Technician Hiring Packet August 2014

Welcome!
We are excited to have you join our team and look forward to your aid in making White
Knight Pest Control one of the best pest control companies in the industry. Our goal is to
not only grow as a company, but to help each employee grow personally. We believe
that each employee’s personal success and growth is a direct reflection of the success and
growth of the company. To help each employee find greater success we have outlined
four important characteristics each individual should have:
1) Honesty
2) Integrity
3) Teamwork
4) Commitment
We call these 4 characteristics our Coat of Arms…a creed which we strive to live by. We
challenge you to continue to develop these characteristics and define what they mean to
you! As you do so, you will find greater joy and self worth as an employee at White
Knight Pest control and most importantly as an individual!
It is our hope that you will put forth your best efforts in your position as Technician. By
doing so you will find happiness in serving customers and discover a sense of self
fulfillment in knowing that you play an important role in the success of White Knight
Pest Control!
Sincerely,
White Knight Management

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WHITE KNIGHT PEST CONTROL, INC.
AUTHORIZATION TO RELEASE INFORMATION

I,
Last Name First Name Middle Name
Current Address Dates Lived Here
Addresses for the Past Seven Years: (include street, city, state, zip code) Dates of Residence:
Date of Birth Other Names Used (including maiden name) Years Used
Social Security Number Driver's License # State
do hereby authorize verification of all information in my employment application from all sources of employment, education, motor
vehicle, financial history, criminal history, personal character, and worker's compensation records in accordance with ADA, labor and
wage records, etc. or any part thereof, and authorize any duly authorized agent of IntelliCorp Records, Inc to obtain, whether the said
records are public or private, and including those which may be deemed to be privileged or confidential in nature and I release all persons
from liability on account of such disclosures. Information appearing on this Authorization will be used exclusively by IntelliCorp
Records, Inc for identification purposes and for the release information which will be considered in determining any suitability for
employment. I certify that I have made true, correct, and complete answers and statements on my employment application, any
supplements to it and in any interview in the knowledge that they will be relied upon in considering my application for employment. I
agree to provide additional information that may be requested to process my employment application. I authorize without reservation,
any party or agency contacted by IntelliCorp Records, Inc to furnish the above-mentioned information. This authorization is valid
during the course of my employment to the extent permitted by law.
**I hereby do _______do not_________ authorize you to contact my current employer for Employment and Reference Verifications
(This will authorize immediate inquiries to the Human Resources Department and to any listed supervisors or references in the
Employment/Reference Section of your application.)
I have the right to make a request to IntelliCorp Records, Inc, upon proper identification, to request the nature and substance of all
information in its files on me at the time of my request, including sources of information, and the recipients of any reports on me which
IntelliCorp Records, Inc has previously furnished within the two year period preceding my request.
I understand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any
supplements to it and in any interviews will be sufficient grounds for rejection of employment and my discharge after employment.
________________________________________ _______________
Printed Name Applicant Signature Date
CALIFORNIA, OKLAHOMA, and MINNESOTA RESIDENTS ONLY: If you are a current California, Oklahoma, or
Minnesota resident and would like to request a copy of your Consumer Report or Investigative Consumer Report, please check
the box. This report may include character and reputation information obtained through personal interviews.
P.O. Box 12076 Austin, Texas 78711 (877) 542-2474
Hearing impaired: (800) 735-2988 voice www.TexasAgriculture.gov
Texas Department of Agriculture

Notice of Apprentice Employment &
Todd Staples, Commissioner
Application for Technician License SPT-430
1
LICENSE TYPE (PLEASE CHECK ONE) TDA USE ONLY
SECTION A
Commercial Client No. Account No.

Noncommercial
Noncommercial Political (Government or School) Date (mm/dd/yy) Initials
My spouse is an active duty service member.* Yes No / /
1
APPLICANT INFORMATION
Social Security No. - - (SSN – required†) Date of Birth
First Name (Legal Name) M. I. Last Name Suffix
Home Mailing Address City State Zip

SECTION B
Physical Address (if different) City State Zip
Email Address Phone Number Date of Hire

( ) -
***Important Note*** I understand that my email address is required for the Texas Department of Agriculture to keep me
informed of critical information, including licensing and regulatory updates; renewal invoices; and other important
communications. Failure to provide an email address may result in my not receiving time-sensitive information that could
affect my compliance with state regulations, thereby, resulting in monetary penalties.
1
EMPLOYER INFORMATION
Business Name License Number
SECTION C
2
EMPLOYER LOCATION ADDRESS (NO P.O. BOX)
Address
City State Zip
Please send correspondence for this applicant to the Employer (rather than to the applicant)
† A social security number is mandatory and required by Texas Family Code § 231.302 for this occupational license. Social security numbers
are required to assist in child support enforcement. In the event the applicant does not have a social security number, an affidavit of no social
security number (form OGC-001) must be attached and a driver license number or state-issued ID number provided. This form is available on
our website www.TexasAgriculture.gov or by mail. Failure to provide a social security number or an affidavit of no social security number will
result in rejection of your application and a license will not be issued to you.
* Pursuant to Section 55.005 of the Texas Occupations Code.
This document becomes public record and is subject to disclosure. With few exceptions, you have the right to request and be informed about the
information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the
right to ask the state agency to correct any information that is determined to be incorrect. (Reference: Government Code, Sections 552.021,
552.023, and 559.004.)
Licensing Department Revised 01/01/14

Administrative Services Division
SPT-430 Application for Apprentice Registration Page 2 of 2
Applicant Name _________________________
1
STRUCTURAL PEST CONTROL ELIGIBILITY NOTIFICATIONS
Notice on Criminal Histories: TDA performs criminal history searches on all Structural Pest Control applicants and licensees,
SECTION D
including those applying for renewal of an existing license. At minimum, criminal history information is sought from the Texas
Department of Public Safety. This process may delay agency action on a license application, if the applicant’s criminal history
reveals an arrest for, conviction of, or a plea of guilty to a criminal offense. If an applicant’s or licensee’s criminal history
reveals a conviction or plea of guilty to a criminal offense which relates to the occupation of structural pest control, the
applicant will be asked to submit additional information to demonstrate the applicant’s current fitness to be licensed. Failure to
submit the requested information, submission of false or misleading information, or failure to demonstrate current fitness to be
licensed may result in denial of the application or revocation of existing license.
1
SIGNATURE
The applicant and the applicant’s employer, by and through their personal or agent's signature below (1) certifies that all
information provided in connection with this application at any time is true and correct to the best of the signer’s knowledge;
(2) acknowledges that any misrepresentation or false statement made by the applicant, or the applicant’s employer, in
connection with this application, whether intentional or not, will constitute grounds for denial, revocation, or non-renewal of
any license issued pursuant to this application and/or assessment of monetary administrative penalties; and (3) if applying as an
individual, further acknowledges that this application may be denied and that any license issued pursuant to this application
SECTION E
may be suspended, revoked, or denied renewal due to delinquency in payment of a guaranteed student loan and that any license
issued pursuant to this application may be suspended or denied renewal for failure to pay child support. If signed by an agent of
the applicant or employer, the person signing certifies that he or she is authorized to make the preceding certifications on
behalf of the applicant.
Name of Applicant (print) Name and Title of Employer’s Representative (print)
Signature of Applicant Signature of Employer’s Representative
Date (mm/dd/yy) Date (mm/dd/yy)

/ / / /
1
PAYMENT
SECTION F
Application Fee for Technician License is $81.00

This fee is non-refundable.
Mail to:
Texas Department of Agriculture
P.O. Box 12076, Austin, TX 78711-2076
• Date of Hire refers to the date the applicant began training to perform Pest Control Services for the business named
above. Pest Control is defined as identifying infestations, making inspection reports, recommendations, estimates, or bids
whether oral or written, submitting bids or performing services designed to prevent, control or eliminate infestation.
• This application must be submitted by the employer within 10 days of the Date of Hire.
• An individual must be at least 16 years of age and be able to demonstrate proficiency in reading U.S. Environmental
Protection Agency approved pesticide labels and warnings to register as an apprentice and apply for a technician’s
license.
•
Licensing Department Revised 01/01/14

Administrative Services Division
COMMISSIONER TODD STAPLES
TEXAS DEPARTMENT OF AGRICULTURE
STRUCTURAL PEST CONTROL SERVICE
P.O. BOX 12847, AUSTIN, TEXAS 78711-2847
Phone: 877-542-2474 Fax: 888-232-2567
Internet Address: www.texasagriculture.gov/spcs
Hearing Impaired: (800) 735-2988 (voice)
Change of License Form
***This form is NOT to be used to change a Business License or an Apprentice Card.***

Check Type of License to Be issued: [ ] Certified Applicator [ ] Technician
Check Type of Classification: [ ] Commercial [ ] Noncommercial
Must Indicate The Type of Change to be Made:
[ ] Change of Employer – If leaving current employer or changing branch office and going to work for different employer or branch office.
Complete All Sections. In Section B List the new employers information. Fees are based upon expiration date of new employer’s license and
insurance.
[ ] Additional License – If currently licensed and want another license issued at another location. Complete All Sections.
In Section B List the information of the employer you want the additional licensed issued to. Fees are based upon expiration date of additional
employer’s license and insurance.
[ ] Lost / Reprint License – If you lost a license or want a reprint. Complete All Sections. Fee for reprint is $30.
[ ] Inactive Status – No longer employed with a pest control company or noncommercial entity. Complete Sections A & C. No charge unless a
duplicate license is wanted. To maintain license, must renew license yearly. See Section 593.6 of the SPCS Regs.
[ ] Address Change – Licensee’s residential/mailing address only. Complete All Sections.
[ ] Changing Individual name – If your name has changed enclose a copy of a legal document evidencing your name change, such as marriage
license or court decree verifying your identity.
[ ] Other- Explain:
Section A – MUST be completed by applicant (Print or Type)
Legal Name of Applicant License #
Social Security No.* Drivers License No. Date of Birth
Home Location Address

Street City County State Zip
Home Mailing Address
Home Tel. No. ( ) Home Email: Effective Date of Change:
Section B – Must be completed if applicable (Print or Type)

Name of Company or Entity TPCL # If Applicable
Business Telephone No. ( ) Business Fax No. ( ) Bus Email:
Location Address:
Mailing Address:
Street or PO Box City County State Zip
Section C – Must be completed by Applicant (Print or Type)

The Structural Pest Control Service performs criminal history searches on all license applicants and licensees, including those
applying for renewal of an existing license. At minimum, criminal history information is sought from the Texas Department of
Public Safety. This process may delay agency action on a license application, if the applicant's criminal history reveals an
arrest for, conviction of, or a plea of guilty to a criminal offense. If an applicant's or licensee's criminal history reveals a
conviction or plea of guilty to a criminal offense which relates to the occupation of structural pest control, the applicant will be
asked to submit additional information to demonstrate the applicant's current fitness to be licensed. Failure to submit the
requested information, submission of false or misleading information, or failure to demonstrate current fitness to be licensed
may result in denial of the application or revocation of an existing license.
SIGNATURE OF APPLICANT DATE

Revised 9-1-12
Texas Department of Agriculture Structural Pest Control Service
Fee Structure Effective September 1, 2012
$224 for an original and renewal business license;
$108 for an original certified applicators license; $100 for a renewal certified applicators license;
$81 for an original technician license; $76 for a renewal technician license;
$75 for administering exams in each category;
1½ for late renewal fee for up to ninety (90) days late;
2 x for later renewal fee for ninety-one (91) – three hundred sixty-five (365) days late;
***Important Note*** I understand that my email address is required for the Texas Department of Agriculture to keep me informed
of critical information, including licensing and regulatory updates; renewal invoices; and other important communications. Failure to
provide an email address may result in my not receiving time-sensitive information that could affect my compliance with state
regulations, thereby, resulting in monetary penalties.
TAPE VOIDED CHECK HERE
DIRECT DEPOSIT AGREEMENT
American Payroll is pleased to offer you a new payday convenience. DIRECT DEPOSIT. Now you can have your paycheck automatically deposited into your checking or savings account on
payday. Direct Deposit is safe, convenient and easy. You do not even have to change your present banking relationship.
The first payday after setup you will receive an actual check and your accounts will be verified through the Direct Deposit System. After account approvals, on payday you will receive a direct
deposit voucher showing gross pay, taxes, other deductions and net pay and your money will be deposited into your accounts. The amount of the deposits will appear on your bank statements as
well.
Please fill out the below form, sign and attach a voided check for each account listed. No deposit slips please.
Employees Authorization – Please fill out and return to your employer.

I authorize my employer, Intercept Corporation, and the financial institutions listed below to initiate electronic credit entries and, if necessary, debit
entries and adjustments for any; credit entries which were incompletely funded by my employer or for any credit entries otherwise in error to the
listed accounts each payday. This authority will remain in effect, until I cancel it in writing.
EMPLOYEE NAME – FIRST, MIDDLE INITIAL, LAST SOCIAL SECURITY NUMBER
CHECKING ACCOUNT FLAT AMOUNT $ BANK NAME
SAVINGS PERCENTAGE %
ROUTING NUMBER ( 9 NUMBERS )
ACCOUNT NUMBER
SIGNATURE
DATE
(DO NOT STAPLE)
Employee Enrollment Form

UnitedHealthcare Insurance Company
UnitedHealthcare of Texas, Inc.
To speed the enrollment process, please be thorough and fill out all sections that apply. National Pacific Dental, Inc.
Group
To BeName
Completed by Employer Requested Effective Date of Coverage/Date of Change / /
Group Name Policy Number
Date of Hire
/ / Reason for Application
New Group Plan New Hire
Employee Type
(Check all that apply)
Position/Title Life Event/Date_______ Annual Active COBRA State Continuation
Status Change_______ Open Start dt ____/____/____
Dependent Add/Delete Enrollment End dt____/____/____
Hours Worked per week Change Name/Address Late Hourly* Salary*
Part time to Full time Enrollee Union* Non-Union* Retired
Required only if Life, STD, Waiving Coverage Termination Other ____________________________
Salary $_____________ or LTD Plan based on salary Other _________________________ *Does not apply to health benefits
A. Employee Information If you are waiving all coverage, please complete sections A and F.
Last Name First Name MI Social Security Number
Address Apt # City State Zip Code Home/Cell Phone
Date of Birth Sex Email Address Work Phone

/ / M F
Marital Status Single Married Divorced Widowed Do you use tobacco?1 Yes No
If yes, are you currently participating in a tobacco cessation program or
Language Preference, if not English do you intend to join one? Yes No
Do you have a disability affecting your ability to communicate or read? Yes No
Primary Care Physician2, Obstetrician or Gynecologist Existing Patient? Yes No Primary Care Dentist3
Physician First & Last Name ______________________________________ Dentist First & Last Name ____________________________
Address ______________________________________________________ ID#______________________________________________
ID# ___I___I___I___I___I___I___I___I___I___I___I – I___I___I Existing Patient? Yes No
HMO female enrollees are not required to select an obstetrician or gynecologist. Obstetrical or gynecological care can be received from her
primary care physician, primary care provider or an obstetrician or gynecologist.
B. Family Information List All Enrolling (Attach sheet if necessary)
Relationship4 Last Name First Name MI Sex Date of Birth

MF / /
Spouse Social Security Number Do you use tobacco?1 Yes No
/Domestic If yes, are you currently participating in a tobacco cessation program or
Partner do you intend to join one? Yes No
Primary Care Physician2, Obstetrician or Gynecologist Existing Patient? Yes No Primary Care Dentist3
Physician First & Last Name ______________________________________ Dentist First & Last Name ____________________________
Address ______________________________________________________ ID#______________________________________________
ID# ___I___I___I___I___I___I___I___I___I___I___I – I___I___I Existing Patient? Yes No
(1) Tobacco means all tobacco products, including, but not limited to, cigarettes, cigars, and chewing tobacco. You should only check the “yes” box above if tobacco
was used four or more times per week on average (excluding religious or ceremonial use) within the past 6 months by someone of legal age to purchase tobacco in
the state of residence. (2) For UnitedHealthcare Health Maintenance Organization (HMO) products, including Compass, Navigate, Select, Select Plus, and other
products requiring you to choose a Primary Care Physician (PCP), you must use the UnitedHealthcare directory of providers to choose a PCP for yourself and each
of your covered dependents. (3) Please see employer representative as some HMO dental plans require a Primary Care Dentist (PCD) selection. (4) For court
ordered dependent, legal documentation must be attached. If a dependent does not reside with eligible employee, please provide address on a separate sheet. (5) If
you answered “Yes” for Disabled and the dependent child is 26 years of age or older, unmarried, chiefly dependent upon subscriber for support and is not able to be
self-supporting because of a physically or mentally disabling injury, illness or condition, please attach a medical certification of disability.
275-7354 1/14
SG.EE.14.TX 5/13 Page 1 of 4 [groups of 2-50]
Employee Name __________________________________________________________________________________________________________
B. Family/Dependent Information (continued) List All Enrolling (Attach sheet if necessary)

