Start Date R E

Location:

Posted:

October 16, 2024

Resume:

LOCATION: B/G CHK: Complete - - ****

START DATE: PAY RATE: DAYS TO WORK: Mon Tues Wed Thurs Fri Sat Sun SCHEDULED HOURS: - PART TIME FULL TIME (30 hours or more )

**R E P L A C I N G E MPLOYEE OR ADDED POSITION TO SITE TAX CODES: ( FILLED BY OFFICE ONLY ) LIVE IN WORK IN LST SOCIAL SECURITY: - - DATE OF BIRTH: / / ADDRESS: APT/FLOOR: PHONE: CITY : STATE: ZIP CODE: EMAIL: @ Have you ever been convicted of a felony? Yes No If yes, date, reason Are you a U.S. Citizen? Yes No EMERGENCY CONTACT Relationship to employee? Phone MARRIED: SINGLE: DEPENDENTS: MALE: FEMALE: TOBACCO USER: YES NO White Hispanic Black/African American American Indian 2 or More Race Other

PLEASE PROVIDE COPY OF VOIDED CHECK / LETTER FROM YOUR BANK TO INSURE ACCURACY DIRECT DEPOSIT: ROUTING NUMBER: - - ACCOUNT NUMBER: CHECKING ACCT: SAVINGS ACCT: PREPAY VISA CARD 2 0 2 4 A P P L I C A T I O N

465 AMWELL RD, HILLSBOROUGH, NJ 08844 MGR PHONE: 908-***-**** FAX: 908-***-****

Employment History ( Last 2 Jobs)

Historial de Empleo ( Ultimos 2 anos )

Company: Address:

Position: Duties:

Total Years Employed: Ok to Contact Supervisor:

Supervisor's Name: Supervisor's phone:

Reason for Leaving:

Nombre de la Compania: Direccion:

Posicion: Obligaciones laborales:

Total # anos Empleado: Esta bien para ponerse en contacto: Nombre del Supervisor: Telefono del la Supervisor: Razon Para Retiro:

Company: Address:

Position: Duties:

Total Years Employed: Ok to Contact Supervisor:

Supervisor's Name: Supervisor's phone:

Reason for Leaving:

Nombre de la Compania: Direccion:

Posicion: Obligaciones laborales:

Total # anos Empleado: Esta bien para ponerse en contacto: Nombre del Supervisor: Telefono del la Supervisor: Razon Para Retiro:

ENHANCITY FACILITY SERVICES, 465 Amwell Road, Hillsborough, NJ 08844 Phone: 908-***-**** Fax: 298-8020 I to tion The subsequent derstand without I application certify understand abide cost of any that notice. by of that drug the all for the employment that I the employment examination I have testing answers also false rules acknowledge been and or and given does misleading hired background with regulations will not herein be at Enhancity that create the paid information are will the investigation. by of a true the EFS. contract following of Facility my employer. and I understand employer given complete Services, of offenses I employment understand in I understand my and as to I are may application the maybe my grounds best that not be employment subject necessary does that a of background my for or any it interview knowledge. immediate guarantee to offer random in may arriving of check be may employment dismissal employment drug terminated I authorize may at result testing an be employment from in performed investigation at discharge. at will for employment any any any be time. time, contingent definite by decision. I I understand the understand with of at period company all the or In upon statements discretion without the of also, that the time. event prior this successful that cause of If contained to of employed, EFS: application I employment. employment, am and required comple with in I this un or or

Use of cell phones during working hours is prohibited.

Being out of the assigned work area without authorization is prohibited.

Excessive lateness reporting for duty, and/or failure to notify EJS of absence or excessive absenteeism.

Failure to call in 3 or more hours prior to your scheduled start time.

Failure to be in proper uniform. (All uniforms must be clean and pressed at all times - NO EXCEPTIONS.

Failure to perform duties in a professional manner.

Insubordination toward ANY Enhancity Representatives — (Executives, Managers, Supervisors, Lead Person)

Falsifying any Enhancity Facility Services reports. (Time sheets, Log Books, Reports)

Leaving work without proper authorization from the Client or Enhancity Facility Services.

Reporting to work intoxicated or under the influence of drugs, or engaging in these activities while on duty.

Any employee caught sleeping while on duty.

Any employee caught stealing personal property from the building or someone else' personal belongings.

Borrowing or lending money to or from ANY employee of the Client or Enhancity Facility Services.

