SOCIAL SECURITY NUMBER:

STATE

FROM: FROM: TO:

RELATIONSHIP

PLEASE CHECK ANY OF THE FOLLOWING WITH WHICH YOU ARE FAMILIAR: OTHER: (PLEASE EXPLAIN)

Address

LAST OR PRESENT EMPLOYER

TO:

Company

HOME PHONE: MOBILE PHONE: EMAIL ADDRESS:

Duties

DO NOT WRITE IN THIS AREA BELOW

HOME PHONE: MOBILE PHONE: EMAIL ADDRESS:

ZIP CODE

- -

ADDRESS: CITY:

MIDDLE

EMPLOYMENT APPLICATION

Rehireable

SKILL CODES ASSIGNED: INTERVIEWER SIGNATURE:

PERSONAL INFORMATION

GENERAL WORK EXPERIENCE

FROM:

EMERGENCY CONTACT INFORMATION

NAME: LAST FIRST

Reference Comments

HOW DID YOU HEAR ABOUT MAGNUM STAFFING SERVICES?

Are you legally eligible to work in the United States? Will you now or in the future require visa sponsorship for long term employment? Do you have reliable transportation?

AVAILBILITY:(Check all that apply)

Reason Left

Supervisor

Telephone Number

PREVIOUS EMPLOYER

TO:

PREVIOUS EMPLOYER

Dates Employed

NAME: LAST MIDDLE

Salary / Hours

SHORT NOTICE? DISTANCE? DATE ENTERED: PAY RATE DESIRED? ASSIGNED TO: Reference Name

ADDRESS: CITY: STATE ZIP CODE

FIRST

YES NO

YES NO

YES NO

Assembly

Carpenter

Shipping / Receiving

Operator (Type)

Electrician

Equipment Operator

Food Service

Labor / Warehouse

Forklift

Order Pulling / Inventory

Painter (Type)

Facility Maintenance Welder (Type) GOOGLE JOB BOARD REFERRAL WALK IN OTHER (PLEASE EXPLAIN) YES NO YES NO YES NO

Days Nights Weekends Part Time:

YES NO YES NO

STATE: ZIP:

TO: FROM:

AUTHORIZATION AND CONSENT

I hereby declare that all statements contained in this application are true and correct and I understand that false, misleading, or inaccurate information in this application will be the basis for withdrawal of any employment offer or if employed, may result in dismissal. In connection with me employment/apllication for employment with this company, I hereby authorize and understand that this release acknowledges that Magnum Staffing Services may now, or at any time in the future, prior to my employment or while I am employed, conduct a background investigation including a public record research report containing information for verification of prior employment, academic achievement, medical and financial history, use of a motor vehicle, general background and personal character. This release shall include, but not limited in its scope or purpose for reasons of business necessity. I authorize and request all persons, schools, corporations, credit bureaus, courts, law enforcement agencies, health care providers, armed forces, employment commissions, and all government agencies to release any and all information without restriction or qualification. I authorize a photostat of this release to be considered as effective and valid as the original. All results will be proprietary and confidential, and will not be provided to any parties other than the company or its legal representative. I am aware that I have the right to request the nature and scope of the results, as reported from the company hired to conduct the research (if any). I voluntarily waive all recourse and release the requested parties from liability for complying with this release/request. I UNDERSTAND Magnum Staffing Services is committed to providing a DRUG FREE WORK PLACE. I have been provided with a copy of Magnum Staffing Services drug abuse and testing policy. I understand Magnum Staffing Services will require a drug screen test upon application for employment, randomly and whenever an on-the-job accident or injury is reported. I further understand that this test may be required of only the person involved or required of all employees within the area of the occurence. My signature to this application acknowledges my consent and release to be personally tested by Magnum Staffing Services and/or their designated medical/testing service. I further understand and agree to Magnum Staffing Services periodically testing its employees to ensure personnel do not report for assignments with illegal drugs and/or legal drugs illegally taken in their systems. I agree to hold marmless all parties not submitting to the test(s) or as a result of the report of the test. This includes possible clerical or laboratory error. In the event of vehicle accident, regardless of who is at fault, I understand that if I am transported to work in a Magnum staffing Services vehicle, or if I accept transportation from another Magnum Staffing Services field staff, agree to hold harmless and indemnify all parties involved. I agree to look solely to the compensation insurance coverage provided by Magnum Staffing Services in the event of an injury to me during the course of my employment.

I agree that any recovery which I might receive as the result of an injury during the course and scope if my employment will be limited to the extent of Magnum Staffing Services insurance in force at the time of the injury. This authorization and consent has been explained to me in a language I understand and I have been advised of the answers to any question(s) I have about these policies. I undestand that this agreement is a legal and binding document because Magnum Staffing Services is sending me or my application for the examination and will incur expenses for the same.

HAVE YOU EVER BEEN CONVICTED OF A FELONY? IF YES, PLEASE EXPLAIN: PRINT APPLICANT'S NAME: SOCIAL SECURITY NUMBER:

EDUCATION

HIGH SCHOOL: CITY / STATE: GRADUATION DATE: YEARS COMPLETED: IF GED, WHERE? I the undersigned do hereby auhorize Magnum Staffing Services to examine any and all criminal records and arrests on file in the counties in the state of Texas or any other state. In doing so, I understand that I am waiving my right of confidentiality concerning my criminal history. SIGNATURE: DATE:

COLLEGE: CITY / STATE: GRADUATION DATE: TYPE OF DEGREE: BACKGROUND CHECK RELEASE

DRIVERS LICENSE NUMBER"

STREET ADDRESS: CITY:

SIGNATURE OF APPLICANT: DATE:

YES NO

13. I will perform only the job that is assigned by Magnum Staffing Services and contact Magnum Staffing Services before performing new job duties.