Last Name First Name MI Sex Date of Birth
Relationship4
MF / /
Social Security Number Do you use tobacco? Yes No If yes, are you currently participating
1
Dependent in a tobacco cessation program or do you intend to join one? Yes No
Primary Care Physician2, Obstetrician or Gynecologist Existing Patient? Yes No Primary Care Dentist3 Existing Patient? Yes No
Physician First & Last Name ________________________________________ Dentist First & Last Name ___________________________
Address ________________________________________________________ ID# ____________________________________________
ID# ___I___I___I___I___I___I___I___I___I___I___I – I___I___I Permanently disabled and age 26 or older5 Yes No

MF / /
1
Address ________________________________________________________ ID# ____________________________________________

MF / /
1
Address ________________________________________________________ ID# ____________________________________________

MF / /
1
Address ________________________________________________________ ID# ____________________________________________
Please check the box for each coverage in which you or your dependents are enrolling.
If your employer offers a choice of plans, indicate which plan you are selecting. Indicate the dollar amount
C. Product Selection selected for the Life and Accidental Death & Dismemberment (AD&D), Supplemental Life, Short-Term Disability
(STD), and Long-Term Disability (LTD) plans. Benefit offerings are dependent upon employer selection.
Person Medical Dental Vision Basic Life/AD&D Supp Life/AD&D
Employee _____________ _____________ $_____________ $_____________
Spouse/Domestic Partner _____________ _____________ $_____________ $_____________
Dependent _____________ _____________ $_____________ $_____________
Person STD LTD
Employee
Life Insurance Beneficiary Full Name and Address (if applying for Life Insurance with UnitedHealthcare) Relationship
Primary
Secondary
Page 2 of 4
Employee Name __________________________________________________________________________________________________________
D. Prior Medical Insurance Information

Within the last 12 months, have you, your spouse, or your dependents had any other medical coverage?
NO YES (if yes, please complete this section.)
Prior medical carrier name ____________________________________________________ Effective date ___/___/___ End date ___/___/___
Prior coverage type: Employee Spouse Child(ren) Family
E. Other Medical Coverage Information This section must be completed. (Attach sheet if necessary.)
On the day this coverage begins, will you, your spouse or any of your dependents be covered under any other medical health plan or policy,
including another UnitedHealthcare plan or Medicare? YES (continue completing this section) NO (skip the rest of this section)
Name of other carrier ______________________________________________________
Other Group Medical Coverage Information Type Effective Date End Date Name and date of birth of policyholder
(only list those covered by other plan) (B/S/F)* MM/DD/YY MM/DD/YY for other coverage
Employee:
Spouse Name:
Dependent Name:
Dependent Name:
Dependent Name:
*B. Enter ‘B’ when this dependent is covered under both you and your spouse’s insurance plan (married)
S. Enter ‘S’ if you are the parent awarded custody of this dependent and no other individual is required to pay for this dependent’s medical expenses.
F. Enter ‘F’ if this dependent is covered by another individual (not a member of your household) required to pay for this dependent’s medical expenses.
Medicare – Employee Information: If enrolled in Medicare, please attach a copy of your Medicare ID card.
Enrolled in Part A: Effective Date _____________ Ineligible for Part A* Not Enrolled in Part A (chose not to enroll)**
Enrolled in Part B: Effective Date _____________ Ineligible for Part B* Not Enrolled in Part B (chose not to enroll)**
Enrolled in Part D: Effective Date _____________ Ineligible for Part D* Not Enrolled in Part D (chose not to enroll)**
Reason for Medicare eligibility: Over 65 Kidney Disease Disabled Disabled but actively at work
Are you receiving Social Security Disability Insurance (SSDI)? YES NO Start Date ___ /___ /___
Medicare – Spouse/Dependent Name: ____________________________________________
Enrolled in Part A: Effective Date _____________ Ineligible for Part A* Not Enrolled in Part A (chose not to enroll)**
Enrolled in Part B: Effective Date _____________ Ineligible for Part B* Not Enrolled in Part B (chose not to enroll)**
Enrolled in Part D: Effective Date _____________ Ineligible for Part D* Not Enrolled in Part D (chose not to enroll)**
Reason for Medicare eligibility: Over 65 Kidney Disease Disabled Disabled but actively at work
*Only check “Ineligible” if you have received documentation from your Social Security benefits that indicate that you are not eligible for Medicare.
** If you are eligible for Medicare on a primary basis (Medicare pays before benefits under the group policy), you should enroll in and maintain
coverage under Medicare Part A, Part B, and/or Part D as applicable.
F. Waiver of Coverage Declining coverage due to existence of other coverage: I understand that by waiving coverage at this time, I
I decline all coverage for: Spouse’s Employer’s Plan Individual Plan will not be allowed to participate unless I qualify at a
Myself Covered by Medicare Medicaid special enrollment period or as a late enrollee, if
Spouse COBRA from Prior Employer VA Eligibility applicable, or at the next open enrollment period.
Dependent Children Tri-Care
Myself and all dependents I (we) have no other coverage at this time
Other ____________________________________
Date Employee Signature if waiving coverage
Page 3 of 4
Texas Mandatory Disclosure Statement:
Dental indemnity benefits are provided through UnitedHealthcare Insurance Company and Dental HMO (DHMO) benefits are offered through
National Pacific Dental, Inc. In order to receive benefits from the DHMO plan, an enrollee must utilize only network providers, except for
emergency dental care, and pay the copayments specified in the evidence of coverage. To receive benefits under the dental indemnity plan,
the enrollee may utilize any provider but prior to receiving reimbursement, the enrollee must meet the required deductible and is responsible
for the coinsurance amount specified in the policy or certificate.
G. Signature
I authorize UnitedHealthcare Insurance Company and its affiliates (collectively, "UnitedHealthcare") to obtain, use and disclose my medical,
claim or benefit records, including any individually identifiable health information contained in these records. I understand these records may
contain information created by other persons or entities (including health care providers) as well as information regarding the use of drug,
alcohol, HIV/AIDS, mental health (other than psychotherapy notes), sexually transmitted disease and reproductive health services. I authorize
any health care provider, pharmacy benefit manager, other insurer or reinsurer, hospital, clinic or other medical facility, health care
clearinghouse, and any of their affiliates, representatives or business associates, to disclose my information to UnitedHealthcare and Affiliates.
I understand that the purpose of the disclosure and use of my information is to allow UnitedHealthcare to facilitate the appropriate
management of treatment, services, payment and benefits. I further understand that the information disclosed will not be used for purposes
of eligibility, enrollment, underwriting and premium risk rating. I understand this authorization is voluntary and I may refuse to sign the
authorization. I understand I may revoke this authorization at any time by notifying my UnitedHealthcare representative in writing, except to
the extent that action has already been taken in reliance on this authorization. As required by HIPAA, UnitedHealthcare also requires that I
acknowledge the following, which I do: I understand that information I authorize a person or entity to obtain and use may be re-disclosed and
no longer protected by federal privacy regulations. This authorization, unless revoked earlier, expires 30 months after the date it is signed.
I understand that I am completing a joint life and health application and that each response must be complete and accurate. I (we) request the
indicated group medical coverage. I authorize any required premium contributions to be deducted from my earnings. I (we) have not given the
agent or any other persons any required information not included on the application. I (we) understand that UnitedHealthcare is not bound by
any statements I (we) have made to any agent or to any other persons, if those statements are not written or printed on this application and
any attachments.
Please note that if you knowingly or intentionally leave out information or make a misrepresentation of a material fact on this form we may be
allowed by law to take one or more of the following actions: terminate or non-renew your coverage or change your premium retroactively to
the date your policy became effective.
Please maintain a copy of this authorization for your records.
Date Employee Signature for all applying Spouse Signature (if applying for coverage)
H. Census Information (optional)
NOTE: Responding to this question is optional and is not required. Data collected in this section will be used only to help communicate with
enrollees and inform them of specific programs to enhance their well-being. This information will not be used in the eligibility process.
1. Race, check all that apply: White Black, African-American American Indian/Alaska Native Asian
Native Hawaiian/Pacific Islander Other Race, please specify_______________________
2. Are you of Hispanic or Latino origin? Yes No
Coverage Provided by “UnitedHealthcare and Affiliates”:

Medical coverage provided by UnitedHealthcare Insurance Company (PPO, indemnity) or UnitedHealthcare of Texas, Inc. (HMO)
Dental coverage provided by UnitedHealthcare Insurance Company (indemnity) or National Pacific Dental, Inc. (HMO)
Life, Short-Term Disability (STD), Long-Term Disability (LTD) Insurance coverage provided by UnitedHealthcare Insurance Company
Vision coverage provided by UnitedHealthcare Insurance Company (PPO, indemnity)
Page 4 of 4
New Health Insurance Marketplace Coverage Form Approved
Options and Your Health Coverage OMB No.
PART A: General Information

ΈΙΖΟ͑ΜΖΪ͑ΡΒΣΥΤ͑ΠΗ͑ΥΙΖ͑ΙΖΒΝΥΙ͑ΔΒΣΖ͑ΝΒΨ͑ΥΒΜΖ͑ΖΗΗΖΔΥ͑ΚΟ͑ͣͥ͑͢͡͝ΥΙΖΣΖ͑ΨΚΝΝ͑ΓΖ͑Β͑ΟΖΨ͑ΨΒΪ͑ΥΠ͑ΓΦΪ͑ΙΖΒΝΥΙ͑ΚΟΤΦΣΒΟΔΖ: ΥΙΖ ͹ΖΒΝΥΙ͑
ͺΟΤΦΣΒΟΔΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑͟΅Π͑ΒΤΤΚΤΥ͑ΪΠΦ͑ΒΤ͑ΪΠΦ͑ΖΧΒΝΦΒΥΖ͑ΠΡΥΚΠΟΤ͑ΗΠΣ͑ΪΠΦ͑ΒΟΕ͑ΪΠΦΣ͑ΗΒΞΚΝΪ͑͝ΥΙΚΤ͑ΟΠΥΚΔΖ͑ΡΣΠΧΚΕΖΤ͑ΤΠΞΖ͑ΓΒΤΚΔ͑
ΚΟΗΠΣΞΒΥΚΠΟ͑ΒΓΠΦΥ͑ΥΙΖ͑ΟΖΨ͑;ΒΣΜΖΥΡΝΒΔΖ͑ΒΟΕ͑ΖΞΡΝΠΪΞΖΟΥνΓΒΤΖΕ͑ΙΖΒΝΥΙ͑ΔΠΧΖΣΒΘΖ͑ΠΗΗΖΣΖΕ͑ΓΪ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΣ͑͟
͑
What is the Health Insurance Marketplace?
΅ΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑ΚΤ͑ΕΖΤΚΘΟΖΕ͑ΥΠ͑ΙΖΝΡ͑ΪΠΦ͑ΗΚΟΕ͑ΙΖΒΝΥΙ͑ΚΟΤΦΣΒΟΔΖ͑ΥΙΒΥ͑ΞΖΖΥΤ͑ΪΠΦΣ͑ΟΖΖΕΤ͑ΒΟΕ͑ΗΚΥΤ͑ΪΠΦΣ͑ΓΦΕΘΖΥ͑͟΅ΙΖ͑
;ΒΣΜΖΥΡΝΒΔΖ͑ΠΗΗΖΣΤ͓͑ΠΟΖ͞ΤΥΠΡ͑ΤΙΠΡΡΚΟΘ͓͑ΥΠ͑ΗΚΟΕ͑ΒΟΕ͑ΔΠΞΡΒΣΖ͑ΡΣΚΧΒΥΖ͑ΙΖΒΝΥΙ͑ΚΟΤΦΣΒΟΔΖ͑ΠΡΥΚΠΟΤ͑͟ΊΠΦ͑ΞΒΪ͑ΒΝΤΠ͑ΓΖ͑ΖΝΚΘΚΓΝΖ͑
ΗΠΣ͑Β͑ΟΖΨ͑ΜΚΟΕ͑ΠΗ͑ΥΒΩ͑ΔΣΖΕΚΥ͑ΥΙΒΥ͑ΝΠΨΖΣΤ͑ΪΠΦΣ͑ΞΠΟΥΙΝΪ͑ΡΣΖΞΚΦΞ͑ΣΚΘΙΥ͑ΒΨΒΪ͑͟΀ΡΖΟ͑ΖΟΣΠΝΝΞΖΟΥ͑ΗΠΣ͑ΙΖΒΝΥΙ͑ΚΟΤΦΣΒΟΔΖ͑
ΔΠΧΖΣΒΘΖ͑ΥΙΣΠΦΘΙ͑ΥΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑ΓΖΘΚΟΤ͑ΚΟ͑΀ΔΥΠΓΖΣ͑ͣͤ͑͢͡ΗΠΣ͑ΔΠΧΖΣΒΘΖ͑ΤΥΒΣΥΚΟΘ͑ΒΤ͑ΖΒΣΝΪ͑ΒΤ͑ͻΒΟΦΒΣΪ͑͑ͣͥ͑͢͢͟͝͡
Can I Save Money on my Health Insurance Premiums in the Marketplace?

