CALIFORNIA NOTICE TO EMPLOYEE
Labor Code section 2810.5
California Labor Code section 2810.5(a) requires that the following information be provided to each employee at the time of hire and rehire in the
language the employer normally uses to communicate employment-related information. Temporary services employers must also provide customer
information; since this information changes with each assignment, a new Notice is required for each position.
If an exact rate of pay is known at time of hire, the Kelly Representative will enter the exact assignment pay rate. If no assignment is identified at time of
hire, the Kelly Representative will enter a range of pay that can be expected for the type(s) of assignment(s) sought and for which the employee is
qualified; exact wages depend on type, geographic location, and skill level. Additionally, pre-assignment activities such as interviews will be paid at state
or local minimum wage, whichever is higher. If you are unfamiliar with your state or local minimum wage, contact your Kelly representative.
EMPLOYEE (To be completed by Kelly)
Employee Name:
Last Four Digits of Social Security Number:
Start Date:
(This is the date when you became eligible for an assignment with Kelly Services. You will not be on an active payroll until you commence working on
an assignment for Kelly Services.)
EMPLOYER
Legal Name of Hiring Employer: Kelly Services
Is hiring employer a staffing agency/business (e.g., Temporary Services Agency; employee Leasing Company; or Professional employer Organization
[PEO])? x Yes □ No
Other Name Hiring Employer is “doing business as” (if applicable): Kelly Services, Inc., Kelly Services, Kelly, Kelly Temporary Services, Kelly
Educational Services (KES), Kelly Engineering Resources (KER), Kelly Financial Resources (KFR), Kelly Government Solutions, Kelly Healthcare
Resources (KHR), Kelly IT Resources (KITR), Kelly Law Registry (KLR), Kelly Marketing Services (KMS), Kelly Scientific Resources (KSR), Kelly
Connect, KellyDirect, KellySelect, Kelly Outsourcing and Consulting Services (OCG), Kelly Business Process Outsourcing (BPO), Kelly
Recruitment Process Outsourcing (RPO), Kelly Contingent Workforce Outsourcing (CWO), Kelly Managed Service Provider (MSP), Kelly Payroll
Process Outsourcing (PPO), Kelly Project Management Office (PMO), Kelly Project Services, Kelly Electronic Assembly, Kelly Light Industrial
Services, Kelly Office Services, Kelly Insurance, Kelly Human Resources, Kelly Partnered Staffing, Kelly Higher Education, Kelly Electronic
Assembly, Kelly Search & Placement, Kelly HR Consulting, The Ayers Group, Strategic Accounts and Operations (SAO)
Physical Address of Hiring Employer’s Main Office:
999 West Big Beaver Troy, MI 48084
Hiring Employer’s Mailing Address (if different than above): PO Box 33845 Detroit, MI 48232-5845
Hiring Employer’s Telephone Number:
866-535-5948
EMPLOYER (To be completed by Kelly)
Has an assignment been identified?
No, an assignment has not been identified. At the time an assignment is identified, you will be provided with the Customer Name, Physical Address of
Main Office, Mailing Address, Telephone Number, and Kelly Reference Number.
Yes, an assignment has been identified. The following is the other entity for whom this employee will perform work:
Customer Name:
Physical Address of Main Office:
Mailing Address:
Telephone Number:
Kelly Reference Number:
WAGE INFORMATION (To be completed by Kelly)
Rate(s)/Range of Pay: $
Time-and-a-Half Rate(s)/Range of Pay (multiply hourly rate by 1.5): $
Double-Time Rate(s)/Range of Pay (multiply hourly rate by 2): $
Or such other rates as federal and state law may require. Kelly Services will verbally notify you of the exact rate of pay of any assignment offered to
you. Should you accept and work the specific assignment offered to you, the exact rate of pay agreed to will also be set forth on the pay stub (i.e.,
itemized wage statement) that you will receive each pay day following the date that the assignment commenced. Your assignment-specific overtime
rates will be time-and-a-half and double your hourly and/or differential rate and will be shown on your pay stub when you work overtime and double time.
Rate by (check box):
Hour
Shift
Day
Week
Salary
Piece rate
Commission
Kelly Standard Service Bonus: Employees accumulating specified hours-worked thresholds on certain assignments may receive a bonus of 1% or 2% of total
earnings over a defined 12-month period. Eligibility requirements and plan details are described in the Kelly Services Employee Handbook, on myKelly.com, or from
your Kelly representative.
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Other (provide specifics):
Does a written agreement exist providing the rate(s) of pay? (check box)
Yes
No
Allowances, if any, claimed as part of minimum wage (including meal or lodging allowances): None
Regular Pay Day: As long as you submit your time promptly and accurately at the end of your work week, in accordance with Kelly policy, you will be
paid within seven days from the end of the pay period.
This is not a contract of employment. By signing this notice, I acknowledge that I received a copy of this notice and understand the following:

