 1, your employer does
not have to change your withholding until
the first payment of compensation is made
to you after October 1. If you file the new
form on September 2, your employer does
not have to change your withholding until
the first payment of compensation made to
you after December 31.
How long is Form IL-W-4 valid?
Y our Form IL-W-4 remains valid until a
new form you have filed takes effect or
until your employer is required by the
department to disregard it. Y our employer
is required to disregard your Form IL-W-4
if you claim total exemption from Illinois
Income Tax withholding, but you have not
filed a federal Form W-4 claiming total
exemption. Also, if the Internal Revenue
Service (IRS) has instructed your em-
ployer to disregard your federal Form W-4,
your employer must also disregard your
Form IL-W-4. Finally, if you claim 15 or
more exemptions on your Form IL-W-4
without claiming at least the same number
of exemptions on your federal Form W-4,
and your employer is not required to refer
your federal Form W-4 to the IRS for re-
view, your employer must refer your Form
IL-W-4 to the department for review. In that
case, your Form IL-W-4 will be effective
unless and until the department notifies
your employer to disregard it.
What is an exemption?
An exemption is a dollar amount on
which you do not have to pay Illinois
Income Tax. Therefore, your employer will
withhold Illinois Income Tax based on your
compensation minus the exemptions to
which you are entitled.
What is an allowance?
The dollar amount that is exempt from
Illinois Income Tax is based on the number
of allowances you claim on this form. As
an employee, you receive one allowance
unless you are claimed as a dependent on
another persons tax return (e.g., your par-
ents claim you as a dependent on their tax
return). If you are married, you may claim
additional allowances for your spouse and
any dependents that you are entitled to
claim for federal income tax purposes. Y ou
also will receive additional allowances if
you or your spouse are age 65 or older, or
if you or your spouse are legally blind.
How do I figure the correct
number of allowances?
Complete the worksheet on the back of
this page to figure the correct number
of allowances you are entitled to claim.
Give your completed Form IL-W-4 to your
employer. K eep the worksheet for your
records.
If you have more than one job or
your spouse works, you should figure the
total number of allowances you are en-
titled to claim. Y our withholding usually will
be more accurate if you claim all of your
allowances on the Form IL-W-4 for the
highest-paying job and claim z ero on all of
your other IL-W-4 forms.
What if I underpay my tax?
If the amount withheld from your com-
pensation is not enough to cover your
tax liability for the year, (e.g., you have
non-wage income, such as interest or
dividends), you may reduce the number of
allowances or request that your employer
withhold an additional amount from your
pay. Otherwise, you may owe additional
tax at the end of the year. If you do not
have enough tax withheld from your pay,
and you owe more than $500 tax at the
end of the year, you may owe a late-pay-
ment penalty. Y ou should either increase
the amount you have withheld from your
pay, or you must make estimated tax pay-
ments.
Y ou may be assessed a late-payment
penalty if your required estimated pay-
ments are not paid in full by the due dates.
Y ou may still owe this penalty for an
earlier quarter, even if you pay enough tax
later to make up the underpayment from a
previous quarter.
For additional information on penalties,
see Publication 103, Uniform Penal-
ties and Interest. Visit our web site at
tax.illinois.gov to obtain a copy.
Where do I get help?
Visit our web site at tax.illinois.gov
Call our Taxpayer Assistance Division
at 1 800 732-8866 or 217 782-3336
Call our TDD (telecommunications
device for the deaf) at 1 800 544-5304
Write to
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19044
SPRINGFIELD IL 62794-9044
Illinois Withholding Allowance Worksheet
General Information If you have more than one job or your spouse works, you should
Complete this worksheet to figure your total withholding allow- figure the total number of allowances you are entitled to claim.
ances. Your withholding usually will be more accurate if you claim all of
Everyone must complete Step 1. your allowances on the Form IL-W-4 for the highest-paying job
Complete Step 2 if and claim zero on all of your other IL-W-4 forms.
you (or your spouse) are age 65 or older or legally blind, or You may reduce the number of allowances or request that your
you wrote an amount on Line 4 of the Deductions and employer withhold an additional amount from your pay, which may
Adjustments Worksheet for federal Form W-4. help avoid having too little tax withheld.