ΊΠΦ͑ΞΒΪ͑΢ΦΒΝΚΗΪ͑ΥΠ͑ΤΒΧΖ͑ΞΠΟΖΪ͑ΒΟΕ͑ΝΠΨΖΣ͑ΪΠΦΣ͑ΞΠΟΥΙΝΪ͑ΡΣΖΞΚΦΞ͑͝ΓΦΥ͑ΠΟΝΪ͑ΚΗ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΣ͑ΕΠΖΤ͑ΟΠΥ͑ΠΗΗΖΣ͑ΔΠΧΖΣΒΘΖ͑͝ΠΣ͑
ΠΗΗΖΣΤ͑ΔΠΧΖΣΒΘΖ͑ΥΙΒΥ͑ΕΠΖΤΟ͘Υ͑ΞΖΖΥ͑ΔΖΣΥΒΚΟ͑ΤΥΒΟΕΒΣΕΤ͑͟΅ΙΖ͑ΤΒΧΚΟΘΤ͑ΠΟ͑ΪΠΦΣ͑ΡΣΖΞΚΦΞ͑ΥΙΒΥ͑ΪΠΦ͘ΣΖ͑ΖΝΚΘΚΓΝΖ͑ΗΠΣ͑ΕΖΡΖΟΕΤ͑ΠΟ͑
ΪΠΦΣ͑ΙΠΦΤΖΙΠΝΕ͑ΚΟΔΠΞΖ͑͟
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
ΊΖΤ͑͟ͺΗ͑ΪΠΦ͑ΙΒΧΖ͑ΒΟ͑ΠΗΗΖΣ͑ΠΗ͑ΙΖΒΝΥΙ͑ΔΠΧΖΣΒΘΖ͑ΗΣΠΞ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΣ͑ΥΙΒΥ͑ΞΖΖΥΤ͑ΔΖΣΥΒΚΟ͑ΤΥΒΟΕΒΣΕΤ͑͝ΪΠΦ͑ΨΚΝΝ͑ΟΠΥ͑ΓΖ͑ΖΝΚΘΚΓΝΖ͑
ΗΠΣ͑Β͑ΥΒΩ͑ΔΣΖΕΚΥ͑ΥΙΣΠΦΘΙ͑ΥΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑ΒΟΕ͑ΞΒΪ͑ΨΚΤΙ͑ΥΠ͑ΖΟΣΠΝΝ͑ΚΟ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΣ͘Τ͑ΙΖΒΝΥΙ͑ΡΝΒΟ͑͟͹ΠΨΖΧΖΣ͑͝ΪΠΦ͑ΞΒΪ͑ΓΖ͑
ΖΝΚΘΚΓΝΖ͑ΗΠΣ͑Β͑ΥΒΩ͑ΔΣΖΕΚΥ͑ΥΙΒΥ͑ΝΠΨΖΣΤ͑ΪΠΦΣ͑ΞΠΟΥΙΝΪ͑ΡΣΖΞΚΦΞ͑͝ΠΣ͑Β͑ΣΖΕΦΔΥΚΠΟ͑ΚΟ͑ΔΖΣΥΒΚΟ͑ΔΠΤΥ͞ΤΙΒΣΚΟΘ͑ΚΗ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΣ͑ΕΠΖΤ͑
ΟΠΥ͑ΠΗΗΖΣ͑ΔΠΧΖΣΒΘΖ͑ΥΠ͑ΪΠΦ͑ΒΥ͑ΒΝΝ͑ΠΣ͑ΕΠΖΤ͑ΟΠΥ͑ΠΗΗΖΣ͑ΔΠΧΖΣΒΘΖ͑ΥΙΒΥ͑ΞΖΖΥΤ͑ΔΖΣΥΒΚΟ͑ΤΥΒΟΕΒΣΕΤ͑͟ͺΗ͑ΥΙΖ͑ΔΠΤΥ͑ΠΗ͑Β͑ΡΝΒΟ͑ΗΣΠΞ͑ΪΠΦΣ͑
ΖΞΡΝΠΪΖΣ͑ΥΙΒΥ͑ΨΠΦΝΕ͑ΔΠΧΖΣ͑ΪΠΦ͙͑ΒΟΕ͑ΟΠΥ͑ΒΟΪ͑ΠΥΙΖΣ͑ΞΖΞΓΖΣΤ͑ΠΗ͑ΪΠΦΣ͑ΗΒΞΚΝΪ͚͑ΚΤ͑ΞΠΣΖ͑ΥΙΒΟ͖͑ͪͦ͑͟ΠΗ͑ΪΠΦΣ͑ΙΠΦΤΖΙΠΝΕ͑
ΚΟΔΠΞΖ͑ΗΠΣ͑ΥΙΖ͑ΪΖΒΣ͑͝ΠΣ͑ΚΗ͑ΥΙΖ͑ΔΠΧΖΣΒΘΖ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΣ͑ΡΣΠΧΚΕΖΤ͑ΕΠΖΤ͑ΟΠΥ͑ΞΖΖΥ͑ΥΙΖ͓͑ΞΚΟΚΞΦΞ͑ΧΒΝΦΖ͓͑ΤΥΒΟΕΒΣΕ͑ΤΖΥ͑ΓΪ͑ΥΙΖ͑
ͲΗΗΠΣΕΒΓΝΖ͑ʹΒΣΖ͑ͲΔΥ͑͝ΪΠΦ͑ΞΒΪ͑ΓΖ͑ΖΝΚΘΚΓΝΖ͑ΗΠΣ͑Β͑ΥΒΩ͑ΔΣΖΕΚΥ͑͟͢
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ͿΠΥΖͫ͑ͺΗ͑ΪΠΦ͑ΡΦΣΔΙΒΤΖ͑Β͑ΙΖΒΝΥΙ͑ΡΝΒΟ͑ΥΙΣΠΦΘΙ͑ΥΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑ΚΟΤΥΖΒΕ͑ΠΗ͑ΒΔΔΖΡΥΚΟΘ͑ΙΖΒΝΥΙ͑ΔΠΧΖΣΒΘΖ͑ΠΗΗΖΣΖΕ͑ΓΪ͑ΪΠΦΣ͑
ΖΞΡΝΠΪΖΣ͑͝ΥΙΖΟ͑ΪΠΦ͑ΞΒΪ͑ΝΠΤΖ͑ΥΙΖ͑ΖΞΡΝΠΪΖΣ͑ΔΠΟΥΣΚΓΦΥΚΠΟ͙͑ΚΗ͑ΒΟΪ͚͑ΥΠ͑ΥΙΖ͑ΖΞΡΝΠΪΖΣ͞ΠΗΗΖΣΖΕ͑ΔΠΧΖΣΒΘΖ͑͟ͲΝΤΠ͑͝ΥΙΚΤ͑ΖΞΡΝΠΪΖΣ͑
ΔΠΟΥΣΚΓΦΥΚΠΟ͑͞ΒΤ͑ΨΖΝΝ͑ΒΤ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΖ͑ΔΠΟΥΣΚΓΦΥΚΠΟ͑ΥΠ͑ΖΞΡΝΠΪΖΣ͞ΠΗΗΖΣΖΕ͑ΔΠΧΖΣΒΘΖ͑͞ΚΤ͑ΠΗΥΖΟ͑ΖΩΔΝΦΕΖΕ͑ΗΣΠΞ͑ΚΟΔΠΞΖ͑ΗΠΣ͑
ͷΖΕΖΣΒΝ͑ΒΟΕ͑΄ΥΒΥΖ͑ΚΟΔΠΞΖ͑ΥΒΩ͑ΡΦΣΡΠΤΖΤ͑͟ΊΠΦΣ͑ΡΒΪΞΖΟΥΤ͑ΗΠΣ͑ΔΠΧΖΣΒΘΖ͑ΥΙΣΠΦΘΙ͑ΥΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑ΒΣΖ͑ΞΒΕΖ͑ΠΟ͑ΒΟ͑ΒΗΥΖΣ͞
ΥΒΩ͑ΓΒΤΚΤ͑͟
How Can I Get More Information?

ͷΠΣ͑ΞΠΣΖ͑ΚΟΗΠΣΞΒΥΚΠΟ͑ΒΓΠΦΥ͑ΪΠΦΣ͑ΔΠΧΖΣΒΘΖ͑ΠΗΗΖΣΖΕ͑ΓΪ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΣ͑͝ΡΝΖΒΤΖ͑ΔΙΖΔΜ͑ΪΠΦΣ͑ΤΦΞΞΒΣΪ͑ΡΝΒΟ͑ΕΖΤΔΣΚΡΥΚΠΟ͑ΠΣ͑
Mike Bilbry (817) 377-8787
ΔΠΟΥΒΔΥ͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͑͟
͑
΅ΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑ΔΒΟ͑ΙΖΝΡ͑ΪΠΦ͑ΖΧΒΝΦΒΥΖ͑ΪΠΦΣ͑ΔΠΧΖΣΒΘΖ͑ΠΡΥΚΠΟΤ͑͝ΚΟΔΝΦΕΚΟΘ͑ΪΠΦΣ͑ΖΝΚΘΚΓΚΝΚΥΪ͑ΗΠΣ͑ΔΠΧΖΣΒΘΖ͑ΥΙΣΠΦΘΙ͑ΥΙΖ͑
;ΒΣΜΖΥΡΝΒΔΖ͑ΒΟΕ͑ΚΥΤ͑ΔΠΤΥ͑͟΁ΝΖΒΤΖ͑ΧΚΤΚΥ͑͹ΖΒΝΥΙʹΒΣΖ͟ΘΠΧ͑ΗΠΣ͑ΞΠΣΖ͑ΚΟΗΠΣΞΒΥΚΠΟ͑͝ΚΟΔΝΦΕΚΟΘ͑ΒΟ͑ΠΟΝΚΟΖ͑ΒΡΡΝΚΔΒΥΚΠΟ͑ΗΠΣ͑ΙΖΒΝΥΙ͑
ΚΟΤΦΣΒΟΔΖ͑ΔΠΧΖΣΒΘΖ͑ΒΟΕ͑ΔΠΟΥΒΔΥ͑ΚΟΗΠΣΞΒΥΚΠΟ͑ΗΠΣ͑Β͑͹ΖΒΝΥΙ͑ͺΟΤΦΣΒΟΔΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑ΚΟ͑ΪΠΦΣ͑ΒΣΖΒ͑͟
͑͢ͲΟ͑ ΖΞΡΝΠΪΖΣ͞ΤΡΠΟΤΠΣΖΕ͑ ΙΖΒΝΥΙ͑ΡΝΒΟ͑ΞΖΖΥΤ͑ΥΙΖ͑ ͓ΞΚΟΚΞΦΞ͑ ΧΒΝΦΖ͑ΤΥΒΟΕΒΣΕ͓͑ ΚΗ͑ ΥΙΖ͑ΡΝΒΟ͘Τ͑ΤΙΒΣΖ͑ΠΗ͑ ΥΙΖ͑ΥΠΥΒΝ͑ΒΝΝΠΨΖΕ͑ΓΖΟΖΗΚΥ͑ΔΠΤΥΤ͑ΔΠΧΖΣΖΕ͑

ΓΪ͑ ΥΙΖ͑ΡΝΒΟ͑ΚΤ͑ ΟΠ͑ ΝΖΤΤ͑ΥΙΒΟ͑ͧ͑͡ΡΖΣΔΖΟΥ͑ΠΗ͑ ΤΦΔΙ͑ΔΠΤΥΤ͑͟
PART B: Information About Health Coverage Offered by Your Employer
΅ΙΚΤ͑ΤΖΔΥΚΠΟ͑ΔΠΟΥΒΚΟΤ͑ΚΟΗΠΣΞΒΥΚΠΟ͑ΒΓΠΦΥ͑ΒΟΪ͑ΙΖΒΝΥΙ͑ΔΠΧΖΣΒΘΖ͑ΠΗΗΖΣΖΕ͑ΓΪ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΣ͑͟ͺΗ͑ΪΠΦ͑ΕΖΔΚΕΖ͑ΥΠ͑ΔΠΞΡΝΖΥΖ͑ΒΟ͑
ΒΡΡΝΚΔΒΥΚΠΟ͑ΗΠΣ͑ΔΠΧΖΣΒΘΖ͑ΚΟ͑ΥΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑͝ΪΠΦ͑ΨΚΝΝ͑ΓΖ͑ΒΤΜΖΕ͑ΥΠ͑ΡΣΠΧΚΕΖ͑ΥΙΚΤ͑ΚΟΗΠΣΞΒΥΚΠΟ͑͟΅ΙΚΤ͑ΚΟΗΠΣΞΒΥΚΠΟ͑ΚΤ͑ΟΦΞΓΖΣΖΕ͑
ΥΠ͑ΔΠΣΣΖΤΡΠΟΕ͑ΥΠ͑ΥΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑ΒΡΡΝΚΔΒΥΚΠΟ͑͟
3. Employer name 4. Employer Identification Number (EIN)

White Knight Pest Control, Inc. 87-0759433
5. Employer address 6. Employer phone number
1900 FM 967 Suite A 512-535-3008
7. City 8. State 9. ZIP code
Buda TX 78610
10. Who can we contact about employee health coverage at this job?
Alfred White or Szucceed Ly
11. Phone number (if different from above) 12. Email address
͑ Alfred 817-914-7825, or Szucceed 512-673-373838 chipwhite@whiteknightpest.com or szucceedly@whiteknightpest.com
͹ΖΣΖ͑ΚΤ͑ΤΠΞΖ͑ΓΒΤΚΔ͑ΚΟΗΠΣΞΒΥΚΠΟ͑ΒΓΠΦΥ͑ΙΖΒΝΥΙ͑ΔΠΧΖΣΒΘΖ͑ΠΗΗΖΣΖΕ͑ΓΪ͑ΥΙΚΤ͑ΖΞΡΝΠΪΖΣͫ͑
x ͲΤ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΣ͑͝ΨΖ͑ΠΗΗΖΣ͑Β͑ΙΖΒΝΥΙ͑ΡΝΒΟ͑ΥΠͫ͑
✔ ͲΝΝ͑ΖΞΡΝΠΪΖΖΤ͑͑͑͟
͑
΄ΠΞΖ͑ΖΞΡΝΠΪΖΖΤ͑͟ͶΝΚΘΚΓΝΖ͑ΖΞΡΝΠΪΖΖΤ͑ΒΣΖͫ͑͑
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͑
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x ΈΚΥΙ͑ΣΖΤΡΖΔΥ͑ΥΠ͑ΕΖΡΖΟΕΖΟΥΤͫ͑
✔ ΈΖ͑ΕΠ͑ΠΗΗΖΣ͑ΔΠΧΖΣΒΘΖ͑͟ͶΝΚΘΚΓΝΖ͑ΕΖΡΖΟΕΖΟΥΤ͑ΒΣΖͫ͑
͑
Dependents of the employee and children up to age 26.
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ΈΖ͑ΕΠ͑ΟΠΥ͑ΠΗΗΖΣ͑ΔΠΧΖΣΒΘΖ͑͟
͑
✔ ͺΗ͑ΔΙΖΔΜΖΕ͑͝ΥΙΚΤ͑ΔΠΧΖΣΒΘΖ͑ΞΖΖΥΤ͑ΥΙΖ͑ΞΚΟΚΞΦΞ͑ΧΒΝΦΖ͑ΤΥΒΟΕΒΣΕ͑͝ΒΟΕ͑ΥΙΖ͑ΔΠΤΥ͑ΠΗ͑ΥΙΚΤ͑ΔΠΧΖΣΒΘΖ͑ΥΠ͑ΪΠΦ͑ΚΤ͑ΚΟΥΖΟΕΖΕ͑ΥΠ͑
ΓΖ͑ΒΗΗΠΣΕΒΓΝΖ͑͝ΓΒΤΖΕ͑ΠΟ͑ΖΞΡΝΠΪΖΖ͑ΨΒΘΖΤ͑͟
͑
͛͛͑ ͶΧΖΟ͑ΚΗ͑ΪΠΦΣ͑ΖΞΡΝΠΪΖΣ͑ΚΟΥΖΟΕΤ͑ΪΠΦΣ͑ΔΠΧΖΣΒΘΖ͑ΥΠ͑ΓΖ͑ΒΗΗΠΣΕΒΓΝΖ͑͝ΪΠΦ͑ΞΒΪ͑ΤΥΚΝΝ͑ΓΖ͑ΖΝΚΘΚΓΝΖ͑ΗΠΣ͑Β͑ΡΣΖΞΚΦΞ͑
ΕΚΤΔΠΦΟΥ͑ΥΙΣΠΦΘΙ͑ΥΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑͟΅ΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑ΨΚΝΝ͑ΦΤΖ͑ΪΠΦΣ͑ΙΠΦΤΖΙΠΝΕ͑ΚΟΔΠΞΖ͑͝ΒΝΠΟΘ͑ΨΚΥΙ͑ΠΥΙΖΣ͑ΗΒΔΥΠΣΤ͑͝
ΥΠ͑ΕΖΥΖΣΞΚΟΖ͑ΨΙΖΥΙΖΣ͑ΪΠΦ͑ΞΒΪ͑ΓΖ͑ΖΝΚΘΚΓΝΖ͑ΗΠΣ͑Β͑ΡΣΖΞΚΦΞ͑ΕΚΤΔΠΦΟΥ͑͟ͺΗ͑͝ΗΠΣ͑ΖΩΒΞΡΝΖ͑͝ΪΠΦΣ͑ΨΒΘΖΤ͑ΧΒΣΪ͑ΗΣΠΞ͑
ΨΖΖΜ͑ΥΠ͑ΨΖΖΜ͙͑ΡΖΣΙΒΡΤ͑ΪΠΦ͑ΒΣΖ͑ΒΟ͑ΙΠΦΣΝΪ͑ΖΞΡΝΠΪΖΖ͑ΠΣ͑ΪΠΦ͑ΨΠΣΜ͑ΠΟ͑Β͑ΔΠΞΞΚΤΤΚΠΟ͑ΓΒΤΚΤ͚͑͝ΚΗ͑ΪΠΦ͑ΒΣΖ͑ΟΖΨΝΪ͑
ΖΞΡΝΠΪΖΕ͑ΞΚΕ͞ΪΖΒΣ͑͝ΠΣ͑ΚΗ͑ΪΠΦ͑ΙΒΧΖ͑ΠΥΙΖΣ͑ΚΟΔΠΞΖ͑ΝΠΤΤΖΤ͑͝ΪΠΦ͑ΞΒΪ͑ΤΥΚΝΝ͑΢ΦΒΝΚΗΪ͑ΗΠΣ͑Β͑ΡΣΖΞΚΦΞ͑ΕΚΤΔΠΦΟΥ͑͟
͑
ͺΗ͑ΪΠΦ͑ΕΖΔΚΕΖ͑ΥΠ͑ΤΙΠΡ͑ΗΠΣ͑ΔΠΧΖΣΒΘΖ͑ΚΟ͑ΥΙΖ͑;ΒΣΜΖΥΡΝΒΔΖ͑͝͹ΖΒΝΥΙʹΒΣΖ͟ΘΠΧ͑ΨΚΝΝ͑ΘΦΚΕΖ͑ΪΠΦ͑ΥΙΣΠΦΘΙ͑ΥΙΖ͑ΡΣΠΔΖΤΤ͑͟͹ΖΣΖ͘Τ͑ΥΙΖ͑
ΖΞΡΝΠΪΖΣ͑ΚΟΗΠΣΞΒΥΚΠΟ͑ΪΠΦ͘ΝΝ͑ΖΟΥΖΣ͑ΨΙΖΟ͑ΪΠΦ͑ΧΚΤΚΥ͑͹ΖΒΝΥΙʹΒΣΖ͟ΘΠΧ͑ΥΠ͑ΗΚΟΕ͑ΠΦΥ͑ΚΗ͑ΪΠΦ͑ΔΒΟ͑ΘΖΥ͑Β͑ΥΒΩ͑ΔΣΖΕΚΥ͑ΥΠ͑ΝΠΨΖΣ͑ΪΠΦΣ͑
ΞΠΟΥΙΝΪ͑ΡΣΖΞΚΦΞΤ͑͟
͑
I have received a copy of the form below:
“New Health Insurance Marketplace Coverage Options and Your Health Coverage Form”
_________________________________ ______________
Employee Signature Date
___________________________________________________
Print Name
www.whiteknightpest.com
Employment Eligibility Verification USCIS
Form I-9
Department of Homeland Security OMB No. 1615-0047
U.S. Citizenship and Immigration Services Expires 03/31/2016
START HERE. 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-authorized individuals. Employers CANNOT specify which
document(s) they will accept from an employee. The refusal to hire an individual because the documentation presented has a future
expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later
than the first day of employment, but not before accepting a job offer.)
Last Name (Family Name) First Name (Given Name) Middle Initial Other Names Used (if any)
Address (Street Number and Name) Apt. Number City or Town State Zip Code
Date of Birth (mm/dd/yyyy) U.S. Social Security Number E-mail Address Telephone Number
- -
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in
connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following):
A citizen of the United States
A noncitizen national of the United States (See instructions)
A lawful permanent resident (Alien Registration Number/USCIS Number):
An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy) . Some aliens may write "N/A" in this field.
(See instructions)
For aliens authorized to work, provide your Alien Registration Number/USCIS Number OR Form I-94 Admission Number:
1. Alien Registration Number/USCIS Number:
3-D Barcode
OR Do Not Write in This Space
2. Form I-94 Admission Number:
If you obtained your admission number from CBP in connection with your arrival in the United
States, include the following:
Foreign Passport Number:
Country of Issuance:
Some aliens may write "N/A" on the Foreign Passport Number and Country of Issuance fields. (See instructions)
Signature of Employee: Date (mm/dd/yyyy):
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.
Signature of Preparer or Translator: Date (mm/dd/yyyy):
Last Name (Family Name) First Name (Given Name)
Address (Street Number and Name) City or Town State Zip Code
Employer Completes Next Page
Form I-9 03/08/13 N Page 7 of 9

Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You
must physically examine one document from List A OR examine a combination of one document from List B and one document from List C as listed on
the "Lists of Acceptable Documents" on the next page of this form. For each document you review, record the following information: document title,
issuing authority, document number, and expiration date, if any.)
Employee Last Name, First Name and Middle Initial from Section 1:
List A OR List B AND List C

Identity and Employment Authorization Identity Employment Authorization
Document Title: Document Title: Document Title:
Issuing Authority: Issuing Authority: Issuing Authority:
Document Number: Document Number: Document Number:
Expiration Date (if any)(mm/dd/yyyy): Expiration Date (if any)(mm/dd/yyyy): Expiration Date (if any)(mm/dd/yyyy):
Document Title:
Issuing Authority:
Document Number:
Expiration Date (if any)(mm/dd/yyyy):

3-D Barcode
Document Title: Do Not Write in This Space
Issuing Authority:
Document Number:
Expiration Date (if any)(mm/dd/yyyy):
Certification
I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the
above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the
employee is authorized to work in the United States.
The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions.)
Signature of Employer or Authorized Representative Date (mm/dd/yyyy) Title of Employer or Authorized Representative
Last Name (Family Name) First Name (Given Name) Employer's Business or Organization Name
Employer's Business or Organization Address (Street Number and Name) City or Town State Zip Code
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
A. New Name (if applicable) Last Name (Family Name) First Name (Given Name) Middle Initial B. Date of Rehire (if applicable) (mm/dd/yyyy):
C. If employee's previous grant of employment authorization has expired, provide the information for the document from List A or List C the employee
presented that establishes current employment authorization in the space provided below.
Document Title: Document Number: Expiration Date (if any)(mm/dd/yyyy):
I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if
the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized Representative: Date (mm/dd/yyyy): Print Name of Employer or Authorized Representative:
Form I-9 03/08/13 N Page 8 of 9

LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED
Employees may present one selection from List A
or a combination of one selection from List B and one selection from List C.
LIST A LIST B LIST C

Documents that Establish Documents that Establish Documents that Establish
Both Identity and Identity Employment Authorization
Employment Authorization OR AND
1. U.S. Passport or U.S. Passport Card 1. Driver's license or ID card issued by a 1. A Social Security Account Number
State or outlying possession of the card, unless the card includes one of
2. Permanent Resident Card or Alien
United States provided it contains a the following restrictions:
Registration Receipt Card (Form I-551)
photograph or information such as (1) NOT VALID FOR EMPLOYMENT
name, date of birth, gender, height, eye
3. Foreign passport that contains a color, and address (2) VALID FOR WORK ONLY WITH
temporary I-551 stamp or temporary INS AUTHORIZATION
I-551 printed notation on a machine- 2. ID card issued by federal, state or local
(3) VALID FOR WORK ONLY WITH
readable immigrant visa government agencies or entities,
DHS AUTHORIZATION
provided it contains a photograph or
4. Employment Authorization Document information such as name, date of birth, 2. Certification of Birth Abroad issued
that contains a photograph (Form gender, height, eye color, and address by the Department of State (Form
I-766) FS-545)
3. School ID card with a photograph
5. For a nonimmigrant alien authorized 3. Certification of Report of Birth
to work for a specific employer 4. Voter's registration card issued by the Department of State
because of his or her status: (Form DS-1350)
5. U.S. Military card or draft record
a. Foreign passport; and 4. Original or certified copy of birth
6. Military dependent's ID card certificate issued by a State,
b. Form I-94 or Form I-94A that has
county, municipal authority, or
the following: 7. U.S. Coast Guard Merchant Mariner territory of the United States
(1) The same name as the passport; Card bearing an official seal
and
8. Native American tribal document 5. Native American tribal document
(2) An endorsement of the alien's
nonimmigrant status as long as 9. Driver's license issued by a Canadian
6. U.S. Citizen ID Card (Form I-197)
that period of endorsement has government authority
not yet expired and the 7. Identification Card for Use of
proposed employment is not in For persons under age 18 who are Resident Citizen in the United
conflict with any restrictions or unable to present a document States (Form I-179)
limitations identified on the form. listed above:
8. Employment authorization
6. Passport from the Federated States of document issued by the
10. School record or report card
Micronesia (FSM) or the Republic of Department of Homeland Security
the Marshall Islands (RMI) with Form 11. Clinic, doctor, or hospital record
I-94 or Form I-94A indicating
nonimmigrant admission under the 12. Day-care or nursery school record
Compact of Free Association Between
the United States and the FSM or RMI
Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274).
Refer to Section 2 of the instructions, titled "Employer or Authorized Representative Review

and Verification," for more information about acceptable receipts.
Form I-9 03/08/13 N Page 9 of 9

Employee Non-Competition and
Conflict of Interest Agreement
White Knight Pest Control, Inc.
As a condition of my employment with White Knight Pest Control, Inc., its subsidiaries,
affiliates, successors, or assigns (together “the Company”), and in consideration of my
employment with the Company and my receipt of: 1) annual company paid licensing, 2)
continued company training and education required to hold all licensing, 3) information
concerning company specific trade tools, methods, ideas, and secrets, and 4) the compensation
now and hereafter paid to me by the Company, I will abide by the following non-compete
agreements.
During the employment period and for 12 months after employment termination,
notwithstanding the cause of termination, I will not, directly or indirectly, work for, own, invest
in, direct, or aid any company or person engaged in competition with the Company within a 100
mile radius of Austin, TX or San Antonio, TX. A company or person is in competition with the
Company if it solicits business, performs services, or delivers goods that are competitive to the
Company, its customers, or its prospective customers.
It is the policy of the Company to conduct its affairs in strict compliance with the letter and spirit
of the law and to adhere to the highest principles of business ethics. Accordingly, all officers,
employees, and independent contractors must avoid activities, which are in conflict, or give the
appearance of being in conflict, with these principles and with the interests of the Company.
Employee:
_________________________________________________________________
(Sign) (Print) (Date)
Company:
__________________________________________________________________
Page 1 of 1

Employee Nondisclosure Agreement
This agreement (the "Agreement") is entered into by White Knight Pest Control, Inc.
("Company") and __________________________ ("Employee").
In consideration of the commencement of Employee's employment with Company and the

compensation that will be paid, Employee and Company agree as follows:
1. Company's Trade Secrets
In the performance of Employee's job duties with Company, Employee will be exposed to
Company's Confidential Information. "Confidential Information" means information or material
that is commercially valuable to Company and not generally known or readily ascertainable in
the industry. This includes, but is not limited to:
(a) technical information concerning Company's products and services, including product know-
how, formulas, designs, devices, diagrams, software code, test results, processes, inventions,
research projects and product development, technical memoranda and correspondence;
(b) information concerning Company's business, including cost information, profits, sales
information, accounting and unpublished financial information, business plans, markets and
marketing methods, customer lists and customer information, purchasing techniques, supplier
lists and supplier information and advertising strategies;
(c) information concerning Company's employees, including salaries, strengths, weaknesses and
skills;
(d) information submitted by Company's customers, suppliers, employees, consultants or co-

venture partners with Company for study, evaluation or use; and
(e) any other information not generally known to the public which, if misused or disclosed,
could reasonably be expected to adversely affect Company's business.
2. Nondisclosure of Trade Secrets
Employee shall keep Company's Confidential Information, whether or not prepared or developed
by Employee, in the strictest confidence. Employee will not disclose such information to anyone
outside Company without Company's prior written consent. Nor will Employee make use of any
Confidential Information for Employee's own purposes or the benefit of anyone other than
Company.
Page 1 of 3

However, Employee shall have no obligation to treat as confidential any information which:
(a) was in Employee's possession or known to Employee, without an obligation to keep it

confidential, before such information was disclosed to Employee by Company;
(b) is or becomes public knowledge through a source other than Employee and through no fault
of Employee; or
(c) is or becomes lawfully available to Employee from a source other than Company.
3. Confidential Information of Others
Employee will not disclose to Company, use in Company's business, or cause Company to use,
any trade secret of others.
4. Return of Materials
When Employee's employment with Company ends, for whatever reason, Employee will
promptly deliver to Company all originals and copies of all documents, records, software
programs, media and other materials containing any Confidential Information. Employee will
also return to Company all equipment, files, software programs and other personal property
belonging to Company.
5. Confidentiality Obligation Survives Employment
Employee's obligation to maintain the confidentiality and security of Confidential Information

remains even after Employee's employment with Company ends and continues for so long as
such Confidential Information remains a trade secret.
6. General Provisions
(a) Relationships: Nothing contained in this Agreement shall be deemed to make Employee a
partner or joint venturer of Company for any purpose.
(b) Severability: If a court finds any provision of this Agreement invalid or unenforceable, the
remainder of this Agreement shall be interpreted so as best to affect the intent of Company and
Employee.
(c) Integration: This Agreement expresses the complete understanding of the parties with respect
to the subject matter and supersedes all prior proposals, agreements, representations and
understandings. This Agreement may not be amended except in a writing signed by both
Company and Employee.
(d) Waiver: The failure to exercise any right provided in this Agreement shall not be a waiver of
prior or subsequent rights.
Page 2 of 3

(e) Injunctive Relief: Any misappropriation of any of the Confidential Information in violation
of this Agreement may cause Company irreparable harm, the amount of which may be difficult
to ascertain, and therefore Employee agrees that Company shall have the right to apply to a court
of competent jurisdiction for an order enjoining any such further misappropriation and for such
other relief as Company deems appropriate. This right is to be in addition to the remedies
otherwise available to Company.
(f) Indemnity: Employee agrees to indemnify Company against any and all losses, damages,
claims or expenses incurred or suffered by Company as a result of Employee's breach of this
Agreement.
(g) Attorney Fees and Expenses: In a dispute arising out of or related to this Agreement, the
prevailing party shall have the right to collect from the other party its reasonable attorney fees
and costs and necessary expenditures.
(h) Governing Law. This Agreement shall be governed in accordance with the laws of the State
of Texas.
(i) Jurisdiction. Employee consents to the exclusive jurisdiction and venue of the federal and
state courts located in Hays County in any action arising out of or relating to this Agreement.
Employee waives any other venue to which Employee might be entitled by domicile or
otherwise.
(j) Successors & Assigns. This Agreement shall bind each party's heirs, successors and assigns.
Company may assign this Agreement to any party at any time. Employee shall not assign any of
his or her rights or obligations under this Agreement without Company's prior written consent.
Any assignment or transfer in violation of this section shall be void.
7. Signatures
Employee has carefully read all of this Agreement and agrees that all of the restrictions set forth
are fair and reasonably required to protect Company's interests. Employee has received a copy of
this Agreement as signed by the parties.
Employee:
_________________________________________________________________
Company:
__________________________________________________________________
Page 3 of 3

Dear White Knight Employee,
This policy concerns a certain activity that can potentially damage the well being of fellow co-workers and the company
as a whole. This is a safeguard to protect our winning culture and most importantly to protect every employee we care so
much about.
GOSSIP: When gossip occurs, the persons involved idly discuss someone’s weaknesses or problems when that person is
not present. Gossip harms not only those who are being talked about, but also those who gossip and those who listen. To
discern when gossip occurs:
• Gossip always involves a person who is not present.

