INTERNATIONAL EMPLOYEE STOCK PURCHASE PLAN ("IESPP") ENROLLMENT/CHANGE FORM
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EXHIBIT 10.11.5
INTERNATIONAL EMPLOYEE STOCK PURCHASE PLAN ("IESPP")
ENROLLMENT/CHANGE FORM
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Action |
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Complete Sections |
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SECTION 1: ACTION |
/ / | New Enrollment | 2, 3, 6, 7 | and sign attached Stock Purchase Agreement | ||||
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Payroll Deduction Change |
2, 4 & 7 |
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Terminate Payroll Deductions |
2, 5 & 7 |
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/ / |
Beneficiary Change |
2, 6 & 7 |
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SECTION 2 PERSONAL DATA |
Name | |
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Last | First | MI | Branch Location | |||||||
Home or Mailing Address: |
Street |
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City | State | Zip Code | ||||||||
Social Security # |
/ / / / / /-/ / / /-/ / / / / / / / |
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SECTION 3: NEW ENROLLMENT |
Effective with the Purchase Period Beginning: | Payroll Deduction Amount % of cash earnings* | ||||
* Must be a multiple of 1% up to a maximum of 10% of cash earnings | ||||||
SECTION 4: PAYROLL DEDUCTION CHANGE |
Effective with the Pay Period Beginning: | Month, Day and Year |
I authorize the following new level of payroll deduction: % of cash earnings* |
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* Must be a multiple of 1% up to a maximum of 10% of cash earnings | ||||||
NOTE: You may reduce your rate of payroll deductions once per purchase period to become effective as soon as possible following the filing of the change form. You may also increase your rate of payroll deductions to become effective as of the start date of the next purchase period. |
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SECTION 5: TERMINATE PAYROLL DEDUCTIONS |
Effective with the Pay Period Beginning: |
Month, Day and Year |
Your election to terminate your payroll deductions for the balance of the purchase period cannot be changed, and you may not rejoin the same purchase period at a later date. You will only be able to resume participation in the IESPP at the beginning of the next purchase period. | |||
In connection with my voluntary termination of payroll deductions (or an approved leave of absence), I elect the following action regarding my IESPP payroll deductions to date in the current purchase period: |
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/ / Purchase shares of Westaff, Inc., at end of the period |
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OR |
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/ / Refund IESPP payroll deductions collected |
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NOTE: |
If your employment terminates for any reason or your eligibility status changes (<20 hrs/wk or <5 months/yr), you will immediately cease to participate in the IESPP and your IESPP payroll deductions collected in that purchase period will automatically be refunded to you. |
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SECTION 6: BENEFICIARY INFORMATION |
Beneficiary(ies) Name |
Address |
Relationship of Beneficiary (ies) |
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SECTION 7: SIGNATURE |
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Signature of Employee |
Date |
INTERNATIONAL EMPLOYEE STOCK PURCHASE PLAN ("IESPP") ENROLLMENT/CHANGE FORM