Envelope Driver

BGC Information

Education Details

School Name

School Complete Address

Major

Graduated Yes or No

Graduation Year

Phone Number of Institution

Employment 1

Company Name

Work Location Address

Position

Start Date

End Date

Contact Employer (Yes/ No)

Reason for leaving

Employment 2

Company Name

Work Location Address

Position

Start Date

End Date

Contact Employer (Yes/ No)

Reason for leaving

DocuSign Envelope ID: 60B10D2D-FEBA-4C82-B20B-57EE32BC373B yes

cardone industries

2021

yes

2021

yes

Arlington

6/1985

2017

233 /555-***-****

need second job/not leaving

2017

cardone industries

Auto mobile

Back up

Arlington

Back up

Accra technical Institute

Need a second job/ not leaving

p o box 223 Accra Ghana

Pitney Bowes (PB) Recruiting Video Confirmation

EMPLOYEE:

I confirm that I have watched and reviewed the PB recruiting videos provided by my employer prior to my assignment at PB. I also understand that the videos are just a representation of the environment and work to be performed while working as a contractor at Pitney Bowes and may not depict my actual duties. My recruiting agency/employer has also addressed all my questions and concerns after reviewing the video(s).

Print Name Signature

EMPLOYER:

I confirm that we have shown our employee, that is being placed at Pitney Bowes as contract labor person, the preassignment video(s) that shows examples of duties, responsibilities, and environment that may be required. I also attest that we have answered any and all questions or concerns of our employee after they reviewed this video(s).

(Printed Name)

(Signature)

(Title)

DocuSign Envelope ID: 60B10D2D-FEBA-4C82-B20B-57EE32BC373B George Oppong

EMPLOYM ENT BACKGROUND SCREENING

AUTHORIZATION, WAIVER, AND RELEASE FORM

CONSENT TO OBTAIN CONSUMER REPORTS FOR EMPLOYMENT PURPOSES In connection with, and for the duration of, my employment (including contract for services) with Niktor LLC (hereafter, “the

Company”), or any of its affiliates, I understand that the Company may obtain consumer reports for employment purposes that may include, but not be limited to my credit, criminal, driving, employment and education history. This information will, in whole or in part, be obtained from Sansei, Inc. d/b/a “Health Street.” These reports may include information as to my general reputation, character, personal characteristics, work habits, job performance, and experience along with reasons for separation from previous employers. I understand that the Company may be requesting information from various federal, state, and other agencies or institutions, which maintain public and non-public records concerning areas of my past that are relevant to my affiliation with the Company, my prior employers, and my credit, criminal, driving, employment, certification, licensure, and/or educational history. I authorize, without reservation, any party, institution, or agency contacted by the Company or Sansei, Inc. d/b/a “Health Street” and/or its associates to furnish the above mentioned information. FIRST NAME

LAST NAME GENDER DATE OF BIRTH SOCIAL SECURITY #

(Required in order to obtain accurate records & will not affect job eligibility) CURRENT STREET ADDRESS APT/SUITE CITY STATE ZIP Year moved to here PRIOR STREET ADDRESS

APT/SUITE CITY

From:

to:

STATE ZIP Years lived at this address

ALIAS/PREVIOUS/MAIDEN NAMES

DRIVER’S LICENSE #

STATE OF LICENSE

Notice to California Applicants: Under SECTION I 786.22 of the California Civil Code, you have the right to request from Sansei, Inc. d/b/a “Health Street”, upon proper identification, the nature and substance of all information in its files on you, including the sources of information, and the recipients of any reports on you, which Sansei, Inc. d/b/a

“Health Street” has previously furnished within the two-year period preceding your request. You may view the file maintained on you by Sansei, Inc. d/b/a “Health Street” during business hours. You may also obtain a copy of this file upon submitting proper identification and paying costs of duplication services. Upon making a written request, you may receive a summary of your report via telephone.

Notice to New York Applicants:

Under Article 25 Section 380-g of the NY General Business Law, should a consumer report received by an employer contain criminal conviction information, the employer must provide to the applicant or employee who is the subject of the report, a printed or electronic copy of Article 23-A of the NY Correction Law, which governs the employment of persons previously convicted of one or more criminal offenses. By signing below, I acknowledge receipt of Article 23- A of NY Correction law.

Notice to California, Minnesota & Oklahoma Applicants: By signing below, I acknowledge that I have been alerted to my right to request to have a copy of my consumer report sent directly to me by the Company.

APPLICANT SIGNATURE

www.health-street.net Page 1 of 1

DocuSign Envelope ID: 60B10D2D-FEBA-4C82-B20B-57EE32BC373B oppong Mail

700 timber oaks ln apt.4106 grand prairie tx75051/029233234 George 05/08/1965

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