We conduct an annual check-in to update your contact information, credentials, and licenses and to remind you of the terms of your engagement with Rodgers Security Solutions and our clients. Please complete the form below to ensure your information is accurate and up-to-date. We look forward to another successful year together. Thank you!

Annual Compliance Check-In
Each year, all RSS employees and contractors are required to complete this form to ensure that RSS maintains accurate and up-to-date information about everyone performing work for or with the company. RSS is committed to adhering to legal and contractual obligations. Consequently, all individuals or companies representing or working for RSS in any capacity must also meet the standards set by our clients and other entities. With this in mind, please make sure you provide current and accurate information.
Legal Name
Which Services Do You Provide Through RSS?
Check all that apply to you
Are you providing services as an individual or do you personally own a company that provides services to RSS?

CONTACT INFORMATION

Address
Are any of the contact details listed above new or different from what RSS has on file?
Please note, we are not responsible for outdated information in your file. You must notify us of any changes.
Drag & Drop Files, Choose Files to Upload
Please provide their first and last name, address, and phone number
Please provide their first and last name, address, and phone number

Conflict of Interest Disclosure

I am unaware of any situations or activities that could create a conflict of interest or the appearance of a conflict of interest with RSS.

Non-Disclosure Agreement (NDA) Acknowledgment

I certify that during my working relationship with Rodgers Security Solutions (RSS), I will not disclose any confidential information about RSS, its clients, employees, contractors, representatives, or agents, in any form (written, video, audio, or otherwise). If in doubt, I will treat information as confidential. I also understand that RSS will not disclose my confidential information for any purposes outside of our working relationship. This Agreement to maintain confidentiality of any disclosed information will remain in effect for ten (10) years.
I acknowledge that I have received, read, and agreed to the terms as outlined in the Client-Specific Addendum to the Non-Disclosure Agreement. I understand that violation of the NDA and Addendum could result in legal consequences, as outlined in both documents. By checking this box and submitting this form, I am bound by the terms as outlined.
This acknowledgment is ONLY for individuals who received a client-specific Addendum that is combined with the NDA. If you were not given an Addendum in addition to the NDA, then please click “Not Applicable.” Thank you.

TAX INFORMATION

Does RSS Have Your Current Year W4/W9 Tax Form on File?
Please note, if we don’t have current information for you this will delay the processing of your tax forms.
[California Residents Only] Does RSS Have Your Current California DE-4 Tax Form on File?
Please note, if we don’t have current information for you this will delay the processing of your tax forms.

Tax Compliance Forms

For your convenience, we have provided links to PDFs of the W4 and DE-4 for employees, and the W9 for Independent (1099) contractors.

IRS Form W4 [Employees Only]

https://www.irs.gov/pub/irs-pdf/fw4.pdf

California Form DE-4 [California-based Employees Only]

For proper withholding of your state income tax from your paycheck

https://edd.ca.gov/siteassets/files/pdf_pub_ctr/de4.pdf

IRS Form W9 [for 1099 independent contractors only]

https://www.irs.gov/pub/irs-pdf/fw9.pdf

LICENSES & PERMITS

I Need to Update or Obtain the Following:
Check all that apply
Please provide permit/license number and expiration date.

HEALTH & SAFETY CERTIFICATIONS

Certification Status
Check all that apply.
Drag & Drop Files, Choose Files to Upload You can upload up to 15 files.
Upload copies of any of the documents, IDs, permits, etc that you need to update

ACKNOWLEDGMENTS & ATTESTATION

I confirm I took my required Ethics Training this year
I confirm I took my required Bullying & Harassment Prevention Training this year
I confirm I took my required Workplace Violence Prevention Training this year
I confirm I took my required Cybersecurity Awareness Training this year
I confirm I took my required Fraud, Waste & Abuse Training this year
I confirm I took my required Cultural Competency Training this year
I acknowledge that I will be working with individuals from diverse backgrounds, skill sets, and experience levels, including RSS employees, contractors, and clients. If a dispute or misunderstanding arises that cannot be amicably resolved, I will promptly seek assistance from RSS management. If my issue is with a site supervisor, I will seek assistance from RSS management.
I understand that RSS has a zero-tolerance policy for all forms of harassment and bullying. If I am accused of such behavior, I may be removed from my assignment and deemed ineligible for future assignments and contracts with RSS. I acknowledge that RSS reserves the right to take appropriate action based on its policies and any investigations, and I accept responsibility for my conduct in accordance with these standards. If I witness harassment or bullying involving an RSS employee, representative, or contractor, I will immediately notify RSS management. If I witness harassment or bullying involving an RSS client, I will follow the established safety protocols to address the situation.
I certify that I will return all materials, badges, equipment, uniforms, or property belonging to RSS and/or its clients at the end of my working relationship with RSS. Whether the relationship ends voluntarily or involuntarily, I will not retain any items that do not belong to me.
I confirm that the information I have provided is truthful, current, and accurate.

Click the “Submit” button below to send this form to our HR team. You will see a confirmation message and links to helpful resources upon submission.

We appreciate you!

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