Usage of Client equipment without proper authorization. (Phone, Fax, Computers, Copiers, Typewriters, Etc.) EFS uniforms, cell phones, and all company owned materials should be returned when the employment relationship has ended. Failure to do so will result in final payroll deductions for the items retail value. Completion of this section is voluntary and won’t affect your opportunity for employment. Male Hispanic Black / African American Hawaiian / Pacific Female White American Indian / Alaska 2 or More Races _

Employee Signature Date

We are an equal opportunity employer dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, sex, religion or national origin. Thank you for your participation. Form W-4

Department of the Treasury

Internal Revenue Service

Employee’s Withholding Certificate

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Give Form W-4 to your employer.

Your withholding is subject to review by the IRS.

OMB No. 1545-0074

2024

Step 1:

Enter

Personal

Information

(a) First name and middle initial Last name

Address

City or town, state, and ZIP code

(b) Social security number

Does your name match the

name on your social security

card? If not, to ensure you get

credit for your earnings,

contact SSA at 800-***-****

or go to www.ssa.gov.

Married filing jointly or Qualifying surviving spouse Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.) Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, and when to use the estimator at www.irs.gov/W4App. Step 2:

Multiple Jobs

or Spouse

Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs. Do only one of the following.

(a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4). If you or your spouse have self-employment income, use this option; or

(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or

(c)

If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate . . . . . . . . . . . . . . . . . . Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.) Step 3:

Claim

Dependent

and Other

Credits

If your total income will be $200,000 or less ($400,000 or less if married filing jointly): Multiply the number of qualifying children under age 17 by $2,000 $ Multiply the number of other dependents by $500 . . . . . $ Add the amounts above for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total here . . . . . . . . . . 3 $ Step 4

(optional):

Other

Adjustments

(a)

Other income (not from jobs). If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income . . . . . . . . 4(a) $

(b)

Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here . . . . . . . . . . . . . . . . . . . . . . . 4(b) $

Sign

Here

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete. Employee’s signature (This form is not valid unless you sign it.) Date Employers

Only

Employer’s name and address First date of

employment

Employer identification

number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 10220Q Form W-4 (2024) Form W-4 (2024) Page 3

Step 2(b)—Multiple Jobs Worksheet (Keep for your records.) If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job. To be accurate, submit a new Form W-4 for all other jobs if you have not updated your withholding since 2019. Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional tables; or, you can use the online withholding estimator at www.irs.gov/W4App. 1

Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the

“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter that value on line 1. Then, skip to line 3 . . . . . . . . . . . . . . . . . . . . . 1 $ 2 Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 2c below. Otherwise, skip to line 3.

Find the amount from the appropriate table on page 4 using the annual wages from the highest paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries and enter that value on line 2a . . . . . . . . . . . . . . . . . . . . . . . 2a $ b

Add the annual wages of the two highest paying jobs from line 2a together and use the total as the wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount on line 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b $ c Add the amounts from lines 2a and 2b and enter the result on line 2c . . . . . . . . . . 2c $ 3 Enter the number of pay periods per year for the highest paying job. For example, if that job pays weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. . . . . . 3 4

Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional amount you want withheld) . . . . . . . . . . . . . . . . . . . . . . . . . 4 $ Step 4(b)—Deductions Worksheet (Keep for your records.) 1

Enter an estimate of your 2024 itemized deductions (from Schedule A (Form 1040)). Such deductions may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to

$10,000), and medical expenses in excess of 7.5% of your income . . . . . . . . . . . . 1 $ 2 Enter: { • $29,200 if you’re married filing jointly or a qualifying surviving spouse

• $21,900 if you’re head of household

• $14,600 if you’re single or married filing separately } . . . . . 2 $ 3 If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater than line 1, enter “-0-” . . . . . . . . . . . . . . . . . . . . . . . . . . 3 $ 4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other adjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information . . . . 4 $ 5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 . . . . . . . . . . . 5 $ Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person with no other entries on the form; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and territories for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return. Form W-4 (2024) Page 4

Married Filing Jointly or Qualifying Surviving Spouse Higher Paying Job

Annual Taxable

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

$0 -

9,999

$10,000 -

19,999

$20,000 -

29,999

$30,000 -

39,999

$40,000 -

49,999

$50,000 -

59,999

$60,000 -

69,999

$70,000 -

79,999

$80,000 -

89,999

$90,000 -

99,999

$100,000 -

109,999

$110,000 -

120,000

$0 - 9,999 $0 $0 $780 $850 $940 $1,020 $1,020 $1,020 $1,020 $1,020 $1,020 $1,370

$10,000 - 19,999 0 780 1,780 1,940 2,140 2,220 2,220 2,220 2,220 2,220 2,570 3,570