Step 1: Figure your basic personal allowances (including allowances for dependents)
Check all that apply:
No one else can claim me as a dependent.
I can claim my spouse as a dependent.
1 Write the total number of boxes you checked. 1 _______________
2 Write the number of dependents (other than you or your spouse) you will claim on your tax return. 2 _______________
3 Add Lines 1 and 2. Write the result. This is the total number of basic personal allowances to which
you are entitled. 3 _______________
4 If you want to have additional Illinois Income Tax withheld from your pay, you may reduce the
number of basic personal allowances or have an additional amount withheld. Write the total number
of basic personal allowances you elect to claim on Line 4 and on Form IL-W-4, Line 1. 4 _______________

Step 2: Figure your additional allowances

Check all that apply:
I am 65 or older. I am legally blind.
My spouse is 65 or older. My spouse is legally blind.
5 Write the total number of boxes you checked. 5 _______________
6 Write any amount that you reported on Line 4 of the Deductions and Adjustments Worksheet
for federal Form W-4. 6 _______________
7 Divide Line 6 by 1,000. Round to the nearest whole number. Write the result on Line 7. 7 _______________
8 Add Lines 5 and 7. Write the result. This is the total number of additional allowances to which
you are entitled. 8 _______________
9 If you want to have additional Illinois Income Tax withheld from your pay, you may reduce the
number of additional allowances or have an additional amount withheld. Write the total number
of additional allowances you elect to claim on Line 9 and on Form IL-W-4, Line 2. 9 _______________

If you have non-wage income and you expect to owe Illinois Income Tax on that income, you may choose to have an additional
amount withheld from your pay. On Line 3 of Form IL-W-4, write the additional amount you want your employer to withhold.

Cut here and give the certificate to your employer. Keep the top portion for your records.

Illinois Department of Revenue

IL-W-4 Employees Illinois Withholding Allowance Certificate
____ ____ ____ - ____ ____ - ____ ____ ____ ____
1 Write the total number of basic allowances that you
Social Security number are claiming (Step 1, Line 4, of the worksheet). 1 ____________
________________________________________________________________________ 2 Write the total number of additional allowances that
Name you are claiming (Step 2, Line 9, of the worksheet). 2 ____________
________________________________________________________________________ 3 Write the additional amount you want withheld
Street address
(deducted) from each pay. 3 ____________
________________________________________________________________________ I certify that I am entitled to the number of withholding allowances claimed on
City State ZIP this certificate.
Check the box if you are exempt from federal and Illinois ______________________________________________________________________
Your signature Date
Income Tax withholding. Employer: Keep this certificate with your records. If you have referred the employees federal
certificate to the IRS and the IRS has notified you to disregard it, you may also be required to
This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this disregard this certificate. Even if you are not required to refer the employees federal certificate
information is REQ UIRED. Failure to provide information could result in a penalty. to the IRS, you still may be required to refer this certificate to the Illinois Department of Revenue
IL-W-4 (R-12/07) This form has been approved by the Forms Management Center. IL-492-0039 for inspection. See Illinois Income Tax Regulations 86 Ill. Adm. Code 100.7110.

Department of Homeland Security
U.S. Citizenship and Immigration Services
Instructions
Please read all instructions carefully before completing this form.
Anti-Discrimination Notice. It is illegal to discriminate against
any individual (other than an alien not authorized to work in the
U.S.) in hiring, discharging, or recruiting or referring for a fee
because of that individual's national origin or citizenship status. It
is illegal to discriminate against work eligible individuals.
Employers CANNOT specify which document(s) they will accept
from an employee. The refusal to hire an individual because the
documents presented have a future expiration date may also
constitute illegal discrimination.
What Is the Purpose of This Form?
The purpose of this form is to document that each new
employee (both citizen and non-citizen) hired after November
6, 1986 is authorized to work in the United States.
When Should the Form I-9 Be Used?
All employees, citizens and noncitizens, hired after November
6, 1986 and working in the United States must complete a
Form I-9.
Filling Out the Form I-9
Section 1, Employee: This part of the form must be
completed at the time of hire, which is the actual beginning of
employment. Providing the Social Security number is
voluntary, except for employees hired by employers
participating in the USCIS Electronic Employment Eligibility
Verification Program (E-Verify). The employer is
responsible for ensuring that Section 1 is timely and
properly completed.
Preparer/Translator Certification. The Preparer/Translator
Certification must be completed if Section 1 is prepared by a
person other than the employee. A preparer/translator may be
used only when the employee is unable to complete Section 1
on his/her own. However, the employee must still sign
Section 1 personally.
Section 2, Employer: For the purpose of completing this
form, the term "employer" means all employers including
those recruiters and referrers for a fee who are agricultural
associations, agricultural employers or farm labor contractors.
Employers must complete Section 2 by examining evidence
of identity and employment eligibility within three (3)
business days of the date employment begins. If employees
are authorized to work, but are unable to present the required
OMB No. 1615-0047; Expires 06/30/09
Form I-9, Employment
Eligibility Verification
document(s) within three business days, they must present a
receipt for the application of the document(s) within three
business days and the actual document(s) within ninety (90)
days. However, if employers hire individuals for a duration of
less than three business days, Section 2 must be completed at
the time employment begins. Employers must record:
1. Document title;
2. Issuing authority;
3. Document number;
4. Expiration date, if any; and
5. The date employment begins.
Employers must sign and date the certification. Employees
must present original documents. Employers may, but are not
required to, photocopy the document(s) presented. These
photocopies may only be used for the verification process and
must be retained with the Form I-9. However, employers are
still responsible for completing and retaining the Form I-9.
Section 3, Updating and Reverification: Employers must
complete Section 3 when updating and/or reverifying the Form
I-9. Employers must reverify employment eligibility of their
employees on or before the expiration date recorded in Section
1. Employers CANNOT specify which document(s) they will
accept from an employee.
A. If an employee's name has changed at the time this
form is being updated/reverified, complete Block A.
B. If an employee is rehired within three (3) years of the
date this form was originally completed and the
employee is still eligible to be employed on the same
basis as previously indicated on this form (updating),
complete Block B and the signature block.
C. If an employee is rehired within three (3) years of the
date this form was originally completed and the
employee's work authorization has expired or if a
current employee's work authorization is about to
expire (reverification), complete Block B and:
1. Examine any document that reflects that the
employee is authorized to work in the U.S. (see
List A or C);
2. Record the document title, document number and
expiration date (if any) in Block C, and
3. Complete the signature block.
Form I-9 (Rev. 06/05/07) N

