Exhibit 99.16
WESTERN STAFF SERVICES, INC.
INTERNATIONAL EMPLOYEE STOCK PURCHASE PLAN ("IESPP")
ENROLLMENT/CHANGE FORM
Action Complete Sections:
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| SECTION 1: | [ ] New Enrollment 2, 3, 6, 7 and sign attached
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ACTIONS Stock Purchase Agreement
[ ] Payroll Deduction Change 2, 4, 7
[ ] Terminate Payroll Deductions 2, 5, 7
[ ] Beneficiary Change 2, 6, 7
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| SECTION 2: |
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Name ________________________________________________________________________
PERSONNEL Last First MI Dept.
DATA
Home or Mailing Address _____________________________________________________________
Street
_____________________________________________________________________________________
City State Zip Code
Social Security #: [ ][ ][ ]-[ ][ ]-[ ][ ][ ][ ]
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| SECTION 3: |
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Effective with the Purchase Period Beginning: Payroll Deduction Amount: _____% of cash earnings*
NEW [ ] February __, 199__
ENROLLMENT [ ] August __, 199__ * Must be a multiple of 1% up to a maximum of 10% of
cash earnings
[ ] Initial Purchase Period -- November 3, 1996
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| SECTION 4: |
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PAYROLL Effective with the I authorize the following new level of payroll
DEDUCTION Pay Period Beginning: ______________________________ deduction: _______% of cash earnings
CHANGE Month, Day and Year
* 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
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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: |
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Effective with the Your election to terminate your payroll deductions
TERMINATE Pay Period Beginning: ______________________________ for the balance of the purchase period cannot be changed,
PAYROLL Month, Day and Year and you may not rejoin the purchase period at a later
DEDUCTIONS date. You will not be able to resume participation in
the IESPP prior to the commencement 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:
[ ] Purchase shares of Western Staff Services, Inc. at end of the period
OR
[ ] Refund IESPP payroll deductions collected
NOTE: If your employment terminates for any reason or your eligibility status changes (less than 20 hrs/wk or less than 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: |
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Beneficiary(ies) Relationship of Beneficiary(ies)
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BENEFICIARY
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| SECTION 7: |
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AUTHORIZATION
I WOULD LIKE MY CERTIFICATE TO BE ISSUED AS FOLLOWS: (PRINT NAME(S) EXACTLY AS THEY SHOULD APPEAR.)
[ ] My name only, ____________________________________________________.
[ ] My name, ________________________________________________, and my spouse, _______________________________, [ ] AS COMMUNITY
PROPERTY OR [ ] AS JOINT TENANTS.
[ ] Issued in street name and delivered to the Corporation-designated brokerage account maintained on my behalf.
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Date Signature of Employee
