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THESE SKILLS ARE USED FOR OUR COMPUTERIZED RETRIEVAL SYSTEM. Please check applicable skills. ❑ ACCOUNTING ❑ 10 -key by touch - El General Ledger, - Payroll ❑ A/P []Manual ❑ Computer ❑ A/R ❑FC Bookkeeper ❑ Computer Taxes El Reconciliation ❑ Collections �HIER / c PUTER DED DRAFTING �CAi7p_j�f`{(� j OMPU �� tt�ilts� PPPP��"""" indows ❑ MS Office ❑MS Word - ❑ Excel El Lotus 1 -2 -3 - ❑ Macintosh / ❑ Word Perfect isc. Q�CP8TOMER SERVICE ATA ENTRY ❑Alpha Alpha Numeric ❑ DICTATIOWTRANSCRIPTION .. 9 (LING - ❑GRAPHIC ARTIST - - ❑INSURANCE BACKGROUND - ❑ LEGAL BACKGROUND - ❑ MARKETING BACKGROUND ❑ MEDICAL BACKGROUND ❑ OOaB£R DESK [A /EDITING ❑ PURCHASING - ❑ RECEPTIONIST ❑Multi -Line Phone System ❑ KEYBOARDING ❑ Speed (WPM) . ❑ TELEMARKETING . ❑ TYPESETTING - APPLICANT - PLEASE READ THIS AUTHORIZATION BEFORE SIGNING I agree that I havo boon informed of the requirements of the work for which I dill applyiny, wid that ltte Information on this application Is correct and complete lu 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 OUESTIONS 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 ayiee 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.myproviding 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 or without 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. l understand my employment maybe contingent on passing of such examination(s). I authorize anycompany, 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 DURING MY OR ENTATION. Applicant Signature f, , Date Interviewed By: ❑ BOILER OPERATOR ❑P ROGRAMMER � L PRESS ORKLIFT ❑ CERTIFIED �NDER ❑ HEAVY EQUIPMENT ❑ PNEUMATIC TOOLS ❑ PRESS BRAKE ❑ PUNCH PRESS ❑ RAIMANN OPERATOR ❑ SHEAR OPERATOR ❑ 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 ❑ ASSEMBLY . ❑ CANNERY _ ❑ CARPENTRY ❑ DRYWALL ❑ ELECTRICIAN ❑ ELECTRONIC ASSEMBLY ❑ .FABRICATING ❑ Blueprints ❑ FOOD SERVICE o GALVANIZING VENTORY ❑ JANITORIAL . ❑ LANDSCAPING ❑ MACHINIST �ECHANICALLY INCLINED' ❑ PACKAGING ❑. PAINTING ❑ Residential ❑ Commercial ❑ Industrial Eg , PRODUCTION - [L- QUALITY CONTROL ❑ SAFETY TRAINING .❑ SHIPPING /RECEIVING ❑ STEEL WORKING ❑ WAREHOUSE - ❑ WELDING ❑ 'Apprentice ❑ Journeyman ❑ Certified ❑ ARC (stick) ❑ ARC (line /wire feed) ❑ Gas Weld .❑ MIG (linefeed) ❑ TIG (allum/titanium) 5 Jotal nurrikier 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 $. Q 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.) 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 City or town, state and ZIP.coda 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 ❑ Form VV-4 Employee's Withholding Allowance Certificate OMB No. 1545-0010 Department of the Treasury - _ - Internal Revenue Service. For Privacy Act and Paperwork Reduction Act Notice, see reverse 20 1 Type or print yo r f st na and mid initial Last Name /J v : •- _ -- - - - Home add s (nu er a s / j�i ee or ru I route) 3 ❑ Single arced ❑ Married, but withhold at higher Single rate. / rU /�! /i Note: ((married but legallyseparated or.spouse is a nonresident alien check the Single Under penalties of I certify that IT entitle to the num r of withho ng allowances claimed on this certificate or Employee's signature j Date ntitled to claim exempt status. W