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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 ❑FCBookkeeper ❑ Computer Taxes ❑Reconciliation ❑ Collections ❑ CASHIER ❑ COMPUTER AIDED DRAFTING (CAD) ❑ COMPUTER F] Windows ❑ MS Office ❑ MS Word ❑ Excel ❑Lotus 1 -2 -3 ❑ Macintosh ❑Word Perfect ❑ Misc. ❑ CUSTOMER SERVICE ❑ DATA ENTRY ❑Alpha ❑ Alpha Numeric ❑ DICTATIONrfRANSCRIPTION ❑ FILING ❑ GRAPHIC ARTIST ❑ INSURANCE BACKGROUND ❑ LEGAL BACKGROUND ❑ MARKETING BACKGROUND ❑ MEDICAL BACKGROUND ❑ ORDER DESK ❑ PROOFREADING /EDITING ❑ PURCHASING ❑ RECEPTIONIST ❑ Multi -Line Phone System ❑ KEYBOARDING ❑ Speed (WPM) ❑ TELEMARKETING ❑ TYPESETTING L✓j ASSEMBLY ❑ CANNERY (- ITARPENTRY ❑ DRYWALL ❑ ELECTRICIAN ❑ ELECTRONIC ASSEMBLY ❑ FABRICATING ❑ Blueprints ❑ FOOD SERVICE ❑ GALVANIZING ❑ INVENTORY JANITORIAL p ❑ MACHINIST ❑ MECHANICALLY INCLINED ❑ PACKAGING p,fPAtNTING ❑ RQydential ER El Industrial ❑ PRODUCTION ❑ QUALITY CONTROL �ETYTRAINING ❑ SHIPPING /RECEIVING ,❑ STEEL WORKING �+AREHOUSE ❑ WELDING ❑ 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 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 specific 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, 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 anytime 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 maybe 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 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. I HAVE READ, UNDERSTAND, AND SUBSCRIBE TO THIS CERTIFICATION AND AGREEMENT AND TO THE WRITTEN EMPLOYEE POLICIES RECEIVED DUjONG MY ORIENTATION. nt Signature ❑ BOILER OPERATOR ❑ CNC PROGRAMMER Q DRILL PRESS, p,PORKLIFT _ ❑ CERTIFIED Li-ORINDER J�J EQUIPMENT 2-ITN ❑ PRESS BRAKE PUNCH PRESS ❑ RAIMANN OPERATOR ❑ SHEAR OPERATOR E? CS (tablesaw, chopsaw, ripsaw, resaw) ❑ OTHER (k— Date _S 1 ( Form W-4 I Employee's Withholding Allowance Certificate I OMB No. 1545 -0010 Department of the Treasury internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see reverse 2n print your first name no middle Initial Last Name 2 ,Hom Wdr and street or rural route) 3 Ingle ❑ Married ❑ Married, but withhold at higher Single rate. K 6,)I,1- , 1 C. T Note: If 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 t 9 2- 0 here and call 1 -800- 772 -1213 for a new card ❑ 5 Total number of alto and s 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 $ 7 1 claim exemption from withholding for 20_, and I certify that I 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 CABINET MAKING ❑ CLEAN UP ❑ DRYER FEEDER ❑ GRADER ❑ GREEN CHAIN ❑ Lumber ❑ Veneer ❑ MOULDER OPERATOR ❑ MOULDER/PLANER SETTER ❑ OFF BEARER ❑ Lumber ❑ Veneer ❑ ON BEARER ❑ Lumber ❑ Veneer ❑ PLANER CHAIN ❑ SPREADERMAN ❑ OTHER Under penalties of perjury, I c ify that I'am entitled to the number of withholdp wances claimed on this certificate or entitled to claim exempt status. ure Employee's signat �� Date <- - ° or I ` 20