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5 Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No Expires 08/31/2019 "START HERE:!Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form.!employers are liable for errors in the completion of this form. ANTI-DISCRIMINATION NOTICE:?`!W_!WYYSUOY!`\!RW_Q^WZW[O`S!OUOW[_`!c\^X(Oa`V\^WfSR!W[RWbWRaOY_)!;Z]Y\eS^_!CANNOT!_]SQWTe!cVWQV! R\QaZS[`%_&!O[!SZ]Y\eSS!ZOe!]^S_S[`!`\!S_`OPYW_V!SZ]Y\eZS[`!Oa`V\^WfO`W\[!O[R!WRS[`W`e)!IVS!^STa_OY!`\!VW^S!\^!Q\[`W[aS!`\!SZ]Y\e! O[!W[RWbWRaOY!PSQOa_S!`VS!R\QaZS[`O`W\[!]^S_S[`SR!VO_!O!Ta`a^S!Sd]W^O`W\[!RO`S!ZOe!OY_\!Q\[_`W`a`S!WYYSUOY!RW_Q^WZW[O`W\[) Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.) AO_`!COZS!(Family Name) <W^_`!COZS!(Given Name) BWRRYS!?[W`WOY D`VS^!AO_`!COZS_!J_SR!(if any) 6RR^S!(Street Number and Name) 6]`)!CaZPS^ 8W`e!\^!I\c[ H`O`S N?E!8\RS 9O`S!\T!7W^`V!(mm/dd/yyyy) J)H)!H\QWOY!HSQa^W`e!CaZPS^!;Z]Y\eSS$_!;(ZOWY!6RR^S ;Z]Y\eSS$_!ISYS]V\[S!CaZPS^ ( ( I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am (check one of the following boxes):,)!6!qw`wfs[!\t!`vs!j[w`sr!h`o`s_ -)!6![\[QW`WfS[![O`W\[OY!\T!`VS!J[W`SR!H`O`S_!(See instructions).)!6!yoctay!]s^zo[s[`!^s_wrs[` %6YWS[!GSUW_`^O`W\[!CaZPS^*JH8?H!CaZPS^&4 /)!6[!OYWS[!Oa`V\^WfSR!`\!c\^X!!!!a[`WY!%Sd]W^O`W\[!RO`S'!WT!O]]YWQOPYS'!ZZ*RR*eeee&4 H\ZS!OYWS[_!ZOe!c^W`S!"C*6"!W[!`VS!Sd]W^O`W\[!RO`S!TWSYR) (See instructions) Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number. FG!8\RS!(!HSQ`W\[!,!!! 9\!C\`!L^W`S!?[!IVW_!H]OQS 1. 6YWS[!GSUW_`^O`W\[!CaZPS^*JH8?H!CaZPS^4 OR 2. <\^Z!?(3/!6RZW W\[!CaZPS^4 OR 3. <\^SWU[!EO ]\^`!CaZPS^4 8\a[`^e!\T!? ao[qs4 HWU[O`a^S!\T!;Z]Y\eSS I\ROe$_!9O`S (mm/dd/yyyy) Preparer and/or Translator Certification (check one):?!rwr![\`!a_s!o!]^s]o^s^!\^!`^o[_yo`\^)!6!]^s]o^s^%_&!o[r*\^!`^o[_yo`\^%_&!o W_`SR!`VS!SZ]Y\eSS!W[!Q\Z]YS`W[U!HSQ`W\[!,) (Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.) I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct. HWU[O`a^S!\T!E^S]O^S^!\^!I^O[_YO`\^ I\ROe$_!9O`S!(mm/dd/yyyy) AO_`!COZS!(Family Name) <W^_`!COZS!(Given Name) 6RR^S!(Street Number and Name) 8W`e!\^!I\c[ H`O`S N?E!8\RS Employer Completes Next Page Form I-9 07/17/17 N Page 1 of 3