• Gossip involves unwelcomed, negative criticisms of another person
• Gossip often is about speculation that can injure another person’s credibility or reputation.
In the dictionary, gossip is defined as: idle talk or rumor, especially about the personal or private affairs of others.
Trivial, chatty talk or writing.
Gossip is something that we choose to do or not do, and is entered by choice either through verbal communications or
electronic communications. At White Knight Pest Control, this type of activity in the workplace cannot and will not be
tolerated. It is a productivity killer and can hurt not only the gossiper and the gossipee, but the entire company!
Appropriate measures will be taken if any activity of this type is observed and reported by any employee of the company.
When put in the situation, have the courage, integrity, and the loyalty to not be involved, or stop the negative conversation
all together. Strive to cultivate a team oriented environment which we all desire and deserve. This is the only way we can
be successful and reach our greatest potential! In order to have a teamwork environment and gossip free workplace the
following must be observed:
1. DO not speak or insinuate another person’s name when that person is not present unless it is to compliment or
reference regarding work matters.
2. Refuse to participate when another mentions a person who is not present in a negative light. Change the subject
or tell them you have agreed not to talk about another.
3. Choose not to respond to negative email, texts, messaging or use electronic means to pass on private or
derogatory information about any person in the company.
4. While off the job, do not speak to another co-worker about people at work in a derogatory light. If you have
feelings, select to talk to someone not at the workplace.
5. If another person in the workplace does something unethical, incorrect, against procedures, or disruptive use
the proper channels to report this to the person in authority to take corrective action.
6. Work hard, strive to gain respect from others, and be a professional and expect the same from others.
7. Do not share personal information in the workplace you do not want everyone to know.
By doing these things, there is no doubt we will have a better and more enjoyable work environment; thereby taking steps
to creating a successful career and company. We hope it is clear to everyone that it is our ultimate goal to help each and
every one of our employees to enjoy what they do, to do it to the best of their ability, and most importantly, to create
financial stability in order to support their families. We consider everyone within the company members of the White
Knight Family. And as family, we must respect and gain the respect of those we work so closely with. We appreciate all
that you do and continue to do to cultivate a winning culture!
Sign: _________________________________________ Print: _______________________ Date: _______________

White Knight Pest Control
Technician Manual
2
Effective Date: 09/09/2008

Revision Date: 06/01/2014
Introductory statement:
This manual is designed to be a guide to all technicians to help them understand White Knight Pest
Control’s treatment methods and policies. You should read, understand, and comply with all provisions
of the manual.
No Handbook can anticipate every circumstance or question about every one of our policies. Further,
there may be situations where the need arises for us to revise, add, or cancel policies. Therefore, White
Knight Pest Control reserves the right to add new policies and to change or cancel existing policies at
any time. White Knight Pest Control also has the right to interpret all policies and programs, and to
make departures from these policies on a case-by-case basis as circumstances warrant. We will notify
you of any changes to the manual as they occur.
Any abuse of a policy contained herein may result in a write up, fine, or dismissal
Initial: __________
3
LAWS AND REGULATIONS
Each employee is responsible for following all state, local and federal laws as pertaining to pest control.
As a licensed apprentice, technician, or certified applicator, you are liable for the proper handling of
pesticides and any treatments you provide to the customer according to the Structural Pest Control
Service of Texas. Remember to apply pesticides according to the label and to keep the products locked
and stored properly on your truck. Avoid write ups, fines and termination by simply obeying the law. If
any technician fails to follow these laws, it can result in being written up, fined or dismissed. Please
remember to obey the law. By following the policies and guidelines of this manual, you will find
success and enjoy your job as a pest control applicator with White Knight Pest!
POLICIES AND PROCEDURES
Appearance/Uniforms
We take pride in our company image! As a White Knight technician, you will be required to comply to
the dress code and grooming policies we hold.
Uniforms: Uniforms will be on a rental basis from a uniform rental company. These rentals will be
paid for by the technician (including set-up fees: name badge, company logo, etc.) and will be deducted
from the technician’s paycheck every pay roll. The uniform company will provide 13 sets of uniforms
(pants and shirts). Uniforms will be picked up for cleaning in the mornings at 7:10am on a date
designated by your manager, so please bring your worn uniforms that day. You will have the remaining
7 sets of uniforms to last until the following week. The cost of renting uniforms is minimal compared to
the benefits each technician receives. (cost of rental will change from year to year due to inflation.
Please inquire with your manager) If any damage is made on any piece of your uniform and the uniform
rental company cannot repair it, you will be responsible for replacing that piece of garment. If at any
time your employment is terminated, you will be responsible for all charges for uniforms not returned.
The benefits of a uniform rental program include:

1) Saving time from doing laundry
2) Less worry about properly washing clothing exposed to pesticides.
3) Having uniform cleaned properly will prevent any chronic health issues in the future
4) Less money spent on detergent
5) A Professional appearance which promotes confidence which then encourages excellent
performance!
All technicians are required to wear the following:

1) White shirt with name and company logo (provided by uniform company)
2) White undershirt
3) Black Pants (provided by uniform company)
4) Belt
5) Water repellant work boots (no rubber boots)
6) White Knight cap (optional and can be purchased from the company)
Grooming: A White Knight technician should look professional and neatly groomed. This includes a
clean shave and an appropriate hair cut (please ask the service manager what is to be expected). It is
important to know that coming into the office without proper appearance and grooming will result in
your route being taken away until the Service Manager deems your appearance appropriate for work. If
Initial: __________
4
a technician does not work that day due to non-compliance with the dress and appearance standards, 1 of
their 5 emergency days will be used and they will not be paid for the day. We hope you feel the
importance of maintaining a professional appearance and that you will encourage and promote this by
being an example to other team members.
Smoking
Smoking is prohibited in or within 25’ of company trucks or the offices. Do not smoke while at a
customer’s home, whether it is in front of the home near the truck or while treating. Smoke only away
from the homes (such as at a convenience store, park or restaurant). You will be fined a minimum of
$100 for violating this policy and are responsible for any additional costs for repairing any damages
from the smoking such as odors, burns, etc.
Sleeping
Sleeping is not encouraged while on the job as technicians may oversleep or may be seen sleeping while
on the job. This looks unprofessional. However, if you have time and want to rest, please do so outside
the community or are in which you are providing services.
Sickness
Times when you are ill, please call the manager before 7:00 in the morning. On rare occasions you may
be needed to complete your route when you are undergoing fever and cold-type sicknesses. (Also see
company sick policy)
Cell Phones
The company provides a cell phone reimbursement benefit for each technician in the amount of $25 per
payroll. By doing so, it is required that the technician keeps their cell phone activated at all times
because it will be the main lines of communication for work. White Knight Pest Control is not liable for
any overages incurred. If your personal phone is lost or damaged, you will need to replace it
immediately in order to maintain smooth work operations. At any time your cell phone has been
deactivated for any reason or the office cannot communicate with you during any day of the pay period,
you will not be reimbursed for that pay period. Your cell phone reimbursement will commence the
following pay period once your cell phone is in proper working order.
Needed Supplies in the Truck

There are other supplies you must have in your truck besides product. Remember to have at least 2
pens, a stack of business cards, Welcome Packets, surveys, flyers, blank invoices, blank reservice slips,
blank service contracts, plenty of business return envelopes, paperclips, and small plastic bags for
samples. Pay close attention to your truck’s inventory of these items. Be sure you carry a flashlight with
you while on the job. This is essential in providing good inspections!
Mapsco
Each truck should contain a current Mapsco. Mapscos are essential for completing your route so please
be sure to have one in the truck before leaving the office. If you come across a road not listed in the
Mapsco, you can call the customer and get directions, call the office to see if there are any special
directions in the computer, or call Mapsco and ask them where the street is. Remember, you are
responsible for the Mapsco assigned to your truck. When the Mapsco is not in use, please close it to
prevent damage to its pages. A good way to hold a page for quick access to the page is to use a
paperclip. Through out the year the Mapsco gets a lot of wear and tear. Please do your best to take care
of it.
Initial: __________
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Sources of Information
There are a few important source items that you should carry with you at all times when on a route.
These items include:
1. A price list with the different price brackets for each program
2. A list of phone numbers for every White Knight employee
3. A folder with Material Safety Data Sheets (MSDS)
Gas and Refueling

Each truck will contain a list of gas stations where you may use your “Fuel Man” card to fill up your
tank. Each truck is assigned a gas card for the truck and one for the rig (Off Road Card). Please keep
these two cards in your truck at ALL times. In the event that you need to switch trucks, please leave the
cards in the truck as they are assigned to that specific truck. You will be provided with a PIN number
which you should not share with any other employees. If at any time you feel another employee knows
your PIN, please inform a manager and we will change it for you. You will need this PIN number to
refuel your truck and your rig. After refueling, please make sure and get the receipt and turn it in with
your route. Every time you fill up, check the oil and tire pressures and write down the readings on the
receipt along with your name and truck number. When you turn in your paperwork, make sure your
receipt is on the top above the route slip. Fueling charges are monitored weekly.
Arrival Time
You should arrive to the office by 7:15 A.M. Times when you are running behind, please call and
inform the manager. You are allowed 2 tardies. The third tardy (and subsequent times each month)
White Knight Pest Control has the option to penalize you. These options include but are not limited to:
 Losing the privilege of taking a truck home
 Being placed on shorter routes for a week
 Suspension
Note that if you are 30 or more minutes late to your first stop, truck privileges may be withdrawn from
you. If you are late past 10:00 am and neglect to inform the manager or simply do not show up, your
employment with White Knight Pest Control will be terminated.
If you are given the privilege to print your routes out from home and not required to come into the
office, you must leave your house or place of residence by 7:45am. The time you leave will be checked
daily via GPS by the service manager. Leaving after 7:45am is considered a tardy. You are allowed 2
tardies. The third tardy (and subsequent times each month) you will be penalized. These options include
but are not limited to:
 Losing the privilege of taking a truck home
 Being placed on shorter routes for a week
 Suspension
 Losing the privilege to print route from home
Training Meetings
There is a mandatory technician’s meeting for all technicians each week held on Tuesdays unless
informed otherwise. All technicians must be present at these meetings. The meeting starts at 7:15 AM.
Be on time! Be sure to sign in on the sign in sheet to receive credit for required Training Verification
topics by the Structural Pest Control Service that may be covered in the meeting. The meeting will
consist of announcements and important training topics to help better you as a technician. During this
Initial: __________
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meeting, you will be given opportunities to ask any questions you may have. Being late to these
meetings will penalize you. (Please see Tardy/Arrival Time policy)
Route Slip
When you arrive in the morning the routes will be distributed with your name on it. After receiving
your route, fill out a route sheet and make a copy of it for the office staff. In the appropriate spaces,
write down the name, map code, time block, and city. There is a legend at the bottom of the route slip
you can reference to on how to fill out the route slip. If you have the privilege of printing your routes
from home, you must email your route sheet to the office and your service manager every morning.
Notes and Comments

When you get your route, there will often times be comments, printed or handwritten, in the comments
section or on a note paper-clipped to the invoice. Any instructions in those areas need to be followed
exactly. With a note, it normally is something for the technician to see and not the customer. Once you
have completed any special instructions put your initials and a check mark by each item individually so
the office staff knows you completed it.
Products
It is extremely important to restock your truck with the proper products to treat each home on your
route. Every morning look into your product box to see what you are low on and what you have run out
of. After all your paperwork is done in the morning go to the service or branch manager to check out
any product you might need. You must fill out a pick sheet and give it to the service manager to receive
product. Make sure whoever is distributing products actually hand you the products you need.
(PLEASE DO NOT GET PRODUCTS YOURSELF). In each truck there is a spill kit which consists of
a hand brush and broom, a trash bag, and some cat litter. In case of a spill, sprinkle some of the cat litter
on the spill then just sweep it up into the trash bag. If by any chance something larger than 4 gallons is
spilled you have to call and let the service manager know. He then has to report it to a state agency for
safety means. For any product that is in a large container that could be used to store liquids you need to
dispose of it in a certain way. First, triple-rinse the container, then puncture it twice and throw it away
in the garbage can at the office.
Dogs
In instances you encounter dogs, make note of it on the invoice if it has not already been noted. Make a
good judgment whether it is safe or not to spray. Sweeping the eaves with the Webster will help with
preventing any harm done to you by a dog because you will be able to use it to defend aggressive pets.
Many times dogs are more intimidating than dangerous. But please don’t put your self at risk. It is the
responsibility of the customer to make sure their pets are taken care of. Remind the customer to allow
30 minutes for products to dry before allowing their pets to go back outside.
Samples
There may be times when you come across a pest you can’t identify. In this instance, do your best to put
the pest in a zip lock bag and bring it back to the office for identification. You should always carry zip
lock bags in your truck for this purpose. When you get back to the office with the sample get a Pest I.D.
Form and fill it out completely. Make sure you note the specific location where you found the pest and
that you leave the Sample Identified, Call Back, and Special Treatment sections blank for the manager
to fill out.
Initial: __________
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End of Work Day

Please call in when you are done with your route to check in with a manager. You must do this at the
end of your route before you leave your last service. At this time please have your completion and
collection ratios completed. The completion ratio is how many were completed during the day over the
amount of stops you were given in the morning (not including reservices). The collection ratio is how
many payments you received that day over the total possible appointments where you could have
received one. If you aren’t done by 4:30, call in and let a manager know how you are doing on your
route. If you get done before then, call whenever you are done. During the summer you also need to let
the office manager know which of your initials were treated and which sales representative sold them. If
you are falling behind on your route, call by 1:30 to let the service manager know.
Turning in Your Route

At the end of your route, put all of your paper work together with the route slip on top. All initials must
be together and paper clipped with the invoice and check. Use paperclips for better organization and
neatness. Before you turn it in make sure the route ratios are totaled up. When all of this is complete,
turn in all your work paper clipped together and place it in the route collection tray or give it to the
Service Manager the following day. Be sure routes are turned in by the end of the pay period.
Rain
We provide wet weather treatments on days it is raining using certain products. Each truck should
contain a full body rain suit for treatment in the rain. In the case of a classic Texas thunderstorm, wait a
few minutes before treating. During these storms there is a good possibility the weather will clear and
treatment can resume. If the weather does not permit the treatment to continue, call the manager. Please
do not cancel or reschedule a treatment unless authorized by a manager.
Process and Descriptions on How to Treat an Account

When arriving to your destination, check twice to make sure you are at the correct address. Remember
when approaching a customer’s home to carry your clipboard. Always ring and knock on the front door.
If the customer is not home and it is a regular route stop, treat the entire outside perimeter. If the
appointment was timed and the customer does not answer, call the home number. If no one answers
wait 10 minutes calling periodically and then knock again. If the customer is still not home, treat what
you can on the exterior. Before leaving the home, leave a message on the answering machine (if
available) and a “sorry we missed you!” card on the door. If the appointment is an initial, and you have
followed the explanation above, call your manager and the sales representative for further assistance.
DO NOT TREAT AN INITIAL IF THE CUSTOMER IS NOT HOME. Even when the agreement is
signed and paid, if the customer is not home please call your manager. If for any reason you are running
behind schedule, give your customer a courtesy call and let them know when to expect you. For
example, if the time block is 2-4 call at 2:15 to let the customer know what time you expect to arrive.
INITIALS ARE AN EXCEPTION TO THIS RULE. As a White Knight Technician, we must
make every effort to be at initial treatment within the first fifteen minutes of the time block. (First
impressions are lasting impressions! Whether they are positive or negative) If you are running
behind and will not be able to make it to the Initial within the first fifteen minutes, call the
customer immediately and let them know when you will arrive. If a technician fails to call a
customer when late and the company has to provide a discount to get the home treated, the
discount will be taken out of the technicians pay. If the customer cancels because the technician
failed to call, there will be a $100 taken out of the techs pay check.
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Reschedules
You should do everything possible to complete a treatment. Times when customers need to reschedule
an appointment, call the office while you are at the door to see what times are available. DO NOT
RESCHEDULE THE APPOINTMENT WITHOUT CALLING THE OFFICE FIRST. If customers
have previous balances in excess of 2 treatments (Code Red), collect the payment before treating. If
you’re unable to collect the payment, call the office with the customer present. If you get to a customer
who has a Code Red and no one is home, do not treat. If for some reason you did not treat a customer’s
home (falling behind, getting dark, etc.) and they cancel because you did not follow the proper
procedures for rescheduling a treatment and letting your manager know ahead of time, a fine in the
amount of $100 will be issued and a written warning will also be issued.
Ride Alongs and Quarterly Reviews

A Ride Along is when the Service or Branch manager accompanies you while you treat a few homes.
The purpose of this visit is to make sure the technicians are doing what is required and urge them to
provide the best service possible while treating. Ride alongs may also be performed without the
technician knowing. A Quarter Quest is a quarterly performance review held for each technician. This
is a chance to get to know the management, discuss any question or concerns you might have and to
review performance.
Inspection Schedule
It is extremely important to inspect your truck regularly. You are responsible for the cleanliness in/out,
tire pressure, fluids, oil changes, and general conditions of your truck. You should do a maintenance
check on your truck at least once a week. If you need help with any maintenance issues with the truck,
please let a manager know and fill out a maintenance request form. There will be at least one
maintenance meeting a month to insure trucks are working properly and kept clean.
Lost or Broken Items in the Truck

As a technician, you are responsible for those items checked out to you, most notably your truck. Make
sure all items that need to be in the truck box is there and that the box is locked. The manager must be
notified as soon as possible when any damages to your truck occur. Depending on the circumstances
either the company will replace it or you will need to replace it. For example, if you back into a
lamppost and break a tail light or leave your spreader out and it gets stolen then you will be held
responsible for the repair or replacement of the item. You will be held liable for up to $1000 per
occurrence depending on the severity and cost of the damage or loss to equipment or truck.
Damage or Loss of Customers Property

