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MAY 0 9 2011 THESE SKILLS ARE USED FOR OUR COMPUTERIZED RETRIEVAL SYSTEM. Please check applicable skills. ❑ ACCOUNTING ❑10 -key by touch ❑ General Ledger ❑Payroll ❑ A/' ❑Manual ❑ Computer ❑ AIR ❑FC Bookkeeper ❑ Computer Taxes E] Reconciliation ❑ Collections ® CASHIER ❑ COMPUTER AIDED DRAFTING (CAD) ® COMPUTER MWIndows ® MS Office ❑MS Word ® Excel ❑Lotus 1 -2.3 ❑ Macintosh []Word Perfect ❑ Misc. ® CUSTOMER SERVICE ❑ DATA ENTRY []Alpha ❑ Alpha Numeric ❑ DICTATIONITRANSCRIPTION ❑ FILING ❑ GRAPHIC ARTIST ❑ INSURANCEBACKGROUND ❑ LEGAL BACKGROUND ❑ MARKETING BACKGROUND ❑ MEDICAL BACKGROUND ❑ ORDER DESK ❑ PROOFREADING/EDITING ❑ PURCHASING ❑ RECEPTIONIST OMulti -Line Phone System ❑ KEYBOARDING ❑ Speed (WPM) ❑ TELEMARKETING ❑ TYPESETTING ❑ BOILER OPERATOR ❑ CNCPROGRAMMER ❑ DRILL PRESS ❑ FORKLIFT ❑ CERTIFIED ❑ GRINDER ❑ HEAVYEGUIPMENT ❑ PNEUMATIC TOOLS ❑ PRESS BRAKE ❑ PUNCH PRESS ❑ RAtAMNN OPERATOR ❑ SHEAR OPERATOR ❑ SAWS (tablesaw, chopsaw, ripsaw, resew) ❑ OTHER ❑ CABINETMAKING ❑ CLEAN UP ❑ 'DRYER FEEDER ❑ GRADER ❑ GREEN CHAIN . ❑ Lumber ❑ Veneer ❑ MOULDER OPERATOR ❑ MOULDERIPLANER SETTER ❑ OFF BEARER ❑ Lumber ❑ Veneer ❑ ON BEARER ❑ Lumber ❑ Veneer ❑ PLANER CHAIN ❑ SPREADERMAN ❑ OTHER ❑ ASSEMBLY ❑ CANNERY ❑ .CARPENTRY ❑ DRYWALL ❑ ELECTRICIAN ❑ ELECTRONIC ASSEMBLY ❑ FABRICATING ❑ Blueprints ® FOOD SERVICE ❑ GALVANIZING ❑ INVENTORY ® JANITORIAL LANDSCAPING ❑ MACHINIST - ❑ MECHANICALLY INCLINED ❑ PACKAGING PAINTING R Residential ❑ Commercial ❑ Industrial ❑ PRODUCTION ❑ QUALITY CONTROL ❑ SAFETYTRAiNING ❑ SHIPPINGIRECEIVING ❑ STEEL WORKING ❑ WAREHOUSE ❑ WELDING ❑ Apprentice ❑ Journeyman ❑ Certified ❑ ARC (stick) ❑ ARC einehndre feed) ❑ Gas Weld ❑ MIG (line feed) ❑ TIG (allumftitanium) APPLICANT - PLEASE READ THIS AUTHORIZATION BEFORE SIGNING I agree that I have been informed of the requirements of the work for which I am applying, and that the information on this application is correct and complete to the best of my knowledge. I understand that it shall be grounds for immediate dismissal if any of the information contained herein is found to be untrue. I AUTHORIZE YOU AND ALL FORMER EMPLOYERS, GIVEN BY ME AS REFERENCES, TO ANSWER ALL QUESTIONS AND TO GIVE ALL INFORMATION IN CONNECTION WITH THIS APPLICATION OR IN ANY WAY CONCERNING ME. I understand that if accepted -for employment, I will be working for you on your payroll, at your client's premises. I agree that I will obtain your permission before discussing permanent employment with your client. I understand I may not transfer to the payroll of a Selectemp client I have been previously assigned to for 120 days after the completion of the assignment without speck written consent from Selectemp management. I agree to immediately notify you at the conclusion of each assignment or as soon as I become available. If I fail to give such notice, you may assume that I am not available for reassignment, and am not ready, willing and able to work. I understand that any information I learn while working for a client is to be kept confidential. I will hold you harmless from any claims including, butnot limited to, personal injury or illness as a result of my providing false or misleading information on this application. I hereby acknowledge that my employment is'at will', that I may resign at any time and the company may terminate my employment at anytime, with orwithout cause. I agree to submit to a medical examination or drug screen by a physician designated by Selectemp (at Selectemp expense) at anytime as may be required by Selectemp. I understand my employment maybe contingent on passing of such examination(s). I authorize any company, agency, physician, or person to release Information concerning my medical condition to Selectemp or its representative. In the event of an industrial accident, a testfor drugs, controlled substances and alcohol, will be required as part of the medical examination of the injury. I agree to report any injury to Selectemp within 24 hours, I HAVE READ, UNDERSTAND, AND SUBSCRIBE TO THIS CERTIFICATION AND AGREEMENT AND TO THE WRITTEN EMPLOYEE POLICIES RECEIVED DURING MY ORIENTATION. /� I � Interviewed By. Applicant Signature Date 6 Form W-4 Employee's Withholding Allowance c;ertlTtcaie OMS No. 1�45 -Wlu Department of the Treasury 20 internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see reverse .. ..... � _... ,......., � v..,.� - .,,.,�� en,, rritV number 1 Type or print your tin Home address (number and street or rural City or town, state and ZIP code �-UL -►GNP (��- 3 E9 Single ❑ Married ❑ Married, but withhold at higher Single rate. Note: if married, but legally separated, or spouse Is a nonresident alien, check the Single box 4 If your last name differs from that on your social security card, check here and call 1 -600 -772 -1213 for anew card 0 5 Total number of allowances you are claiming ( from the worksheets on page 2 if they apply) - 6 Additional amount; if any, you want withheld from each paycheck ir 7 1 claim exemption from withholding for 20_, and I certify that I meet BOTH of the following conditions for exemption: Last year 1 had a right to a refund of ALL Federal income tax withheld because I had NO tax liability. AND This year l expect a refund of ALL Federal Income tax withheld because I expect to have NO tax liability. If you most both conditions, enter 'EX EMPT' here ' f ' Under penalties of perjury, I certify that I am entitled to the number of withholding allowances claimed on this certificate or entitled to claim exempt status. I -