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THESE SKILLS ARE USED FOR OUR COMPUTERIZED RETRIEVAL SYSTEM. Please check applicable skills. ❑ ACCOUNTING ❑ 10 -key by touch ❑ General Ledger ❑Payroll ❑ A/P ❑Manual ❑ Computer ❑ A/R ❑FC Bookkeeper ❑ Computer Taxes ❑Reconciliation ❑ Collections ❑ CASHIER ❑ COMPUTER AIDED DRAFTING (CAD) v['COMPUTER Windows ®,,-, � MS Office R / MS Word ❑ Excel El Lotus 1 -2 -3 ❑ Macintosh _j Word Perfect ❑ Misc. CUSTOMER SERVICE ❑ DATA ENTRY []Alpha ❑ Alpha Numeric ❑ DICTATIONrrRANSCRIPTION ❑ FILING ❑ GRAPHIC ARTIST ❑ INSURANCE BACKGROUND ❑ LEGALBACKGROUND ❑ MARKETING BACKGROUND ❑ MEDICAL BACKGROUND ❑ ORDER DESK CrPROOFREADING /EDITING ❑ PURCHASING ❑ RECEPTIONIST ❑Multi -Line Phone System ❑ KEYBOARDING ❑ Speed (WPM) ❑ TELEMARKETING ❑ TYPESETTING first name and middle initial ❑ BOILER OPERATOR ❑ CNC PROGRAMMER RILL PRESS ❑ FORKLIFT ❑ CERTIFIED ❑ GRINDER ❑ HEAVY EQUIPMENT ❑ PNEUMATIC TOOLS ❑ PRESS BRAKE ❑ PUNCH PRESS ❑ RAIMANN OPERATOR ❑ SHEAR OPERATOR ❑ SAWS (lablesaw, chopsaw, ripsaw, resaw) ❑ OTHER ❑ CABINET MAKING ❑ CLEANUP ❑ DRYER FEEDER ❑ GRADI =R GREEN CHAIN ❑ Lumber ❑ Veneer ❑ MOULDER OPERATOR ❑ Mnl ILDER/PLANFR 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 El Residential ❑ Commercial ❑ Industrial ❑ PRODUCTION ❑ QUALITY CONTROL ❑ SAFETY TRAINING ❑ SHIPPING /RECEIVING ❑ STEEL WORKING ❑ WAREHOUSE ❑" WFI -LUNG ❑ Apprentice ❑ Journeyman ❑ Certified ❑ ARC (stick) ❑ ARC (line /wire feed) ❑ Gas Weld ❑ MIG (line feed) ❑ TIG (allum /titanium) 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 sppliiiltiurl is correct aiid complete to tl'le best of my knuwlcdge. I understated that it shall ha 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 specific written consent from Selectemp management. I agree to immediately notify you at the conclusion of each assignment or as soon as I become availahle. If I fail to give such notice, you may 033ume that I am Ilul available for reassignment, and arre not ready, willing and able to work. I Inderstand that any information I learn while working for a client is to bo kept confidential. I wi II I euld you harmless from any claims including, but not 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 any time, with orwithout cause. I agree to submit to a medical examination or drug screen by a physician designated by Selectemp (at Selectemp expense) at any time as may be required by Selectemp. I understand my employment may be 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 raj etesentative. I Il 11 eu event of an industrial accident, a test for drugs, controlled substances aiid 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. Applicant Signature % / Date Interviewed By: f ■AI A r°rm •W I tmployee's Withholding Allowancd Certificate I Department of the Treasury 9 OMB No. 1545 -0010 Internal to Service For Privacv Act and Panerwnrk Reduefinn ASf u.,riSe � z 0 Vn- cnr ial security number 1 Type Name Home address (number and street or rural route) 3 [`Single ❑ Married �.Z S�.l "'r '0 W ❑Married, but withhold at higher Single rate. Note: I( married, but legally separated, or spouse is a nonresident alien, check the Single box. City or town, state and ZIP code 4 If your last name differs from that on your social security card, check here and call 1- 800 - 772 -1213 for a new card ❑ 5 Total number of allowances you are claiming( from the worksheets on page 2 if they apply) 5 6 Additional amount, if any, you want withheld from each paycheck 6 g 7 1 claim exemption from withholding for 20_, and I certify that I meet BOTH of the following condition7for xe mption: Last year -I had a right to a refund of ALL Federal income tax withheld because I had NO tax liability: AND This year I expect a refund of ALL Federal income tax withheld because I expect to have NO tax liability. If you meet both conditions, enter "EXEMPT" here > F7 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. Employee's signature �� y�/�/ Date 3` 20//