$20,000 - 29,999 780 1,780 2,870 3,140 3,340 3,420 3,420 3,420 3,420 3,770 4,770 5,770

$30,000 - 39,999 850 1,940 3,140 3,410 3,610 3,690 3,690 3,690 4,040 5,040 6,040 7,040

$40,000 - 49,999 940 2,140 3,340 3,610 3,810 3,890 3,890 4,240 5,240 6,240 7,240 8,240

$50,000 - 59,999 1,020 2,220 3,420 3,690 3,890 3,970 4,320 5,320 6,320 7,320 8,320 9,320

$60,000 - 69,999 1,020 2,220 3,420 3,690 3,890 4,320 5,320 6,320 7,320 8,320 9,320 10,320

$70,000 - 79,999 1,020 2,220 3,420 3,690 4,240 5,320 6,320 7,320 8,320 9,320 10,320 11,320

$80,000 - 99,999 1,020 2,220 3,620 4,890 6,090 7,170 8,170 9,170 10,170 11,170 12,170 13,170

$100,000 - 149,999 1,870 4,070 6,270 7,540 8,740 9,820 10,820 11,820 12,830 14,030 15,230 16,430

$150,000 - 239,999 1,960 4,360 6,760 8,230 9,630 10,910 12,110 13,310 14,510 15,710 16,910 18,110

$240,000 - 259,999 2,040 4,440 6,840 8,310 9,710 10,990 12,190 13,390 14,590 15,790 16,990 18,190

$260,000 - 279,999 2,040 4,440 6,840 8,310 9,710 10,990 12,190 13,390 14,590 15,790 16,990 18,190

$280,000 - 299,999 2,040 4,440 6,840 8,310 9,710 10,990 12,190 13,390 14,590 15,790 16,990 18,380

$300,000 - 319,999 2,040 4,440 6,840 8,310 9,710 10,990 12,190 13,390 14,590 15,980 17,980 19,980

$320,000 - 364,999 2,040 4,440 6,840 8,310 9,710 11,280 13,280 15,280 17,280 19,280 21,280 23,280

$365,000 - 524,999 2,720 6,010 9,510 12,080 14,580 16,950 19,250 21,550 23,850 26,150 28,450 30,750

$525,000 and over 3,140 6,840 10,540 13,310 16,010 18,590 21,090 23,590 26,090 28,590 31,090 33,590 Single or Married Filing Separately

Higher Paying Job

Annual Taxable

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

$0 -

9,999

$10,000 -

19,999

$20,000 -

29,999

$30,000 -

39,999

$40,000 -

49,999

$50,000 -

59,999

$60,000 -

69,999

$70,000 -

79,999

$80,000 -

89,999

$90,000 -

99,999

$100,000 -

109,999

$110,000 -

120,000

$0 - 9,999 $240 $870 $1,020 $1,020 $1,020 $1,540 $1,870 $1,870 $1,870 $1,870 $1,910 $2,040

$10,000 - 19,999 870 1,680 1,830 1,830 2,350 3,350 3,680 3,680 3,680 3,720 3,920 4,050

$20,000 - 29,999 1,020 1,830 1,980 2,510 3,510 4,510 4,830 4,830 4,870 5,070 5,270 5,400

$30,000 - 39,999 1,020 1,830 2,510 3,510 4,510 5,510 5,830 5,870 6,070 6,270 6,470 6,600

$40,000 - 59,999 1,390 3,200 4,360 5,360 6,360 7,370 7,890 8,090 8,290 8,490 8,690 8,820

$60,000 - 79,999 1,870 3,680 4,830 5,840 7,040 8,240 8,770 8,970 9,170 9,370 9,570 9,700

$80,000 - 99,999 1,870 3,690 5,040 6,240 7,440 8,640 9,170 9,370 9,570 9,770 9,970 10,810

$100,000 - 124,999 2,040 4,050 5,400 6,600 7,800 9,000 9,530 9,730 10,180 11,180 12,180 13,120

$125,000 - 149,999 2,040 4,050 5,400 6,600 7,800 9,000 10,180 11,180 12,180 13,180 14,180 15,310

$150,000 - 174,999 2,040 4,050 5,400 6,860 8,860 10,860 12,180 13,180 14,230 15,530 16,830 18,060