Employees may not “opt out” of future notifications, which will be sent to either my email or mailing address as indicated on the Employment
Application. My employment term is not guaranteed and my employment with Kelly Services is “at will.”

Kelly Services or I may end the relationship at any time and for any reason, with or without cause, subject to applicable laws.

The duration of my placement on any individual assignment is determined solely by the needs of Kelly Services’ customer and may be
cancelled at any time by Kelly Services or the customer.

Prior to the commencement of each customer assignment, Kelly Services will verbally inform me of the actual rate of pay for that assignment. I
have the option to accept or reject any assignment. The agreed upon rate of pay for the specific assignment I accept will be reflected on the
paystub I receive each pay day following work on the assignment. In the event that an inadvertent error is made regarding the pay rate or
range on the enclosed Notice, the rate of pay verbally offered and accepted per assignment and reflected on the pay stub for the
corresponding pay period will control.
WORKERS’ COMPENSATION
Insurance Carrier’s Name: ACE American Insurance
Kelly Services’ Worker’s Compensation Third Party Administrator: ESIS, Inc.
Address: Southwest Territory WC Claims Office 9200 Oakdale Avenue, 8th Floor Chatsworth, CA 91311
Telephone Number: Toll Free # 800-654-5374
Policy Number: The policy number changes annually and is available on mykelly.com.
□ Self-Insured (Labor Code 3700) and Certificate Number for Consent to Self-Insure: N/A
PAID SICK LEAVE (Effective July 1, 2015)
Unless specifically exempted from the provisions of the California Paid Sick Leave law the employee identified on this notice is entitled to minimum
requirements for paid sick leave under state law which provides that an employee:
a. May accrue paid sick leave and may request and use up to 3 days or 24 hours of accrued paid sick leave per year;
b. May not be terminated or retaliated against for using or requesting the use of accrued paid sick leave; and
c. Has the right to file a complaint against an employer who retaliates or discriminates against an employee for
1. requesting or using accrued sick days;
2. attempting to exercise the right to use accrued paid sick days;
3. filing a complaint or alleging a violation of Article 1.5 section 245 et seq. of the California Labor Code;
4. cooperating in an investigation or prosecution of an alleged violation of this Article or opposing any policy
or practice or act that is prohibited by Article 1.5 section 245 et seq. of the California Labor Code.
The following applies to the employee identified on this notice: (Check one box)
 1. Accrues paid sick leave only pursuant to the minimum requirements stated in Labor Code §245 et seq. with no
other employer policy providing additional or different terms for accrual and use of paid sick leave.
 2. Accrues paid sick leave pursuant to the employer’s policy which satisfies or exceeds the accrual, carryover, and
use requirements of Labor Code §246.
 3. Employer provides no less than 24 hours (or 3 days) of paid sick leave at the beginning of each 12-month period.
 4. The employee is exempt from paid sick leave protection by Labor Code §245.5. (State exemption and specific
subsection for exemption):_________________________________________________________________
ACKNOWLEDGMENT OF RECEIPT (To be completed by the Employee and Kelly)
(PRINT NAME of Employer Representative)
(PRINT NAME of Employee)
(SIGNATURE of Employer Representative)
(SIGNATURE of Employee)
(Date)
(Date)
The employee’s signature on this notice merely constitutes acknowledgement of receipt.
Labor Code section 2810.5(b) requires that the employer notify you in writing of any changes to the information set forth in this Notice within seven
calendar days after the time of the changes, unless one of the following applies: (a) All changes are reflected on a timely wage statement furnished in
accordance with Labor Code section 226; (b) Notice of all changes is provided in another writing required by law within seven days of the changes.
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