Applicant NameJENNIFER MILLER

Will you work overtime, If required? If No, please explain below.aesONo. _ What wlil.be your commute (length of time) to this work location? _4_5_M_N_I _S _ How did you hear of this position internet source or referral please provide the specific information below? INDEED.COM

Are you related to any employee or Board member of EMSL Analytical, lnc.Ues~No If Yes, please list Employment History :

Provide the following information for your last four (4) employers, assignments, or volunteer activities, starting with the most recent.

Please flllln as completely as possible- do not mark "refer to resume." 1. FromMARCH 3 1988 ToPRESENT E I

mpoyer _OUEENS _CRIMINAL COURT _ _

Telephone. _

JobTitle DATA RECORDING ASSISTANT

Address (Street Address/City/State/Zip) 125-05 QUEENS BLVD KEW GARDENS NY 11415 Immediate Supervisor and Job Title KEITH FEASTER ! ' Summarize the nature of work performed and job responsibilities. _ INPUT INFROMATION INTO SYSTEM OF DAILY C<?URT ACTIVITIES. PREPARE FILES AND VARIOUS OOCKESTS OUTSIDE FOR COUF{AGENCIES T SI!SSIOII"RESPONSIBLE I ~eSPOII"ID TO FOR UI"TRACKIN IOUIF{ES F~OM THE LOCATION Tr1f: PUI:3LIC AND Al110 . 1 . May we contact for reference? ~Yes 0 No,.

Reason for Leaving N_O_N__E : 2. From9 2016 · To3 2017 Employer uc Telephone.

Job;,tle CABIN CLEANER

Address (Street Address/City/State/Zip) LAGUARDIA AIRPORT Immediate Supervisor and Job Title

Summarize the nature of work performed and Job responsibilities. REMOVED ALL TRASH FROM AIRCRAFT CLEANED SAN)TIZED AND RESTOCKED bWATORIES SWEPT AND MOPPED AIRf30~T TERMIII"IALS ANO BAGGAGE: CLAIM AREAS. MAINTAINED AWARENESS OF HEALTH AND SAFETY ISSUES IN LEGISLATION. May we contact for reference? 0 Yes 0 No

ReasonforLeavtng ASSIGNMENT TERMINATED

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Applicant NameJENNIFER MILLER

I"

3. From4/2012 To_4_/2_0_1_3 Employer NARCO FREEDOM INC. Telephone _..;_ _

Job Title MEDICAL ASSISTANT

Address (Street Address/City/State/Zip) Immediate Supervisor·and Job Title _M_Y_R_N_A_P_IN_K_S_R_n _ Summarize the nature of work performed and job responsibilities .. PREPARED PATIENTS FOR THE HEALTH CARE VISIT PREPARED LABORATORY SPECIMENS. PERFORME:e BASIC LABORATORY TeSTS 01~ 'fHe P~EMISE:S COMPLETED RECORD BY RECORDING PATIENT EXAMINATION AND TEST RESULTS May we contact for reference? 0ves D No

Reason for Leaving ASSIGNMENT TERMINATED

4. From. To. Employer _

Telephone. _

Job Title

Address (Street AddressfCity/State/Zip} _.;. Immediate Supervisor and Job Title Summarize the nature of work performed and job responsibilit.ies .. _ May we contact for reference? DYes D No

Reason for Leaving

Page 3 of6

Applicant NameJENNIFER MILLER

Education and Training

Name of high school HIGH SCHOOL EQUIVALENCY DIPLOMA Number of years completed Diploma: DYes 0 No College/Undergraduate school _

City/State -:- Dates attended Number of years completed

Di~loma Received: 0 Yes ONo Year diploma awarded Type of degree Majo_rfArea of study

Graduate school _

City/State. _

Dates attended Number of years completed ... Diploma Received: 0 Yes 0 No Year diploma awarded _ Type of degree. Major/Area of study _ Additional training, education, or certificates that are related to the position for which you are applying: CAREER INSTITUTE OF HEALTH AND TECHNOLOGY DIPLOMA

Professional, trade, business, or civic activities and offices held {exclude labor organizations and memberships that reveal race, color, national origin, sex, age, disability, or other protected status); List additional skills that are related to 'the position for which you are applying: Computer skills (such as competence with software packages Clerical skills (such as typing)

TYPING 95WPM FILING

Page 4 of6

DISCLOSURE AND AUTHORIZATION TO OBTAIN INFORMATION I understand that EMSL Analytical Inc. ("EMSL") or other authorized third parties may conduct a background investigation in connection with my application for employment, and that a consumer report may be requested from public records including, but not limited to, social security, trace, motor vehicle history report, workers compensation information and criminal history to the extent permitted by law from various state, local and federal agencies. I further understand that an investigative consumer report may be requested, and that this report will include information as to my character, general reputation, personal characteristics, mode of living, work habits, performance, experience, as well as reasons for termination of past employment, whichever are applicable, obtained through personal interviews with associates who have knowledge concerning such items of information. I also understand that if my application is granted, EMSL may obtain further information from subsequent investigations so as to update, renew or extend my employment. In accordance with the Fair Credit Reporting Act, this information may only be used to verifY statement(s) made by an individual in conjunction with legitimate business needs. In the event that information from the report ~is utilized in whole or in part in making an adverse action decision with regard to my potential employment, before making the adverse decision, EMSL will provide me with a copy of the consumer report and a description in writing of my rights under the law. I bgye read and understgnd tbjs release and consent; and I authorize the bgs:keround yer!ficatjop. I authorize persons, schools, current and former employers, and other organizations and Agencies to provide EMSL or authorized third parties with all information that may be requested. I hereby release all of the persons and Agencies providing such information from any and all claims and damages connected with their release of any requested information. I agree that any copy ofthis document is as valid as the original. I do hereby agree to forever release and discharge EMSL and their associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs and expenses, or any other charge or complaint filed with any Agency arising from retrieving and reporting of information. According to the Federal Fair Credit Reporting Act, I am entitled to know if employment was denied based on information obtained by my prospeetive employer and to receive a disclosure of the public record information and of the nature and scope of the investigative report.

CONFIDENTIAL INFORMATION FOR VERIFICATION PURPOSES ONLY Applicant: Last Name Middle Name

Social Security Number

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List Other Names Used Date of Birth

Sta~s?ied Last ""Name .\ \ -Listed e r on License

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Drivers' License Number

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Current Address

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Dates

Previous Address . City/--State/--Zip Dates

Previous Address City/State/Zip Dates

Applicant's Signature Today's Date

Contact this candidate