What Is the Filing Fee?
There is no associated filing fee for completing the Form I-9.
This form is not filed with USCIS or any government agency.
The Form I-9 must be retained by the employer and made
available for inspection by U.S. Government officials as
specified in the Privacy Act Notice below.
Submission of the information required in this form is
voluntary. However, an individual may not begin employment
unless this form is completed, since employers are subject to
civil or criminal penalties if they do not comply with the
Immigration Reform and Control Act of 1986.
Paperwork Reduction Act

USCIS Forms and Information
To order USCIS forms, call our toll-free number at 1-800-870-
3676. Individuals can also get USCIS forms and information
on immigration laws, regulations and procedures by
telephoning our National Customer Service Center at 1-800-
375-5283 or visiting our internet website at www.uscis.gov.
Photocopying and Retaining the Form I-9
A blank Form I-9 may be reproduced, provided both sides are
copied. The Instructions must be available to all employees
completing this form. Employers must retain completed Forms
I-9 for three (3) years after the date of hire or one (1) year
after the date employment ends, whichever is later.
We try to create forms and instructions that are accurate, can
be easily understood and which impose the least possible
burden on you to provide us with information. Often this is
difficult because some immigration laws are very complex.
Accordingly, the reporting burden for this collection of
information is computed as follows: 1) learning about this
form, and completing the form, 9 minutes; 2) assembling and
filing (recordkeeping) the form, 3 minutes, for an average of
12 minutes per response. If you have comments regarding the
accuracy of this burden estimate, or suggestions for making
this form simpler, you can write to: U.S. Citizenship and
Immigration Services, Regulatory Management Division, 111
Massachusetts Avenue, N.W., 3rd Floor, Suite 3008,
Washington, DC 20529. OMB No. 1615-0047.

The Form I-9 may be signed and retained electronically, as

authorized in Department of Homeland Security regulations
at 8 CFR 274a.2.

Privacy Act Notice

The authority for collecting this information is the

Immigration Reform and Control Act of 1986, Pub. L. 99-603
(8 USC 1324a).

This information is for employers to verify the eligibility of

individuals for employment to preclude the unlawful hiring, or
recruiting or referring for a fee, of aliens who are not
authorized to work in the United States.

This information will be used by employers as a record of

their basis for determining eligibility of an employee to work
in the United States. The form will be kept by the employer
and made available for inspection by officials of U.S.
Immigration and Customs Enforcement, Department of Labor
and Office of Special Counsel for Immigration Related Unfair
Employment Practices.