$175,000 - 199,999 2,040 4,710 6,860 8,860 10,860 12,860 14,380 15,680 16,980 18,280 19,580 20,810

$200,000 - 249,999 2,720 5,610 8,060 10,360 12,660 14,960 16,590 17,890 19,190 20,490 21,790 23,020

$250,000 - 399,999 2,970 6,080 8,540 10,840 13,140 15,440 17,060 18,360 19,660 20,960 22,260 23,500

$400,000 - 449,999 2,970 6,080 8,540 10,840 13,140 15,440 17,060 18,360 19,660 20,960 22,260 23,500

$450,000 and over 3,140 6,450 9,110 11,610 14,110 16,610 18,430 19,930 21,430 22,930 24,430 25,870 Head of Household

Higher Paying Job

Annual Taxable

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

$0 -

9,999

$10,000 -

19,999

$20,000 -

29,999

$30,000 -

39,999

$40,000 -

49,999

$50,000 -

59,999

$60,000 -

69,999

$70,000 -

79,999

$80,000 -

89,999

$90,000 -

99,999

$100,000 -

109,999

$110,000 -

120,000

$0 - 9,999 $0 $510 $850 $1,020 $1,020 $1,020 $1,020 $1,220 $1,870 $1,870 $1,870 $1,960

$10,000 - 19,999 510 1,510 2,020 2,220 2,220 2,220 2,420 3,420 4,070 4,070 4,160 4,360

$20,000 - 29,999 850 2,020 2,560 2,760 2,760 2,960 3,960 4,960 5,610 5,700 5,900 6,100

$30,000 - 39,999 1,020 2,220 2,760 2,960 3,160 4,160 5,160 6,160 6,900 7,100 7,300 7,500

$40,000 - 59,999 1,020 2,220 2,810 4,010 5,010 6,010 7,070 8,270 9,120 9,320 9,520 9,720

$60,000 - 79,999 1,070 3,270 4,810 6,010 7,070 8,270 9,470 10,670 11,520 11,720 11,920 12,120

$80,000 - 99,999 1,870 4,070 5,670 7,070 8,270 9,470 10,670 11,870 12,720 12,920 13,120 13,450

$100,000 - 124,999 2,020 4,420 6,160 7,560 8,760 9,960 11,160 12,360 13,210 13,880 14,880 15,880

$125,000 - 149,999 2,040 4,440 6,180 7,580 8,780 9,980 11,250 13,250 14,900 15,900 16,900 17,900

$150,000 - 174,999 2,040 4,440 6,180 7,580 9,250 11,250 13,250 15,250 16,900 18,030 19,330 20,630

$175,000 - 199,999 2,040 4,510 7,050 9,250 11,250 13,250 15,250 17,530 19,480 20,780 22,080 23,380

$200,000 - 249,999 2,720 5,920 8,620 11,120 13,420 15,720 18,020 20,320 22,270 23,570 24,870 26,170

$250,000 - 449,999 2,970 6,470 9,310 11,810 14,110 16,410 18,710 21,010 22,960 24,260 25,560 26,860

$450,000 and over 3,140 6,840 9,880 12,580 15,080 17,580 20,080 22,580 24,730 26,230 27,730 29,230 Group Policy No.:

Policyholder Name: Employee Name: Social Security #: Last First MI

Marital Status: ! Single ! Married ! Widowed ! Divorced Date of Employment: Date of Birth: I was given the opportunity to enroll in this plan of group health benefits offered by my employer and insured by Horizon Blue Cross Blue Shield of New Jersey. I refuse the following:

! Employee, Spouse and Child(ren) coverage

! Spouse coverage

! Child(ren) coverage

Reason for Refusal (Please check all appropriate boxes.)

! other fully-insured Group Health Plan sponsored by this employer

! other Group Health Plan sponsored by my spouse’s employer

! other group coverage sponsored by another organization

! covered under Medicare

! other reasons (please explain) Please identify Group Health Plan(s) and provide names(s) of policyholder(s), carrier(s) and policy number(s). Policyholder/Name: Last First MI

Carrier: Policy Number: Policyholder/Name: Last First MI

Carrier: Policy Number: If you are declining enrollment for yourself or your dependents (including your spouse) because of other Group Health Plan coverage, you may in the future be able to enroll yourself or your dependents in this plan, provided that you request enrollment within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents provided that you request enrollment within 30 days after marriage, birth, adoption or placement for adoption.

