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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 ❑ AIR ❑FC Bookkeeper ❑ Computer Taxes ❑Reconcillation ❑ Collections ❑ CASHIER ❑ COMPUTER AIDED DRAFTING (CAD) ❑ COMPUTER ❑Windows MS Office fibAS Word ❑ Excel Lotus 1-2.3 ❑ Macintosh ❑Word Perfect ❑ Misc. ❑ CUSTOMER SERVICE ❑ DATA ENTRY ❑Alpha ❑ Alpha Numeric ❑ DICTATION/TRANSCRIPTION ❑ FILING. ❑ GRAPHIC ARTIST - ❑INSURANCEBACKGROUND ❑ LEGAL BACKGROUND ❑ �{ MARKETING BACKGROUND IQ MEDICAL BACKGROUND ❑ ORDER DESK ❑ PROOFREADING/EDITING ❑ PURCHASING ❑ RECEPTIONIST ❑Multi -Une Phone System ❑ KEYBOARDING ❑ Speed (WPM) ❑ TELEMARKETING ❑ TYPESETTING ❑ BOILER OPERATOR ❑ CNC PROGRAMMER ❑ DRILL PRESS ❑ FORKLIFT ❑ CERTIFIED ❑ GRINDER ❑ HEAVY EQUIPMENT ❑ PNEUMATIC TOOLS ❑ PRESS BRAKE ❑ PUNCH PRESS ❑ RAIMANN OPERATOR ❑ SHEAR OPERATOR ❑ SAWS (tablesaw, chopsaw, ripsaw, resaw) ❑ OTHER ❑ CABINETMAKING ❑ CLEAN UP ❑ DRYER FEEDER ❑ GRADER ❑ GREEN CHAIN ❑ Lumber ❑ MOULDER OPERATOR ❑ MOULDER/PLANER SETTER ❑ OFF BEARER ❑ Lumber ❑ ON BEARER ❑ Lumber ❑ PLANER CHAIN ❑ SPREADERMAN ❑ OTHER — ❑ Veneer ❑ Veneer ❑ veneer ❑ .ASSEMBLY ❑ CANNERY ❑ CARPENTRY ❑ DRYWALL ❑ ELECTRICIAN ❑ ELECTRONIC ASSEMBLY ❑ FABRICATING ❑ Blueprints ❑ FOOD SERVICE ❑ GALVANIZING ❑ INVENTORY ❑ JANITORIAL - ❑ LANDSCAPING ❑ MACHINIST ❑ MECHANICALLY INCLINED ❑ PACKAGING ❑ PAINTING ❑ Residential ❑ Commercial ❑ Industrial _ ❑ PRODUCTION ❑ QUALITY CONTROL ❑ SAFETYTRAINING ❑ SHIPPING/RECEIVING ❑ STEEL WORKING ❑ WAREHOUSE ❑ WELDING ❑ Apprentice ❑ Journeyman ❑ Certified ❑ ARC (stick) ❑ ARC (IineAvire reed) ❑ Gas Weld ❑ MEG (line feed) ❑ TIG (allumltitanium) 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. 1 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. 1 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 clientis to be kept confidential. I will hold 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 su bmit 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 may be contingent on passing of such examination(s). I authorize any company, agency, physician, orperson to release information concerning mymedical condition to Selectemp or its representative. In the event of an industrial accident, a test for 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. 1 HAVE READ, UNDERSTAND, AND SUBSCRIBE TO THIS CERTIFICATION AND AGREEMENT AND TO THE WRITTEN EMPLOYEE POLICIES RECEIVED DURING MY ORIENTATION. n _ �� Interviewed By. Applicant Signature Date a-0 Form W-4 Employee's Withholding Allowance Certificate 4 OMB No. 1545.0010 Department of the Treasury I �O Internal Revenue Service For Privacy Act an Paperwork Reduction Act Notice, see re or print your first nam / Z I Sid - 1 ' e Last Name caul security number Home address (number and street or rural route) 3 )ff Single ❑ Married ❑ Married, but withhold at higher Single rate. Note: If married, bur regally separated, or spouse k a nonresklenr alien, check the Sing/e box. City or town, state an8 ZIP code 4 If your last name differs from that on your social security card, check P4 �C, PI 1E L--0 Q C ) +q i here and call 1 -800- 7 - 1213 for anew card ❑ r r 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 y 6 $ 7 1 claim exemption from withholding for 20,_, and I certify that 1 meet BOTH of the following conditions for exemption: • 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 > 7 EX P t Under penalties of perjury, I certify that) am entitled to the number of withholding allowances claimed on this certificate or entitled to claim exempt status. nature //-7X6.r Date 20