Magnum Staffing Services POLICIES AND PROCEDURES

APPLICANT SIGNATURE: DATE:

1. Employees must be telephone accessible and have reliable transportation. INTERVIEWER SIGNATURE: DATE:

2. Employees are expected to complete any job assignment they accept. Failure to complete the assignment will be assumed that have voluntarily quit. I also understand the when working for a Client Company and the Client Company has a reduction in hours, shortage in hours, works slows down, etc., I must report back to Magnum Staffing Services (Employer) to supplement hours with additional work. I understand that a failure to comply with this policy will result in not being eligible for unemployment benefits. 4. Magnum Staffing Services has a very strict "NO DRUG POLICY" and you have signed a consent form to submit to drug testing. Failure to comply with this agreement will be grounds for termination. 5. Once I have accepted a job, I must report to Magnum Staffing Services office to pick up a time sheet. Unless special arrangements have been made, I understand Magnum Staffing Services will not recognize or pay any hours worked by an employee in the absence of an individual's time ticket or card signed by both the client and the employee. 6. If for some unexpected reason, such as an emergency or illness, I cannot make it to work or I will be late, I will contact Magnum Staffing Services as soon as possible so we can call the client and/or find a replacement. My failure to do so may be grounds for dismissal or indicate that I have quit.

7. If I sustain an injury on the job, I will inform the client and Magnum Staffing Services immediately after the accident. Magnum Staffing Services will coordinate with the client and myself the proper procedure for treatment and reporting of the incident. 12. I have read and fully understand the above statements regarding Magnum Staffing Services policies and procedures and agree to the same. I understand that failure to comply with these policies and procedures could lead to my termination and jeopardize my insurance benefits. 3. I understand that I am an Employee of Magnum Staffing Services and only I or Magnum Staffing Services can terminate my employment. When an assignment ends, I must report back in person within 24 hours or the next business day to Magnum Staffing Services at for my next job assignment, and sign a log-sheet as proof of my presence. Failure to do so or to accept my next job assignment will indicate that I have voluntarily quit. Should I not appear, I understand that I have voluntarily quit/refused assignment, and that I will not be eligible for unemployment benefits. 9. Magnum Staffing Services pays its employees weekly. Our pay period starts on a Monday and ends on a Sunday the following week. My check will be ready by 3:00pm on the Wednesday following the 1st week worked (unless other arrangements have been made). 10. I understand that in order to be paid in a timely manner, tickets must be turned in no later than 12:00pm each Monday, following the week worked. Any late tickets will not be paid until the next payroll cycle (next 1 week). 11. I have listed 3 references and given my vehicle information on this application. The information is correct to the best of my knowledge. 8. I understand and will comply with Magnum Staffing Services safety rules and regulations and the hazardous communications program has been explained to me in Magnum Staffing Services orientation. MAGNUM STAFFING SERVICES IS AN EQUAL OPPORTUNITY EMPLOYER SIGNATURE: DATE:

REFERENCES:

SOLICITATION/DISTRIBUTION POLICY

No person not an employee of this company may come on the premises at any time to solicit employees for any cause or to distribute to employees material of any kind for any purpose. Employees may not engage in the distribution or literature for any purposes during work time, or at any time, in working areas of the ompany.

SIGNATURE: DATE:

NON-DISCLOSURE OF TRADE SECRETS

INTERVIEWER NOTES:

Magnum Staffing Services has a very strict "NO DRUG POLICY". My signature below is my consent to submit to standard drug testing as well as standard Breathalzer testing for the presence of alcohol. I also agree to post-incident transport by Magnum Staffing Services to a medical provider. I understand that my failure to comply with this agreement will be grounds for immediate termination. SIGNATURE: DATE:

"SAFETY POLICY"

SIGNATURE: DATE:

"NO DRUG POLICY"

In consideration of my being employed by Magnum Staffing Services, Inc. (Company), the undersigned hereby agrees and acknowledges the following:

1. That during my employment there may be disclosed to me certain trade secrets consisting of; a) Technical information: Methods, processes, formulae, compositions, systems, techniques, inventions, machines, computer programs and research projects

b) Business information: Customer lists, pricing data, sources of supply, marketing, production, or merchadising systems or plans. 2. I agree that during and after the termination of my employment, I shalll not use for myself or others, or disclose or divulge to others any trade secrets, confidential information, or any other data of Magnum Staffing Services or its companies. Magnum Staffing Services has a very strict "SAFETY POLICY". I understand and will comply with all safety rules and safety training and orientation. Magnum Staffing Services performs thorough accident investigations and will report any suspected FRAUDULENT activities to the proper authorities. Magnum Staffing Services has an Alternative Work Program in place. By signing below I agree to accept an Alternative Work assignment upon release by a medical provider. I understand that failure to report for this assignment will result in possible trmination and may terminate any benefits under Texas Workers Compensation Laws. However, this policy will not be applied in a manner that would violate an employees rights under the Family Medical Leave Act.

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