EMPLOYERS MUST RETAIN COMPLETED FORM I-9 Form I-9 (Rev. 06/05/07) N Page 2
PLEASE DO NOT MAIL COMPLETED FORM I-9 TO ICE OR USCIS
 OMB No. 1615-0047; Expires 06/30/09
Department of Homeland Security Form I-9, Employment
U.S. Citizenship and Immigration Services Eligibility Verification
Please read instructions carefully before completing this form. The instructions must be available during completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work eligible individuals. Employers CANNOT
specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a
future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Verification. To be completed and signed by employee at the time employment begins.
Print Name: Last First Middle Initial Maiden Name

Address (Street Name and Number) Apt. # Date of Birth (month/day/year)

City State Zip Code Social Security #

I attest, under penalty of perjury, that I am (check one of the following):

I am aware that federal law provides for A citizen or national of the United States
imprisonment and/or fines for false statements or A lawful permanent resident (Alien #) A
use of false documents in connection with the An alien authorized to work until
completion of this form.
(Alien # or Admission #)
Employee's Signature Date (month/day/year)

Preparer and/or Translator Certification. (To be completed and signed if Section 1 is prepared by a person other than the employee.) I attest, under
penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.
Preparer's/Translator's Signature Print Name

Address (Street Name and Number, City, State, Zip Code) Date (month/day/year)

Section 2. Employer Review and Verification. To be completed and signed by employer. Examine one document from List A OR
examine one document from List B and one from List C, as listed on the reverse of this form, and record the title, number and
expiration date, if any, of the document(s).
List A OR List B AND List C
Document title:

Issuing authority:
Document #:

Expiration Date (if any):

Document #:

Expiration Date (if any):

CERTIFICATION - I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, that
the above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on
(month/day/year) and that to the best of my knowledge the employee is eligible to work in the United States. (State
employment agencies may omit the date the employee began employment.)
Signature of Employer or Authorized Representative Print Name Title

Business or Organization Name and Address (Street Name and Number, City, State, Zip Code) Date (month/day/year)

Section 3. Updating and Reverification. To be completed and signed by employer.

A. New Name (if applicable) B. Date of Rehire (month/day/year) (if applicable)

C. If employee's previous grant of work authorization has expired, provide the information below for the document that establishes current employment eligibility.
Document Title: Document #: Expiration Date (if any):
l attest, under penalty of perjury, that to the best of my knowledge, this employee is eligible to work in the United States, and if the employee presented
document(s), the document(s) l have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized Representative Date (month/day/year)

Form I-9 (Rev. 06/05/07) N

 LISTS OF ACCEPTABLE DOCUMENTS
LIST A
Documents that Establish Both
Identity and Employment
Eligibility OR
1. U.S. Passport (unexpired or expired)
2. Permanent Resident Card or Alien
Registration Receipt Card (Form
I-551)
3. An unexpired foreign passport with a
temporary I-551 stamp
4. An unexpired Employment
Authorization Document that contains
a photograph
(Form I-766, I-688, I-688A, I-688B)
5. An unexpired foreign passport with
an unexpired Arrival-Departure
Record, Form I-94, bearing the same
name as the passport and containing
an endorsement of the alien's
nonimmigrant status, if that status
authorizes the alien to work for the
employer
Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274)
LIST B
Documents that Establish
Identity
AND
1. Driver's license or ID card issued by
a state or outlying possession of the
United States provided it contains a
photograph or information such as
name, date of birth, gender, height,
eye color and address
2. ID card issued by federal, state or
local government agencies or
entities, provided it contains a
photograph or information such as
name, date of birth, gender, height,
eye color and address
3. School ID card with a photograph
4. Voter's registration card
5. U.S. Military card or draft record
6. Military dependent's ID card
7. U.S. Coast Guard Merchant Mariner
Card
8. Native American tribal document
9. Driver's license issued by a Canadian
government authority
For persons under age 18 who
are unable to present a
document listed above:
10. School record or report card
11. Clinic, doctor or hospital record
12. Day-care or nursery school record
LIST C
Documents that Establish
Employment Eligibility
1. U.S. Social Security card issued by
the Social Security Administration
(other than a card stating it is not
valid for employment)
2. Certification of Birth Abroad
issued by the Department of State
(Form FS-545 or Form DS-1350)
3. Original or certified copy of a birth
certificate issued by a state,
county, municipal authority or
outlying possession of the United
States bearing an official seal
4. Native American tribal document
5. U.S. Citizen ID Card (Form I-197)
6. ID Card for use of Resident
Citizen in the United States (Form
I-179)
7. Unexpired employment
authorization document issued by
DHS (other than those listed under
List A)
Form I-9 (Rev. 06/05/07) N Page 2
 Before you begin
working and before you
will receive a paycheck
you need to complete
and submit the
following:
Employee Manual Receipt Acknowledgment
Employee Emergency Information Form
Federal W-4
Illinois W-4
I-9 Including required documentation