If the reason for the refusal of coverage is coverage under another Group Health Plan, it is important to provide information concerning that Group Health Plan on this Waiver of Coverage form. If you fail to provide this information on this Waiver of Coverage form and you later become ineligible for such other coverage and then wish to enroll in any of the refused coverages, you will be considered a Late Enrollee and may be subject to the pre-existing conditions exclusion. IunderstandthatifIlaterwishtoenrollforanyofthecoverage(s)refused,IwillberequiredtosubmitanEnrollmentFormandcoverage may be subject to a pre-existing conditions exclusion. Date: / / Signature of Employee MM DD YYYY

Date: / / Signature of Witness MM DD YYYY

2465 (W0616) An Independent Licensee of the Blue Cross and Blue Shield Association LARGE EMPLOYER HEALTH BENEFITS WAIVER OF COVERAGE

EASTERN JANITORIAL SERVICES INC.

DISCLOSURE AND AUTHORIZATION

IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION DISCLOSURE REGARDING BACKGROUND INVESTIGATION

New York and Maine applicants, volunteers, contractors or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency identified above directly. You may also contact the Company to request the name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which the Company shall provide within 5 days. New York applicants, volunteers, contractors or employees only: Upon request, you will be informed whether or not a consumer report was requested by the Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.

Oregon applicants, volunteers, contractors or employees only: Information describing your rights under federal and Oregon law regarding consumer identity theft protection, the storage and disposal of your credit information, and remedies available should you suspect or find that the Company has not maintained secured records is available to you upon request. Washington State applicants, volunteers, contractors or employees only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. ACKNOWLEDGMENT AND AUTHORIZATION

I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the Company at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Aurico Reports Inc., 116 W. Eastman St., Arlington Heights, Illinois, 60004, 866-***-****, www.aurico.com, another outside organization acting on behalf of the Company, and/or the Company itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original. New York applicants, volunteers, contractors or employees only: By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.

Minnesota and Oklahoma applicants, volunteers, contractors or employees only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the Company. California applicants, volunteers, contractors or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law. Signature: Date:

NOTE: YOU MUST RETURN PAGES 1 and 2

Eastern Janitorial Services ("the Company") may obtain information about you for employment/volunteer or contractor purposes from a third party consumer reporting agency. Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records ("driving records"), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying. You have the right, upon proper request to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the

"consumer report" and/or "investigative consumer report" will be conducted by Aurico Reports Inc., 116 W. Eastman St., Arlington Heights, Illinois, 60004, 866-***-****, www.aurico.com, or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

NOTE: YOU MUST RETURN PAGES 1 and 2

PLEASE PRINT NEATLY AND MAKE SURE THE PRINTING IS LEGIBLE First Name: Middle Name: Last Name:

Maiden Name: Date Changed:

Other last names used: Date Changed:

E M A I L:

Street City State ZIP Month and Year

Present Phone Number (with area code): Social Security Number: Date of Birth* (MM/DD/YYYY): Gender*

Driver’s License Number: Driver’s License State:

*This information will be used for background screening purposes only and will not be used as hiring criteria. Current:

First Name Last Name Birthdate: Social Security # - - Address: City: State: Zip Code Home # Cell # Direct Deposit # 1 $$ Direct Deposit # 2 $$ Checking Savings Checking Savings

Routing # - - Routing # - - Acct # Acct # Cardholder Agreement, and Privacy Notice. I understand that in order to use the Wisely Pay card, I will need to accept and agree to the Cardholder Agreement and to pay the fees as indicated on the Fee Schedule by activating my Wisely Pay card. By electing Wisely Pay card as my wage payment choice, I am consenting to provide my personal information to ADP to enroll in and request a Wisely Pay Card. IMPORTANT INFO ABOUT APPLYING FOR A NEW PREPAID CARD ACCT - To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means for you: When you open a Prepaid Card acct, ADP may require your name, address, date of birth, social security number, tax id number aion from me of its termination and my employer ( or its payroll service provider ) and the bank has had a reasonable opportunity to act on said termination subject to a credit check. I authorize my employer to initiate credit entries each pay date to deposit my pay into the checking, savings, or Wisely Pay Card account selected in this election. If funds to which I am not entitled are deposited to my account, I authorize my employer( or its payroll service provider ) to initiate any action to reverse or correct an erroneous credit entry to my account and to direct the bank to return said funds to my employer ( either directly or through its payroll service provider ) to the extent permitted by applicable law. I will review my pay statement to ensure that my wages are being deposited correctly into my account each period. I understand that I can change my election at any time

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