As a technician you will run the risk of being involved with accident ranging from destroying a flower
bed with the hose to stepping through the ceiling from an attic. You are responsible for any property or
items you have damaged at a customer’s home. Please be careful and aware of any obstacles while
treating a home. When these types of accidents occur, you will be held liable for paying up to $1000 per
occurrence depending on the severity of damage or loss.
Broken Equipment While Treating

On rare occasions that a problem occurs with the power sprayer or rig that keeps you from treating a
home, please contact a manager immediately. Be extremely careful when pulling the hose around a
home. Look for any objects that may cause a hole or break in the hose. If the hose does get a hole or
tear use the repair parts in your glove box to fix the leak. A knife is required for this repair so carry a
simple utility knife. Another preventive measure for the rig is to not allow the tank to go below 10
Initial: __________
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gallons. When the level of product drops below 10 gallons, the diaphragm of the rig begins working
harder and is at risk of being damaged. The pressure (psi) setting on the rig should never exceed 100psi.
This is the biggest cause of diaphragm damage to the rig. When there are exessive reoccurances of your
rig breaking down, the manager will assess the issue and may deem it as a result of equipment abuse and
you will be responsible for repairs in the amount deemed appropriate by your manager.
SCOPE OF SERVICE
Exterior
The exterior treatment is the main treatment provided to our customers. Most exterior treatments will
take care of any pest issues occurring on the interior if you find the source of how and where the pests
are getting in (e.g. ants). In general, the places that need to be treated are the foundation, entry points,
and any cracks or crevices. To accomplish this we treat in several areas. 1) First use the Webster and
sweep the eaves of any wasp’s nests or webs you see. When sweeping the eaves, you should inspect at
the same time. 2) Granulate yard and inspect for and treat ant mounds. 3) When treating, we treat
around the entire foundation. When using the power sprayer, Pin Spray once horizontally right where
the ground and the foundation meet, then go over it vertically spraying 3 feet onto the house and 10-12
feet away from the house (where possible). 4) Treat the lower eaves because there are cracks where the
wall of the home and the roof meet. 5) All the expansion joints need to be treated and do it slowly so
that the products can run down into the cracks. 6) Treat the inside perimeter of the back fence on every
home to slow down any migrating insects. If the yard is so large the hose won’t reach the back, go as
far as you can reach and spray a line in the ground. 7) Treat all landscaping within 10 feet of the home
in addition to the regular perimeter treatment. 8) Inspect and Spot treat any ant mounds in the yard.
Interior
The interior treatment is a free, complimentary treatment to all of our customers on a service plan and is
provided on an as needed basis only (We treat the interior on all Initials unless specified otherwise by
customer). On a general interior treatment, treat baseboards (upstairs, downstairs, utility rooms, pantry,
etc.), corners, plumbing pipes under sinks and the garage. Please use good judgment in treating areas
where product may come into contact with the customer’s personal belongings. For example, many
times customers will place bath towels, toilet paper and toothbrushes under bathroom sinks, or toys and
clothing may rest along the baseboards.
Using common sense and your knowledge and skills as a technician will provide a great and effective
treatment and, as a result, will make the customer happy!
***WARNING***
If a technician is caught, or reported, not performing the full scope of service, they will be heavily
penalized. Not performing the full scope of service is being dishonest to both the customer and the
company. This major infraction will lead to a $100 fine placed on the responsible tech, and termination
of employment.
PAPERWORK
Corrections
If any information on the paper work you come across is wrong or missing, please update the right
information by asking the customer or looking it up. On the copy of the paperwork that the office keeps,
make the correction, mark it in a way that will stand out when they look at it (high lighter), and put your
initials by it.
Initial: __________
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Initials
On initials the paperwork we do is a little different. In the occasion that a customer was signed up by a
sales rep, the sales rep will have left the customer with the agreement. When introducing yourself to the
customer, ask for the copies of the agreement (there should be a white copy and a yellow copy attached
together). If the customer does not have an agreement, please fill one out completely using the
information on the service ticket. Please review the agreement with the customer and make certain
everything is filled out and signed correctly and completely before treating. Before treating there are a
few things to remember and explain. 1) It is our policy to collect payment for the first treatment before
treating. If for some reason they are unable to pay call the office and have it approved with a manager.
If they are paying with a credit card be sure to obtain all the information and ask if they want us to bill
this treatment only or if they would like to have their payments applied automatically after each
treatment. If they want to sign up on our EZpay program be sure they sign the agreement under the
payment section to give us authorization; 2) provide the customer with a copy of the agreement (yellow
copy); 3) provide the customer with a Welcome Packet and explain that everything concerning their
treatment and our company is enclosed. Direct them to our website for more information; 4) remind the
customer that if they have any questions not to hesitate to contact us and show them our contact
information.
When you are finished treating, fill out the name, address, date, and payment sections along with all the
products you used on a service ticket. Provide the customer with a copy of the service ticket and explain
in detail what services you performed and what pests you noticed and extend an invitation for any
questions they may have. There are crucial points that are important to mention to each customer:
1) Due to the flush out treatment (Initial) they may see more pests for the first couple of weeks, to see an
occasional pest is normal, and that if they do not notice a decrease after those two weeks, they can give
us a call;
2) Explain our Service Guarantee. We will return within 2 business days for free whenever needed.
3) Explain thoroughly that because we live in Texas, to see occasional pest is normal;
4) Explain that they will receive a call 1-2 days in advance for their regular treatments;
5) This may be the most important…remember to thank them for their business!
Payments
Be sure to ask the customer for a payment. After receiving a payment, make note of what type of
payment was made (cash, check, credit card) and amount on the invoice. When a customer pays you in
cash, put it in an envelope, write the customers name and account number, the amount, initial or route,
seal it, and turn it in with your paperwork. If cash is lost and there are no record of it on the route sheet,
service ticket, or envelope, the technician will be held responsible. If they give you a check write the
amount and number on the invoice, paperclip it to the invoice and turn it in. When they use a credit card
write down the number, expiration date and 3 digit code on the back of the card. Make sure the address
we have is the address on the credit card and that the name on the credit card is the exact name on the
account. If either of those is different then write it down on the invoice you turn in with your
paperwork.
Fill out invoices

When you are finished treating a house always fill out the invoice and provide a copy to the customer.
The bottom portion (pink copy) is the customers; it also has the payment coupon for them to send in
their payment. In the top half write down any payment you might have received, and in the comments
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section write what type of treatment you did along with any extra items you may have noticed or
completed. In the bottom half fill out the materials used. In the materials used portion, fill out the area
where you used the product, the percentage, and the amount. Remember to always include a target pest
on the invoice.
OTHER IMPORTANT ITEMS
Paychecks
Paydays are twice a month. Paychecks will be disbursed on the 15th and again on the last day of the
month. If you’re done with your route and are in the area you can stop by and see if we have received
your check. If it is not here, it will be put in your box the next morning. Direct Deposit is also available.
Pay Periods are from the 10th-24th, and 25th – 9th of each month. (Please keep your compensation
confidential! Sharing of compensation with other employees will result in disciplinary action.)
Training Completion Bonus

After completing and passing the required training you will be given a $250 training completion bonus.
If for any reason your employment is terminated within 90 days after being employed, this training
bonus will be deducted from your last pay check.
Licensing
White Knight Pest Control will pay for your Apprentice License. If your employment is terminated for
any reason within the first 12 months of your hire date, the amount paid for licensing will be deducted
from your last pay check. Further licensing will be available if you meet the requirements to progress.
Technician and Certified Applicator licenses and exams will be paid for as long as you pass the test. If
you fail the test, you will be deducted the costs for classes and exams.
Concerns
If you have any concerns about the routes, scheduling, days off, or anything else let your manager know.
He will try to find a way to solve any problems that might occur. During your weekly meeting, time
will be given at the end for the technicians to voice any concerns or questions you might have. If you
are worried about something or someone, please do not complain or gossip to other technicians or office
staff as this is inappropriate. If you have any concerns or issues with other employees, about pay or
about the job, please speak with a manager directly. We want to make sure that you are happy here at
White Knight Pest Control so please let us know what we can do to help!
CONCLUSION
We want your employment with White Knight Pest Control to be one of enjoyment and complete
satisfaction. By following the items discussed in this manual, you will be able to understand and fulfill
your responsibilities as a White Knight Technician in a way that will bring growth, not only to the
company, but more importantly to yourself as an individual. Please know you are a valued member of
the White Knight Family and we appreciate all that you do!
Initial: __________
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TECHNICIAN MANUAL
EMPLOYEE ACKNOWLEDGEMENT FORM
The White Knight Pest Control Technician Manual (12 pages, Revision 06/1/2014) describes important
laws, policies, procedures, and guidelines about White Knight Pest Control and I understand that I
should consult the Management regarding any questions not answered in the Manual.
Since the information described in the Manual are subject to change as needed, I acknowledge that
revisions to the Manual may occur. All such changes will be communicated through official notices, and
I understand that revised information may supersede, modify, or eliminate existing policies. I also
understand that only the chief executive officers of White Knight Pest Control have the ability to adopt
revisions to the policies in this Manual.
Furthermore, I acknowledge that this Technician Manual is neither a contract of employment nor a legal
document. I have received the Technician Manual and understand that it is my responsibility to read and
comply with the policies contained in this manual and any revisions made to it.
EMPLOYEE'S NAME (printed): _____________________________________________
EMPLOYEE'S SIGNATURE: _______________________________________________
DATE: __________________________________
Initial: __________
Time Off Benefits and Attendance Policies
Holiday Benifits
Vacation Benefits
Sick Leave for Technicians
Requesting Time Off
Emergency Days
Tardiness
Page 1 of 5
Initial _______
Holidays
White Knight Pest Control gives holiday time off to all employees on the following holidays:
 New Year's Day (January 1st )

 Memorial Day
 Independence Day (July 4th )
 Labor Day
 Thanksgiving Day (fourth Thursday in November)
 Black Friday (the Friday following Thanksgiving Day)
 Christmas Eve (December 24th)
 Christmas Day (December 25th )
Vacation Benefits
White Knight Pest Control offers vacation time off with pay to eligible employees for rest,
relaxation, and personal pursuits. Employees in the following employment classifications are
eligible to earn and use vacation:
The amount of paid vacation time you receive each year increases with the length of your
employment as shown in the following schedule:
*Upon initial eligibility the employee is entitled to 5 vacation days each year, accrued
monthly at the rate of 0.417 days.
*After 1 year of eligible service the employee is entitled to 5 vacation days each year, accrued
monthly at the rate of 0.417 days.
*After 2 years of eligible service the employee is entitled to 10 vacation days each year,
accrued monthly at the rate of 0.833 days.
The length of eligible service is calculated on the basis of a "benefit year." A "benefit year" is
defined as the 12-month period that begins when you start earning vacation time. The benefit year
begins on January 1, and ends on December 31. Thus, the year you begin employment counts as
your first year, and on January 1, your second year begins. Your benefit year may be extended
for any significant leave of absence except military leave of absence. (Military leave has no effect
on the benefit year calculation.) See the leave of absence policies in this Employee Handbook for
more information.
Once you enter an eligible employment classification, you begin to earn paid vacation time
according to the schedule in this policy. However, before you may use vacation time, you must
complete a waiting period of 90 calendar days. After the waiting period, you may request to use
earned vacation time including vacation time that accrued during the waiting period.
Page 2 of 5
Initial _______
You may use vacation time in minimum increments of one day. To schedule vacation time, you
should first request advance approval from your supervisor. Please go to Shiftplanning.com to
request vacation time off. Each request will be reviewed based on a number of factors, including
our business needs and staffing requirements.
The amount of your paid Vacation is calculated using your average commission of the previous
six pay periods divided by the amount of working days in the pay period (Saturdays count as
working days). It does not include overtime or any special forms of compensation such as
incentives, commissions, bonuses, or shift differentials.
We encourage you to use your available paid vacation time for rest, relaxation, and personal
pursuits. In the event that you do not use your available vacation by the end of the benefit year,
you will not be paid for the unused time. That will take your earned vacation time back to zero
and your vacation time accruals will resume in the next benefit year.
If your employment terminates, you will be paid for any unused vacation time that has been
earned through your last day of work. However, if White Knight Pest Control, in its sole
discretion, terminates your employment for cause, your unused vacation time may be forfeited.
If vacation is used before it is accrued and employment terminates, then the employee must pay
back the unearned vacation pay. White Knight Pest Control reserves the right to withhold
unearned vacation pay upon the last paycheck of employment.
Sick Leave
If you are unable to report to work due to illness or injury, you should notify your supervisor
before the scheduled start of your workday if possible. Your supervisor must also be contacted on
each additional day of absence. White Knight understands that there are times when employees
are sick and unable to work and need time off to recuperate. This is the reason we provide sick
days. Each technician will have 5 unpaid sick days per year. Sick days are to be used only for
days you are sick and for no other reason, and these five sick days should not be abused. Anytime
these days get abused, it causes additional stress on all other employees. When possible, we ask
that if you know you may be sick to let us know a day in advance to prepare for your absence.
Therefore, if an employee has more than five combined sick or emergency days within each year
mark of their employment with less than 18 hours notice to their supervisor, then it is grounds
for termination (see Emergency Days below).
If you are absent for three or more consecutive days due to illness or injury, a physician's
statement must be provided verifying the disability or illness and its beginning and expected
ending dates. The same verification may be requested for other sick leave absences as well and
may be required as a condition of receiving sick leave benefits.
Page 3 of 5
Initial _______
Requesting Time Off

Effective Date: January 2010
At White Knight, we understand how important time off is to each of our employees. In addition
to holidays and Sundays, there may be times when you need additional days off to take care of
personal business.
Technicians
Full-Time technicians generally work a 6 day week, therefore it is necessary to allow technicians
to coordinate with management additional days off during the month.
All Full-Time commission based technicians may request off 2 days per month (in addition to
company days off) upon approval from the branch and office manager. Technicians should
request days off at least one week prior to the beginning of the next month to be able to
accommodate the days off when scheduling. For example, if a technician wants to schedule time
off for February 10th and 17th, he/she must submit a request by January 25th. Scheduling is based
on a first come first serve basis. If other technicians have already requested off on the days you
are trying to request, you may be denied the days off and asked to select another day. Start
Technicians MUST get approval from the Sales Manager AND the Service Manager.
Sick Days count against the two available days off during the month. Therefore, if a technician
calls in sick for one day, then they would be eligible for one additional day off during the month.
The 2 days of time off in the month is for personal time or sick time.
If at any time the position of any employee changes, the appropriate sick leave benefits
for that position will be applied.
*All time off requests must be approved by using the online Shift Planner at
www.shiftplanning.com. This is the only method in which an employee will be approved.
Emergency Days
All Employees are allowed 5 Emergency Days. Emergency days are any days when an
employee is absent from work without an 18 hour notice. Each employee is allowed five
emergency days within the benefit year (January 1st – December 31st). In the event that
all five emergency days are used within the year, their employment will be reviewed for
termination. Emergency Days are for disciplinary measures and should not be looked
at as a benefit.
Tardy/Late Arrivals
It is imperative that every employee arrive to work on time. You should arrive by
7:15am on your scheduled day of work (unless you have made special accommodations
with your service manager). If you arrive a minute after your scheduled time you will be
considered tardy. Three tardies within a month equal one Emergency Day. By the first
of each month, tardies will begin at zero. If you are late fifteen minutes or more, you are
considered late. Two late arrivals in a month equal one Emergency Day. If you know
you will be late on a given day, please schedule at least one day ahead of time to avoid a
tardy/late arrival (with Supervisor approval).
Page 4 of 5
Initial _______
Any abuse of a policy contained herein may result in a write up, fine, or dismissal
I have read and understand the policies outlined which include:
 Holidays
 Vacation Benefits
 Sick Leave Benefits for Office
 Sick Leave and Personal Days for Technicians
 Emergency Days
 Tardiness
I have also agreed to comply with each policy.
EMPLOYEE'S NAME (printed): _______________________________________________
EMPLOYEE'S SIGNATURE: _________________________________________________
DATE: __________________________________
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WHITE KNIGHT PEST CONTROL

