Application for Employment Healthcare Exchange. Employee Data Sheet I-9 Form US Dept. of Immigration

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1 By signing below, I hereby certify that upon my employment, I have been issued the following checked items: GENERAL EMPLOYMENT PAPERWORK Application for Employment Healthcare Exchange Employee Data Sheet I-9 Form US Dept. of Immigration Federal Withholding Tax Form (W-4) Direct Deposit Form State Tax Form (IT-2104) or (IT2104E) Ski Plan (Employee Benefit) Notification of Optional Membership in the NYS Retirement System or NYS Retirement Application Statement re: Harassment/ Discrimination Ethics, and Code of Conduct ************************************************************************ BELLEAYRE MOUNTAIN HANDBOOK I also acknowledge that I have or will read and will abide by the policies, procedures, codes, and instructions found in the Belleayre Mountain Handbook. The current handbook can be found on the Belleayre website at or upon request, a hard copy can be issued to you from the Human Resources Department. NAME, please print Date Signature

2 EMPLOYEE DATA SHEET Name: _ SS #: Address: Would you be Interested in Ride Sharing/Carpool? Home Phone #: Cell #: In what order should we attempt to contact you (rank 1, 2, or 3): Cell: Phone: Emergency Contact: Address: Phone #: Relationship to the Person: _ Allergies/Medical Conditions: By signing below, I hereby authorize ORDA to use the above information for business/ emergency purposes and for ORDA to contact me and/or my emergency contact via the methods provided. Signature: Date: FOR OFFICE USE: Title: Grade: _ Pay Rate: Date of Hire: Retirement #:

3 2018 Health Care Exchange Notification I, have received notification of the 2018 Health Care Exchange options offered through the Affordable Care Act s health insurance exchanges. Signature: Date: _ cc: personal history folder

4 NOTIFICATION Optional Membership in Retirement Benefit As an employee who works on a less than full-time year-round basis (seasonal or part-time), you may choose to participate in the New York State Employees Retirement System. I understand that benefit eligibility and vesting rights are established by the New York State and Local Retirement Systems. More information may be found at: If you choose NOT to join at this time, please complete the following: Name, please print Signature Social Security number Date By signing above, I certify that I am not currently a member of the New York State Retirement System with another employer. I understand that if I am already a member of the NYS Retirement System, I must enroll through ORDA as well. NOTE: ALL MEMBERS OF THE RETIREMENT SYSTEM MUST JOIN THE RETIREMENT SYSTEM THROUGH ALL PARTICIPATING EMPLOYERS WITH WHOM S/HE WORKS.

5 ORDA EMPLOYEE STATEMENT NAME: VENUE: BELLEAYRE DEPARTMENT: As an employee of the Olympic Regional Development Authority, I have received and read O.R.D.A. s Discrimination and Sexual Harassment Policy, the New York State Code of Conduct, and ORDA s Ethics Policy, and understand, my obligations as an employee to adhere to these policies and codes. I also acknowledge receipt of the Discrimination/Complaint form and understand that if I have a complaint of harassment/discrimination, that I am to submit this form pursuant to the directions contained therein and that I may obtain another complaint form from my payroll office or the ORDA Human Resources Office. Signature Date OLYMPIC REGIONAL DEVELOPMENT AUTHORITY

6 EMPLOYEE PASS APPLICATION SKI3 PASS Please check all that apply: NON-SKI ID CARD Part Time Full Time First Year Employee Mailing Address City Phone ( Returning State ) Non-Paid Zip - By signing below I state that I have read and agree to the SEASON PASS INFORMATION AND CONDITIONS OF PURCHASE, the NOTICE, WARNING TO SKIERS and ASSUMPTION OF RISK AGREEMENT as printed on the reverse side of this Season Pass Application. Print Employee Name Signature of Applicants Age 18 & Over Date of Birth New photo at Belleayre Use my photo on file Choose One: Family Member Information Printed Name of Parent or Legal Guardian for all Applicants Under Age 18: Signature of Parent or Legal Guardian for all Applicants Under Age 18: Today s Date For Belleayre Use Only Parent or Legal Guardian Date of Birth (required): to HR» SUPERVISOR AUTHORIZATION Authorized Signature Date

