Uniform Request Uniform Request Employee InformationDate* MM slash DD slash YYYY Name* First Last Employee Number*Email Address*Location* Green Bay Green Lake LaSalle Neenah Troy Rapid River I need....* to place a new order a different size a repair or replacement missing something? something else Position* Driver Diesel Technician New Uniform Shirt OrderYou will be charged a total of $12.00 per pay period for rental service for uniform sets ordered through the uniform service. When you order, 11 sets will be ordered automatically.Shirt Size*See pictures below for available sizes. You may choose multiple options. Quantities will be split evenly unless noted otherwise.Shirt Length* Regular Length Long Length Shirt Style - Drivers You may choose multiple options. Quantities will be split evenly unless noted otherwise.Shirt Style - Diesel Technician New Uniform Pant OrderYou will be charged a total of $12.00 per pay period for rental service for uniform sets ordered through the uniform service. When you order, 11 sets will be ordered automatically. Pant sizes only come in even numbers. Pant Waist Size*Limitations by style may apply. You may choose multiple options. Quantities will be split evenly unless noted otherwise. Pant sizes only come in even numbers. Pant Inseam Size*Limitations by style may apply.Pant Style - Drivers Pant Style - Diesel Technician Coveralls SizeSee pictures for available sizes. You may choose to order coveralls at no additional cost, three sets will be ordered automatically.Coveralls - Drivers No Coveralls Coveralls - Diesel Technicians No Coveralls New Uniform Order Comments:Note any special requests or additional information including split quantities for orders with multiple options selected.Uniform Issues - Repair or ReplaceNote: Please fill this section if you have an issue with an order placed and are needing a different size. Yellow Tag Process*Do you need a replacement? Fill out the yellow tag found at your location and upload a picture here. If you do not see any yellow tags left, contact HR. | Your replacement will not be processed until your yellow tag has been filled out and uploaded. Max. file size: 12 MB.Garment Number*This number is located on the tag inside the item you are sending in for repair, just above the barcode.Item Needing Service* Pant Shirt Coveralls Please mark repairs to be made: Button Snap Zipper Torn Inseam Seat Patch Pocket Belt Loop Cuff Collar Sleeve Pant Leg Tie Alterations: Waist Inseam Comments:Uniform Issues - Wrong SizeNote: Please fill this section if you have an issue with an order placed and are needing a different size. Shirt Size*See pictures below for available sizes. You may choose multiple options. Quantities will be split evenly unless noted otherwise.Shirt Length* Regular Length Long Length Pant Waist Size*Limitations by style may apply. You may choose multiple options. Quantities will be split evenly unless noted otherwise.Pant Inseam Size*Limitations by style may apply.Missing Items?What are you missing? Shirt(s) Pant(s) Coverall(s) Check all that apply and make notes below on the specifics for each missing item(s).Missing Items Comments:Other Uniform Issues?Uniform Policy AcknowledgementUniform Policy* I agree.I understand that employees are the face of The Company and will dress to fit the position and give an impression of professionalism. Employees issued uniforms may choose to wear other Company apparel (i.e. Company logo shirts) in lieu of his/her uniform shirt with uniform pants. Any Company or other apparel worn must be clean, free of rips and tears, and professional in appearance.Payroll Deduction Authorization-Sets* I agree.I understand that I will be charged $12.00 per pay period for rental service for the shirt/pant sets ordered through the uniform service. I understand that I will be charged an additional fee for coveralls. When you order, 11 sets will be ordered automatically. Payroll Deduction Authorization* I agree.I understand that upon submission of this form, you are authorizing your employer FLASH to deduct from each payroll the per piece cost of the uniform choices noted above. | Upon the ending of your employment, $12.00 will be deducted from your paycheck for each uniform piece that has not been returned. | Upon the return of all uniform pieces to FLASH, any deducted amount will be refunded to the employee. If a dispute arises over the number of uniform pieces missing, a meeting will be held with the employee, the outside uniform service provider, and FLASH management to resolve the issue.NameThis field is for validation purposes and should be left unchanged.