SAFE DRIVING RULES, POLICIES, AND PROCEDURES
OBJECTIVES
• To ensure that employees who drive vehicles in the course of their work demonstrate safe, efficient
driving skills and other good road safety habits at all times.
• To maintain all company vehicles in a safe, clean and roadworthy condition to ensure the maximum
safety of the drivers and other road users, and reduce the impacts of company vehicles on the
environment.
As a White Knight technician, you will be assigned a company truck equipped with the necessary tools to
accomplish your job. With the privilege of driving a company truck, each technician must understand that
additional responsibilities are required and certain policies, rules, and procedures need to be followed. Any
infractions of these policies will lead to warnings, fines, and/or discharge of employment.
COMPANY DRIVING POLICIES AND TRUCK RESPONSIBILITIES
1. If an employee receives a complaint from other drivers who sharing the road:
a. Employee will be written up for each complaint.
b. On the 3rd complaint they will no longer be allowed to take the truck home and will be required
to park the truck at the office.
c. After receiving 4 complaints, employee will be reviewed for termination.
2. Vehicle Accidents:
a. If an employee is in an accident where they are at fault:
i. 1st accident – Final Warning
ii. 2nd accident – Termination
iii. Employee will be liable to pay a deductible of $1000 for each occurrence. Employee
will also be liable if they are involved in a hit and run (another vehicle or person causing
damage to the truck and fleeing the scene).
b. If a truck that has been assigned to an employee is vandalized:

i. Employee will be held responsible for up to $1000 for the repair of the truck.
ii. Employee must report it to the police immediately and obtain a report case number. If a
report is not made, employee will be held liable for ALL damages made to the truck. If
the truck was vandalized due to a result of employee being associated with the perpetrator
in any way, the employee will be held responsible for all costs to repair the damages
incurred on the truck.
c. Employees must promptly report any accidents to local law enforcement as well as to the
company in accordance with established procedures.
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d. In the event of a vehicle accident, employee must take a drug and alcohol test by the next day.
Company will provide the employee with location of testing site. If employee is found to be
driving under the influence, they will be responsible for the fees associated with the testing and
terminated.
3. Employees must report any moving or parking violations received while driving on company business
and/or in company vehicles.
4. All employees are expected to follow all driving laws and safety rules such as adherence to posted speed
limits and directional signs, use of turn signals and avoidance of confrontational or offensive behavior
while driving. Employees are a representatives of White Knight Pest Control and the way they drive
affects the image of the company.
5. All employees are expected to wear seat belts at all times while in a moving vehicle being used for
company business, whether they are the driver or a passenger.
6. When driving a company vehicle, do so with headlights on.
7. Use of handheld cell phones while driving a company vehicle is strictly prohibited. The use of hands-
free technology may be warranted. DO NOT TEXT while driving.
8. Employees are prohibited from using the company truck for personal use. The violation of this policy
will lead to fines and terms for termination. All trucks are equipped with tracking systems to monitor all
usage activities.
9. Do not smoke in or within 25 feet of the truck.
10. At any time the vehicle is parked during working hours, use traffic cones to provide caution to oncoming
traffic.
11. Only White Knight Pest Control employees are allowed in the truck.
12. Do not leave the truck idling anytime an employee is not inside of the truck. Do not leave the truck
running while filling out service tickets
13. When refilling the gas tank, check the oil and tire pressures.
14. Employees are responsible for the maintenance of the truck assigned to them. This includes keeping
both the interior and exterior of the truck clean, headlights, brake lights, parking lights, and signal lights
are working, and regularly checking the oil, brake fluid, tire pressures, and radiator levels of company
vehicles they are assigned. Employees will be responsible for any damages that occur due to neglect of
maintaining the truck. Any maintenance items or damage to company vehicle must be communicated
through submitting a maintenance request form to the service manager immediately. Not doing so will
hold the employee liable for any damages and repairs.
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PROCEDURES WHEN INVOLVED IN AN ACCIDENT
Employee Responsibilities
After being involved in a vehicle collision:
1. Stop immediately to investigate.

2. Help anyone who is injured.
3. Notify Emergency Services.
4. Protect scene of collision by placing warning devices, if applicable, to warn traffic, etc.
5. Protect your vehicle from further damage or theft. Do not put yourself in a position of danger.
6. If possible, do not move your vehicle until police arrive.
7. Be courteous, but do not sign anything or discuss the collision with anyone except the police and the
(Insert Company name) representative, once identified.
8. Report to your dispatcher/manager at once by phone
9. Contact Fleet Response to report the collision
10. Do not admit responsibility or agree to pay for anything.
11. Protect yourself by obtaining witnesses, including first persons to arrive. If names are refused, get
vehicle license numbers.
12. If possible, take pictures of vehicle(s) and collision scene
Manager Responsibilities
When an employee calls to report a collision, the manager must:
1. Make sure the employee is not injured and is out of harm’s way.
2. Determine if the employee requires immediate medical attention and provide the employee with the
means to receive medical attention (call an ambulance if necessary).
3. Ensure that the employee has followed the steps above.
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DRIVING WHILE IMPAIRED POLICY
1. Employees who drive must meet the requirements of the applicable Vehicle Policies, and exercise due
diligence to drive safely. Employees are not permitted, under any circumstances, to operate any vehicle
on company business when impairment causes the employee to be unable to drive safely. This
prohibition includes circumstances in which an employee is temporarily unable to operate a vehicle
safely or because of use of drugs or intoxication.
2. All employees must report to their supervisor, within 24 hours, all law enforcement stops and arrests for
driving under the influence, intoxicated or impaired, while driving on company business in their
personal vehicle or company vehicles as defined in this policy. Failure to report will result in
disciplinary action up to, and including, termination of employment.
3. For alcohol related impairment, impaired is defined by the individual’s alcohol level, as determined by
Breathalyzer or blood test, being equal to or greater than the legal limit in the location in which the
employee was driving. For purposes of this policy, findings will be based on the applicable legal blood
alcohol limits and will not require a conviction. Employees who are found to be impaired due to an
alcohol related collision will be terminated on first offense of violation of this policy. In addition, if an
individual refuses to take a field sobriety, Breathalyzer or blood alcohol test as requested by law
enforcement or the company, that individual’s employment will be terminated.
4. The determination of impairment for unauthorized legal or illegal drugs will rely on an acceptable and
reliable test for the drug at issue. There is no requirement that there be a conviction. Employees who
are found to be impaired by unauthorized legal or illegal drugs will be terminated on first offense of
violation of this policy.
5. Impairment due to legal prescriptions or over-the-counter drugs will be determined by applicable tests,
law enforcement reports, medical advice and any other pertinent information. Employees found to be
driving while impaired due to legal prescription or over-the-counter drugs may be subject to disciplinary
action up to and including termination of employment.
DRIVER LICENSING POLICY
1. It is a fundamental expectation that all drivers comply with all governmental laws.
It is the responsibility of the employee to possess a valid driver’s license.
2. Employees are responsible for notifying their immediate supervisor within 24 hours of any motor
vehicle citation (or violation) that disqualifies them from operating a motor vehicle.
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SAFE DRIVING RULES
Beyond acquiring basic car control skills -- and exercising good judgment behind the wheel -- there are a few
basic rules for safe driving that employees driving company vehicles should know -- and follow:
Don't tailgate: Crowding the car ahead of you makes it more likely you'll smash into it if the driver should
suddenly brake. Modern safety devices such as anti-lock brakes and traction control don't trump physics.
Obey the three second rule: Every driver should know and heed the three second rule: When the vehicle ahead
of you passes a fixed object (such as a tree or telephone pole) slowly count "one thousand, two one thousand,
three one thousand." If you reach the object before completing the count, you're following too closely. Double
your following distance (to six seconds) in poor weather.
Use turn signals: Failing to signal your intentions to other motorists is always dangerous -- as well as
discourteous. Other motorists are not psychic; they can't guess that you are planning on making a right turn -- or
about to move into the next lane. Signaling is especially important for the safety of motorcyclists, bicyclists and
pedestrians, too. If they are in your blind spot and you just assume no one's there and execute a maneuver
without signaling first, these folks will get no advance warning -- and will suffer the most if you strike them.
Don't impede the flow of traffic: Driving too slowly can be more dangerous than driving a little faster than the
posted limit. In a high-density situation, with many others vehicles sharing the road, a dawdler creates what
amounts to a rolling roadblock. Traffic snarls; motorists jockey for position -- the smooth flow of cars is
interrupted. Try to drive with the flow of traffic -- and if the car behind you clearly wishes to go faster, the best
thing to do is let it get by, whether you are "doing the limit" already or not. The other driver may have an
emergency you are unaware of -- and in any event, it is simply safer and more courteous to yield to faster-
moving traffic. Leave enforcement of speed limits to the police.
Maintain appropriate speed: Speed, as such, doesn't kill. If it did, airliners traveling at 500 mph would have
the highest accident/fatality rates of any form of transportation. But air travel is in fact much safer than driving -
- and few cars travel at 500 mph. The problem is inappropriate speed. For example, while it may be perfectly
legal to drive 65 mph on the highway, if you don't slow down when it's raining heavily (or snowing) and your
visibility as well as your car's stopping ability are reduced -- you increase your chances of having an accident.
Use your judgment and adjust speed to match conditions and your comfort
Plan ahead/use your mirrors: Anticipate the need to brake or make lane changes, etc. by constantly scanning
your driving environment and watching the actions of other drivers, pedestrians and so on. This way, it's less
likely you'll need to jam on the brakes -- or make sudden steering changes -- to avoid problems. The best drivers
always maintain "situational awareness" -- where other cars are in relation to their vehicle, what's coming up
ahead -- and what's happening on either side of them and behind them. Use your mirrors -- frequently.
Drive within your limits, the limits set by conditions and the limits of your vehicle: Company trucks are not
equipped for racing or for off road usage. Each vehicle is loaded with 50 gallon tank with gas or electric
powered pumps for the sole purpose of commuting and providing pest control. Be sure to have enough space
for stopping, especially during difficult weather conditions. Know what the vehicle is capable of doing. You'll
need more time to slow down safely; don't drive faster than you, or the vehicle, can drive safely, with ample
"cushion" of time and space to make corrections and react to changing conditions and other motorists.

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1. AGGRESSIVE DRIVING
As traffic congestion continues to grow, motorists commuting to and from work and traveling for business
purposes often find themselves caught up in bottlenecks and significant delays, wasting time and reducing their
productivity. This situation creates a high level of frustration and can spark aggressive driving among these
overwhelmed drivers. To protect against aggressive driving, remember that your primary responsibility is to
drive focused and stay safe.
Safety Facts for the Road
 A major reason for increased traffic congestion is that our highway system has not kept pace with the
growing demands placed on it. Since 1970, the number of drivers increased by 64% while the roadway
system increased by only 6%.
 Many Americans believe aggressive driving is on the rise and worry about the behavior of other drivers
but admit to engaging in aggressive driving themselves.
 A substantial number of the 6.8 million crashes that occur each year are estimated to be caused by
aggressive driving.
 Overly frustrated drivers are turning their cars into extensions of their homes and offices, creating a
dangerous distraction on the road that fuels aggressive driving among other drivers.
Drive Focused. Stay Safe. Avoid Aggressive Driving.
 Correct your own unsafe driving habits that are likely to endanger, antagonize or provoke other drivers.
 Keep your cool in traffic; be patient and courteous to other drivers and don't take their actions
personally.
 If you think you have a problem, seek help. Look for anger or stress management classes or self-help
books.
 Reduce your stress on the road by allowing plenty of time to reach your destination, plan your route in
advance and alter your schedule or route to avoid busy roads.
 If despite all your planning, you're going to arrive late, accept it and avoid aggressive driving.
 Make every attempt to safely move out of an aggressive driver's way. If a hostile motorist tries to pick a
fight, do not make eye contact and do not respond. Ignore gestures and refuse to return them.
 Report aggressive driving to the police. Provide a vehicle description, license number, location and the
direction of travel.
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Are you "just driving like everyone else" or are you driving aggressively?
The Nerves of Steel Survey is a national survey that reveals how Americans define aggressive driving.
Is this act aggressive?

Tailgating 95%
Making rude gestures 91%
Passing on the shoulder 90%
Pulling into parking space someone else is waiting for 88%
Failing to yield to merging traffic 85%
Flashing high beams at the car in front of you 74%
Waiting until the last second to merge with traffic on the highway 66%
Changing lanes without signaling 66%
Driving through a yellow light that is turning red 62%
Honking the horn 53%
Double parking 53%
Driving 10 mph or more under the speed limit 27%
The Steel Alliance, 2002.
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2. DISTRACTED DRIVING
Longer commutes, an increase in heavy traffic, the availability of in-vehicle technology are all factors that result
in driver distraction. More time in your vehicle results in less time at home or on the job, causing drivers to feel
the pressure to multi-task to keep up with their responsibilities. Countless distractions tempt drivers to forget
that their primary responsibility is to drive focused and stay safe.
 Distracted driving is estimated to be a factor in between 25 to 30% of all traffic crashes—that's 4,000 or
more crashes a day.
 Events inside and outside the vehicle can distract a driver. Adverse roadway and weather conditions
require a driver's full attention.
 While taking one's eyes off the road presents obvious risks, activities that take a driver's mind away
from driving are just as risky.
 A driver's ability to manage distractions varies widely and can change from day-to-day depending on
their level of stress and fatigue.
 Distracted drivers fail to recognize potential hazards in the road and react more slowly to traffic
conditions, decreasing their margin of safety."
 Research suggests that distracted driving increases the risk of rear-end and single-vehicle crashes.
Do you know when you're driving distracted?
 Has a passenger in your car screamed or gasped because of something you did or did not do?
 Did you run a stop sign unintentionally?
 Have you slammed on your brakes because you didn't see the car in front of you stop?
 You do not remember driving from one place to another?
Drive Focused. Stay Safe. Avoid Distracted Driving.
 Safe driving practices require that you constantly search the roadway ahead for situations that could
require you to take quick action.
 Recognize that driving requires your full attention.
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Did you know that even the most routine activities are potentially
distracting while driving?
A national survey revealed the activities that distract today's drivers.
NETS DISTRACTED DRIVING SURVEY
Activities Drivers Engage in While Driving

96% Talking to passengers
89% Adjusting vehicle climate/radio controls
74% Eating a meal/snack
51% Using a cell phone
41% Tending to children
34% Reading a map/publication
19% Grooming
11% Preparing for work
Participation in Distracting Activities While Driving for Work or for
Personal Purposes
57% Personal purposes
25% Work purposes
14% Both equally
2% Don't drive for work
3% Don't know
Network of Employers for Traffic Safety, 2001.
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3. DROWSY DRIVING
As a driver, your number one responsibility is to get yourself and your passengers to your destination safely.
When behind the wheel, you always need to be alert and focused. At 55 mph, a vehicle travels the length of a
football field in 3.7 seconds. This is no time for a "mini" snooze. Being an attentive driver, and looking out for
the driver who isn't, is increasingly important. Drive focused. Stay safe.
 Drowsy driving causes more than 100,000 crashes each year, resulting in 40,000 injuries and 1,550
deaths.
 Crashes caused by drowsy driving are often serious crashes and occur most often on high-speed rural
highways when the driver is alone.
 Drowsy driving can happen to anyone. A recent National Sleep Foundation study revealed that one half
(51%) of adults have driven while drowsy and 17% report having fallen asleep while driving within the
past year.
Drive Focused. Stay Safe. Avoid Drowsy Driving.
 Be aware of your behavior and the behavior of others on the road during the late night, early morning
and mid-afternoon hours when drowsy driving crashes are most likely to occur. Plan a rest stop during
these hours.
 Get a full night of rest before driving. If you become tired while driving, stop. A short nap and
consuming caffeine can help temporarily.
 Stop at regular intervals when driving long distances. Get out of the car every 2 hours to stretch and
walk briskly.
 Set a realistic goal for the number of miles you can safely drive each day.
 Avoid taking medications that cause drowsiness.
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Do you know when you're driving drowsy?
Some warning signs of fatigue:
 You can't remember the last few miles driven.

