PER DIEM ELIGIBILITY CERTIFICATION
I. Basic Information
Employer: Synesis Inc_______________
Home Address: ______________________________
Work Address: ______________________________
Estimated Distance: miles
Basic Rate: $_______ per hour
II. Basic Information
I, ______________________________, certify that I am eligible to receive per diem as defined and limited by any applicable section of the United States Internal Revenue Code.
1. Per diem will be paid on the first forty hours of work each week.
2. If this certification is executed at a later time than the basic employment agreement, the rates contained herein take precedence.
3. Any change in status that affects your eligibility for per diem will be reported to us immediately. Appropriate changes to the compensation plan will be executed to reflect your new status.
4. If at any time, the Internal Revenue Service, or any other controlling government body, declares you to have been ineligible for per diem, during a period of employment with Synesis Inc that you certified you were eligible, you will hold Synesis Inc blameless, and will compensate us for all liability incurred. The only exception to the above clause is company liability for FICA payroll taxes.
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