Westaff, Inc. Employee Stock Purchase Plan Enrollment/Change Form

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*

* 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.

Summary

This form allows employees of Westaff, Inc. to enroll in, modify, or terminate participation in the company's Employee Stock Purchase Plan (ESPP). Employees can choose to start or change payroll deductions for purchasing company stock, terminate deductions, or update beneficiary information. Deductions are limited to a maximum of 10% of cash earnings. Termination of deductions is effective for the remainder of the purchase period, and re-enrollment is only possible in the next period. The form also requires employee signature and personal information.

EX-10.112 10 a2071262zex-10_112.htm EXHIBIT 10.11.2
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EXHIBIT 10.11.2

EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM

	Action		Completed Sections:
SECTION 1: ACTION	/ /	New Enrollment	2, 3, 6, 7	and sign attached Stock Purchase Agreement
	/ /	Payroll Deduction Change	2, 4, 7
	/ /	Terminate Payroll Deductions	2, 5, 7
	/ /	Beneficiary Change	2, 6, 7

SECTION 2: PERSONAL DATA	Name
		Last	First	MI	Dept. # or Branch #
	Home or Mailing Address		Street

	City	State			Zip Code
	Social Security #:		/ / / / / /-/ / / /-/ / / / / / / /

SECTION 3: NEW ENROLLMENT	Effective with the Purchase Period Beginning:		Payroll Deduction Amount: % of cash earnings*
	/ / / /	February , August ,	* Must be a multiple of 1% up to a maximum of 10% of cash earnings

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 purchase period at a later date. You will not be able to resume participation in the ESPP 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 ESPP payroll deductions to date in the current purchase period:
	/ / Purchase shares of Westaff, Inc. at end of the purchase period
	OR
	/ / Refund ESPP payroll deductions collected
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 ESPP, and your ESPP payroll deductions collected in that purchase period will automatically be refunded to you.

SECTION 7: SIGNATURE
		Signature of Employee		Date

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EMPLOYEE STOCK PURCHASE PLAN ("ESPP") ENROLLMENT/CHANGE FORM