 You hit a rumble strip or drift from your lane.
 Your thoughts are wandering and disconnected.
 You yawn repeatedly.
 You have difficulty focusing or keeping your eyes
open.
 You tailgate or miss traffic signs.
 You have trouble keeping your head up.
 You keep pulling your vehicle back into the lane.
If you're tired and are in danger of falling asleep, then you

cannot predict when a "mini" sleep may occur. A driver
cannot react to road dangers when tired. Getting enough
sleep will not only help you feel better, it can save your life.
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4. IMPAIRED DRIVING
On our congested roadways, it's more important than ever to drive with a clear head and a sharp focus. Make it
a life-governing rule not to drive when you've had too much to drink. On average, a driver makes over 200
decisions per mile, so it's critical that a driver make the decision to drive alert before getting behind the wheel.
Not only will you be a safer driver but you will be in a much better position to defend yourself from the driver
who doesn't make that choice. Drive focused. Stay safe.
 Alcohol impaired driving accounts for about 40% of fatal crashes.
 About three in every 10 Americans will be involved in an alcohol-related crash at some time in their
lives.
 Research shows that alcohol is a contributing factor in 39% of all work-related traffic crashes.
 Nearly 1.5 million people are arrested each year for driving while intoxicated (DWI). Two-thirds of all
drivers arrested for DWI are first time offenders.
 A DWI/DUI conviction on a person's driving record may prevent them from getting a job, receiving a
promotion or even result in a job loss.
 Many companies have corrective action programs that suspend company driving privileges for a
DWI/DUI violation.
 Nine out of 10 insurance companies automatically cancel the policy of a driver convicted of a DWI/DUI
violation. Consequently, the driver must find a high-risk insurance company and face substantial rate
increases.
Drive Focused. Stay Safe. Avoid Impaired Driving.
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Can you spot an impaired driver on the road?
Drivers under the influence of alcohol often display certain

characteristic driving behaviors. Keep these in mind to avoid
a dangerous situation.
 Weaving, swerving, drifting or straddling the center

line.
 Driving on the wrong side of the road.
 Driving at a very slow speed.
 Stopping without cause or braking erratically.
 Turning abruptly or responding slowly to traffic
signals.
 Driving with the window down in cold weather.
 Driving with headlights off at night.
If you spot an impaired driver, stay a safe distance from their

vehicle. Alert the police that there is an unsafe driver on the
road.

The White Knight Pest Control Safe Driving Rules, Policies, and Procedures (13 pages) describes important
rules, policies, procedures, and guidelines about White Knight Pest Control’s safe driving requirements and I
understand that I should consult the Management regarding any questions.
Since the information described in this manual are subject to change as needed, I acknowledge that revisions to
the manual may occur. All such changes will be communicated through official notices, and I understand that
revised information may supersede, modify, or eliminate existing policies.
Furthermore, I acknowledge that I have read and understand the information provided in these 13 pages
regarding safe driving rules, policies, and procedures and understand that it is my responsibility to comply with
the policies contained in this manual and any revisions made to it.
EMPLOYEE'S NAME (printed): _____________________________________________

EMPLOYEE'S SIGNATURE: _______________________________________________
DATE: __________________________________
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WHITE KNIGHT PEST CONTROL

DRUG AND ALCOHOL TESTING
STATEMENT OF POLICY:
As part of the Company’s commitment to safeguarding the health of employees, providing a safe
place for employees to work, and supplying our clients with the highest quality products and
services possible, the Company issues this policy outlining its position on the use or abuse of
alcohol, drugs, other controlled substances, or inhalants by employees.
Because substance abuse at work or away from work can seriously endanger the safety of
employees and render it impossible to supply top-quality products and services, the Company has a
program established under this policy to detect and remove abusers of alcohol, drugs, other
controlled substances, or inhalants from its workplace where such abuse impacts job performance,
or otherwise has a negative impact on the Company’s business environment.
In implementing and enforcing this policy, the Company may test applicants and employees for the
presence of drugs and/or alcohol. In the absence of state or federal law to the contrary, the
following shall apply:
GUIDELINES:
1. Definitions:
a. Alcohol or alcoholic beverage – means any beverage that has an alcoholic content in
excess of .5% by volume.
b. Drug – means any substance (other than alcohol) capable of altering the mood,
perception, pain level, or judgment of the individual consuming it and/or the
metabolite of any such substance.
c. Prescribed drug – means any controlled substance prescribed for the individual
consuming it by a licensed medical practitioner. Controlled substance means that
distribution of a substance (usually a drug) is subject to regulation by state or federal
law (i.e., it can only be prescribed by a licensed medical practitioner).
d. Illegal drug – means any drug or controlled substance, the sale or consumption of
which is illegal.
e. Specimen – means urine, blood, breath, saliva, or hair.
f. Inhalant – means any glue, paint, aerosol, anesthetic, cleaning agent, solvent, or
other substance that, when inhaled or ingested, will cause a condition of intoxication,
euphoria, excitement, exhilaration, stupefaction, or dulling of the senses and that
contains chemicals including, but not limited to: toluene, xylene; hexane; acetone;
methylene chloride; methanol; Freon(s); benzene; (iso) amyl nitrite; (iso) butyl nitrite;
(iso) propyl nitrite; N-butyl nitrite; butane; propane; fluorocarbon, hydrocarbons; ethyl
chloride; nitrous oxide; halothane; tetrachloroethylene; trichloroethane; trichloro-
ethylene.
Initial: __________
Revision Date:
2. The Company reserves the right to test for the presence of the following drugs and alcohol
at the levels indicated on the following chart:
DRUG CLASS URINE – NG/ML HAIR – NG/GM
Alcohol 0.04% -
Amphetamine/Methamphetamine 1,000 500
Barbiturates 200 -
Benzodiazepines 200 -
Cocaine Metabolite 300 500
Marijuana Metabolite 50 5
Methadone 300 -
Methaqualone 300 -
Opiates 300 500
Phencyclidine (“PCP”) 25 300
Propoxyphene Metabolite 300 -
3. Any individual whose test result indicates the presence of alcohol or drugs at or above the
levels shown in any of the classes of drugs listed above will be considered to have a positive
test.
4. No prescribed drug shall be brought on Company premises by any person other than the
person for whom the drug is currently prescribed by a licensed medical practitioner and shall
be used only in the manner, combination, and quantity prescribed.
5. The Company will not tolerate on-premises or on-duty use, possession, or distribution of
illegal drugs or alcohol or the abuse of inhalants. Employees who use these substances off
duty and report for work under their influence may be terminated.
6. The illegal use, sale, trade, or delivery of a drug or controlled substance or the illegal
possession of same on or off duty is cause for termination.
7. At the request of the Company, based on reasonable suspicion or evidence of illegal sale,
possession, or use of controlled substances, employees must submit to a search of items
within the employee’s work area and any personal vehicle brought on Company premises or
worksites or used on Company business.
Initial: __________
Revision Date:
8. Applicant Testing:
All persons who seek employment for any position may be required to submit to drug testing
only after a conditional offer of employment has been made. Collection sites, laboratory
locations, the Medical Review Officer (“MRO”), and record keeping will all follow the
guidelines set forth in this policy.
9. Employee Testing:
All employees may be required to submit to testing under the specific guidelines described
in the Drug and Alcohol Testing Policy.
a. Post-Accident Testing: Drug and/or alcohol testing, concurrent with treatment for
injury or as soon as practicable after non-injury property damage, will be required if
the employee:
(1) Has sustained a personal injury or caused a co-worker or any other person to
be injured or
(2) Has caused a work-related accident or was operating or helping to operate

machinery, equipment, or a vehicle involved in a work-related accident or in
damage to property.
b. Reasonable Suspicion Testing: Drug and/or alcohol testing may be required if an

employer has a “reasonable suspicion,” based on specific facts and rational
inferences from those facts, that an employee:
(1) Is under the influence of drugs or alcohol or
(2) Has violated the Company’s written work rules against the use, possession,
sale, or transfer of drugs, alcohol, or inhalants.
c. Random Testing: At the discretion of Company management, employees may be

required to participate in random, spot-check drug screens. Drug tests are
unannounced and every employee has an equal chance of being selected for
testing.
d. Return-to-Duty/Follow-Up Testing: The Company may conduct follow-up testing as

permitted and/or required by law. Any positive test during this period may result in
termination without notice.
Initial: __________
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10. Testing Procedures:
a. Testing of employees will be conducted either during the employee’s workday or

immediately thereafter. Employees will be compensated for this time at their regular
rate of pay.
b. The Company may use Breathalyzers or other testing procedures to detect alcohol
use or influence by employees while on duty. If alcohol use or impairment is
suspected, an employee should be treated in the same fashion as other employees
subject to for-cause investigations.
c. All applicants and employees who are requested to submit to testing will be directed
to report to a laboratory selected by the Company for the purpose of testing
including, without limitation, providing a urine, blood, or hair specimen for testing.
d. Specimen collection will be performed by the laboratory’s personnel and will be

conducted in accordance with federal, state, and local requirements to guard the
integrity of the specimens, maintain the chain of custody, and ensure the tests are
treated as confidential and distribution limited to those having a “need to know.”
e. Testing of the specimen will be performed by a certified laboratory. The method of
initial testing used will be EMIT immunoassay. In the event the initial test results are
positive, the laboratory will perform a second test on the same specimen to confirm the
test results. The confirmation test method used will be GC/MS (gas chromatography/
mass spectrometry). Except as otherwise provided in this policy, all initial and
confirmation tests will be performed at the expense of the Company.,IWHVW UHVXOWV
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8SRU3RVW$FFLGHQWWHVWLQJHPSOR\HHZLOOEHUHVSRQVLEOHIRUDOOWHVWLQJIHHV Fees
incurred from accidents where employee is at fault will be covered by the employee.
f. Positive test results will be reviewed by the laboratory’s MRO who will interpret and
evaluate the test results together with the individual’s medical history and any other
relevant information. Applicants and employees will have the right to provide the
MRO with any information the applicant or employee believes may affect the
outcome of the test.
g. All test results will be reported to the Company’s designee.
11. Confidentiality:
a. All test results and related information will be maintained and treated as confidential
by the Company, with distribution limited to those having a “need to know.”
b. Such records are property of the Company, but may be made available to the
applicant or employee upon his or her request for inspection or copying.
c. The testing laboratory will not disclose to the Company any information revealed by
the testing relating to the general health, pregnancy, or other physical or mental
condition of the person tested or any other information if the disclosure is prohibited
by federal, state, or local law.
*OJUJBM@@@@@@@@@@
Revision Date:
12. Policy Violations and Consequences:
a. Applicants who refuse to sign the Substance Abuse Screening Consent and Release
or submit to testing or who adulterate, dilute, or otherwise tamper with a test
specimen or have a positive test result that is confirmed in accordance with federal,
state, and local rules and regulations may be denied employment.
b. Employees who refuse to sign the Substance Abuse Screening Consent and
Release or submit to testing or who adulterate, dilute, or otherwise tamper with a test
specimen or have a positive test result that is confirmed in accordance with federal,
state, and local rules and regulations may be subject to immediate termination from
employment.
c. Unless otherwise prohibited by law, any employee who is terminated from

employment in accordance with this policy is considered to have been terminated for
misconduct and may not be eligible to collect unemployment compensation benefits.
d. The Company will not take any action under this policy in violation of the Americans
with Disabilities Act, or any other law.
e. Employees who come forward to admit they have a substance abuse problem prior
to the Company’s initiation of investigative procedures may, at the Company’s
discretion, be granted leave for the purpose of obtaining appropriate counseling and
treatment. Employees who seek appropriate treatment may be conditionally
reinstated to their previous status provided they undergo Company-approved
substance abuse counseling/treatment at their own expense, maintain the preventive
course of conduct prescribed by their drug and alcohol counselor and doctors, agree
to random drug testing, and their work performance is not adversely affected by
continued abuse of drugs and alcohol.
f. Treatment for alcoholism and other drug addictions is regarded the same as
treatment for any other illness or disability. Eligible employees may apply for these
benefits in accordance with the terms of available coverage.
g. Employees who are granted the opportunity for treatment will have only one
opportunity to complete counseling/treatment. Employees who do not follow the
prescribed preventive maintenance treatment by their drug counselor or engage in
drug or alcohol use on the job will be terminated. Additionally, employees who use
drugs or alcohol off the job that affects their job performance will be terminated.
13. Amendments:
a. In accordance with federal, state, and local regulations, the Company has the right to
make changes to this policy at any time.
b. If any part of this policy is determined to be void or unenforceable under state or

federal law, the remainder of the policy, to the extent possible, remains in full force
and effect.
Initial: __________
&GGFDUJWF%BUF
3FWJTJPO%BUF
SUBSTANCE ABUSE SCREENING CONSENT AND RELEASE
I, the undersigned, having been made an offer of employment or employed by the employer
named :KLWH .QLJKW 3HVW &RQWURO ,QF (hereinafter the ”Company”), hereby voluntarily
consent to the taking of specimens for substance abuse screening as a condition of my
initial and/or continued employment with the Company. I authorize the release of all results of
such screening to the Company
I release the Company; their agents, servants, and assigns; the testing laboratory,
its physicians, nurses, technicians; and any other employees or agents involved with my tests from
any and all liabilities, claims, or causes of action relating to such substance abuse screening
including, without limitation, those that may result from administering such tests and/or the
disclosure of test results.
I understand and freely and voluntarily agree that if the Company asks me to, I will submit
to substance abuse screening. I understand that either refusal to submit to the substance
abuse screen or a positive test result may result in revocation of a conditional offer of
employment or termination of my employment, as applicable. ,DOVRXQGHUVWDQGWKDWLIWHVWUHVXOWV
DUHSRVLWLYHIRUDQ\5DQGRP5HDVRQDEOH6XVSLFLRQ5HWXUQWR'XW\)ROORZ8SRU3RVW$FFLGHQW
WHVWLQJ,ZLOOEHUHVSRQVLEOHIRUDOOWHVWLQJIHHV All Post Accident testing fees for accidents which I
am at fault will be my responsibility.
In the case of a breath alcohol test, I understand and agree that if the breath alcohol test level as
determined by the test reflects an illegal level of intoxication, I will be unable to operate a motor
vehicle and must use an alternative form of transportation operated by someone other than myself.
If I refuse alternative transportation, I understand and agree law enforcement officials may be
notified.
Furthermore, I understand that I may be required to submit to testing for the presence of drugs
and/or alcohol within twenty-four (24) hours of a work-related injury. I understand that if I refuse to
execute all forms of consent and/or refuse to consent to the testing after a work-related injury, my
employer has the right to disciplinary action, up to and including termination.
__________________________________________
Signature Date
__________________________________________
Printed Name Employer

Technician Hiring Packet August 2014

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Technician Hiring Packet August 2014

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Welcome!

White Knight Management

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AUTHORIZATION TO RELEASE INFORMATION

Current Address Dates Lived Here

Social Security Number Driver's License # State

Printed Name Applicant Signature Date

Texas Department of Agriculture

Commercial Client No. Account No.

Home Mailing Address City State Zip

Physical Address (if different) City State Zip

Email Address Phone Number Date of Hire

City State Zip

Licensing Department Revised 01/01/14

Applicant Name _________________________

Signature of Applicant Signature of Employer’s Representative

Date (mm/dd/yy) Date (mm/dd/yy)

Application Fee for Technician License is $81.00

Licensing Department Revised 01/01/14

Change of License Form

***This form is NOT to be used to change a Business License or an Apprentice Card.***

Section A – MUST be completed by applicant (Print or Type)

Legal Name of Applicant License #

Social Security No.* Drivers License No. Date of Birth

Home Location Address

Section B – Must be completed if applicable (Print or Type)

Business Telephone No. ( ) Business Fax No. ( ) Bus Email:

Section C – Must be completed by Applicant (Print or Type)

SIGNATURE OF APPLICANT DATE

$224 for an original and renewal business license;

$75 for administering exams in each category;

1½ for late renewal fee for up to ninety (90) days late;

DIRECT DEPOSIT AGREEMENT

Employees Authorization – Please fill out and return to your employer.

EMPLOYEE NAME – FIRST, MIDDLE INITIAL, LAST SOCIAL SECURITY NUMBER

CHECKING ACCOUNT FLAT AMOUNT $ BANK NAME

Employee Enrollment Form

Address Apt # City State Zip Code Home/Cell Phone

Date of Birth Sex Email Address Work Phone

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This form is NOT to be used to change a Business License or an Apprentice Card.

Sign: _____________________________ Print: _ Date: _____