7 Employee Season Pass Application, Side 2 SEASON PASS INFORMATION AND CONDITIONS OF PURCHASE 1. An ID card will be issued to each employee and season passes to eligible family members. This ID and family member season passes are the property of Belleayre. The employee pass is valid for lift access and for all other benefits requiring presentation of the Belleayre employee ID. The ID and family member season passes must be clearly presented to the ticket checker / scanners above the waist on every lift boarding occasion. All employees must have a season pass / non-ski ID card issued to them to receive employment benefits and privileges. 2. Upon termination of employment, employee ID and family member season passes must be returned to Belleayre. 3. Current photos may be used for the season, as long as your photo has not been used for three or more snow seasons. We will take a new photo upon request. 4. If the employee ID or family member season pass is lost or stolen you must notify Belleayre at once. A fee of $25 will be charged to process a new pass. A one-day ticket will be issued ONLY one time during the season for a lost or forgotten pass. After that, a fee of $5 per day ticket will be charged for forgotten passes. 5. An employee ID or season pass is non-transferable and is for the applicant s exclusive use. Use by another person constitutes fraud and will result in revocation of the pass and possible prosecution. 6. Ski area regulations are enforced by the reckless skier policy and New York State Code Rule 54, Article 18, Safety In Skiing Code. Any misuse, fraudulent use, misconduct or nuisance caused by the passholder or failure to follow New York State law may result in recall of the pass without refund or other consideration. Belleayre management reserves the right to recall season passes depending upon the severity of rules infractions. 7. All employee ID and season pass applicants must sign this application before it can be processed and the pass distributed. A parent or legal guardian of persons under age 18 must complete and sign the application and the Season Pass Assumption of Risk Agreement. 8. I have sought out, read, and agree as a passholder to adhere to the entirety of Belleayre s Skier s Responsibility Code, which includes, but is not limited to, an agreement to show respect for others [both on and off the slopes] and to keep off closed trails and closed areas. BEFORE SIGNING THIS FORM OR USING YOUR PASS, YOU MUST READ THE NOTICE, WARNING TO SKIERS, AND ASSUMPTION OF RISK BELOW. NOTICE: Skiers and ski lift passengers are governed by the New York State Safety in Skiing Code (Article 18, of the NYS General Obligations Law). Before accepting this pass or allowing this pass to be affixed to your person, your attention is directed to a posted WARNING TO SKIERS which is printed below and where lift passes are purchased. New York Law requires you to seek out, read, review and understand the WARNING TO SKIERS before you decide to participate in the sport of skiing. WARNING TO SKIERS: Downhill skiing, like many other sports contains inherent risks including, but not limited to the risk of personal injury including, catastrophic injury, or death, or property damage, which may be caused by variations in terrain or weather conditions; or, surface or subsurface snow, ice, bare spots or areas of thin cover, moguls, ruts, bumps; or other persons using the facilities; or rocks, forest growth, debris, branches, trees, roots, stumps; or, other natural objects or man made objects that are incidental to the provision or maintenance of a ski facility in New York State. New York law imposes a duty on to you to become apprised of, and understand, the risks inherent in the sport of skiing, which are set forth above, so that you make an informed decision whether to participate in skiing notwithstanding the risks. New York law also imposes additional duties upon you, to which you must adhere, for the purpose of avoiding injury caused by any of the risks inherent in skiing. If you are not willing to assume all of these risks and abide by these duties, you must not participate in skiing at this area. ASSUMPTION OF RISK AGREEMENT: I have read and understand the NOTICE above. I have read, reviewed and understand the WARNING TO SKIERS printed above. In signing this application and receiving the Season Pass, I signify that I am aware of and understand the risks inherent in the sport of skiing and that I am accountable for my action as set forth on the WARNING TO SKIERS signs. I agree that this acknowledgment shall be for the entire term of the season pass.