6 Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No Expires 08/31/2019 Section 2. Employer or Authorized Representative Review and Verification (Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.") Employee Info from Section 1 AO_`!COZS!(Family Name) <W^_`!COZS!(Given Name) B)?) 8W`WfS[_VW]*?ZZWU^O`W\[!H`O`a_ List A OR List B AND List C Identity and Employment Authorization Identity Employment Authorization 6RRW`W\[OY!?[T\^ZO`W\[ FG!8\RS!(!HSQ`W\[_!-!#!.! 9\!C\`!L^W`S!?[!IVW_!H]OQS Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States. The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions) HWU[O`a^S!\T!;Z]Y\eS^!\^!6a`V\^WfSR!GS]^S_S[`O`WbS I\ROe$_!9O`S!(mm/dd/yyyy) IW`YS!\T!;Z]Y\eS^!\^!6a`V\^WfSR!GS]^S_S[`O`WbS AO_`!COZS!\T!;Z]Y\eS^!\^!6a`V\^WfSR!GS]^S_S[`O`WbS <W^_`!COZS!\T!;Z]Y\eS^!\^!6a`V\^WfSR!GS]^S_S[`O`WbS ;Z]Y\eS^$_!7a_W[S!\^!D^UO[WfO`W\[!COZS ;Z]Y\eS^$_!7a_W[S!\^!D^UO[WfO`W\[!6RR^S!%H`^SS`!CaZPS^!O[R!COZS& 8W`e!\^!I\c[ H`O`S N?E!8\RS Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.) A. CSc!COZS!(if applicable) B. 9O`S!\T!GSVW^S!(if applicable) AO_`!COZS!(Family Name) <W^_`!COZS!(Given Name) BWRRYS!?[W`WOY 9O`S!(mm/dd/yyyy) C.?T!`VS!SZ]Y\eSS$_!]^SbW\a_!U^O[`!\T!SZ]Y\eZS[`!Oa`V\^WfO`W\[!VO_!Sd]W^SR'!]^\bWRS!`VS!W[T\^ZO`W\[!T\^!`VS!R\QaZS[`!\^!^SQSW]`!`VO`!S_`OPYW_VS_! Q\[`W[aW[U!SZ]Y\eZS[`!Oa`V\^WfO`W\[!W[!`VS!_]OQS!]^\bWRSR!PSY\c) ;d]w^o`w\[!9o`s (if any&!(mm/dd/yyyy) I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual. HWU[O`a^S!\T!;Z]Y\eS^!\^!6a`V\^WfSR!GS]^S_S[`O`WbS I\ROe$_!9O`S (mm/dd/yyyy) COZS!\T!;Z]Y\eS^!\^!6a`V\^WfSR!GS]^S_S[`O`WbS Form I-9 07/17/17 N Page 2 of 3

7 LISTS OF ACCEPTABLE DOCUMENTS All documents must be UNEXPIRED ;Z]Y\eSS_!ZOe!]^S_S[`!\[S!_SYSQ`W\[!T^\Z!AW_`!6!! \^!O!Q\ZPW[O`W\[!\T!\[S!_SYSQ`W\[!T^\Z!AW_`!7!O[R!\[S!_SYSQ`W\[!T^\Z!AW_`!8) LIST A LIST B LIST C Documents that Establish Both Identity and Employment Authorization OR Documents that Establish Identity AND Documents that Establish Employment Authorization 1. J)H)!EO ]\^`!\^!J)H)!EO ]\^`!8O^R 2. ES^ZO[S[`!GS_WRS[`!8O^R!\^!6YWS[! GSUW_`^O`W\[!GSQSW]`!8O^R!%<\^Z!?(00,& 3.!!<\^SWU[!]O ]\^`!`VO`!Q\[`OW[_!O! `SZ]\^O^e!?(00,!_`OZ]!\^!`SZ]\^O^e!?(00,!]^W[`SR![\`O`W\[!\[!O!ZOQVW[S( ^SOROPYS!WZZWU^O[`!bW_O 4.!;Z]Y\eZS[`!6a`V\^WfO`W\[!9\QaZS[`! `VO`!Q\[`OW[_!O!]V\`\U^O]V!%<\^Z!?(211&! 5. <\^!O![\[WZZWU^O[`!OYWS[!Oa`V\^WfSR!! `\!c\^x!t\^!o!_]sqwtwq!sz]y\es^! PSQOa_S!\T!VW_!\^!VS^!_`O`a_4 a.!<\^swu[!]o ]\^`5!O[R b.!<\^z!?(3/!\^!<\^z!?(3/6!`vo`!vo_!! `VS!T\YY\cW[U4 %,&!IVS!_OZS![OZS!O_!`VS!]O ]\^`5! O[R %-&!6[!S[R\^_SZS[`!\T!`VS!OYWS[$_! [\[WZZWU^O[`!_`O`a_!O_!Y\[U!O_! `VO`!]S^W\R!\T!S[R\^_SZS[`!VO_! [\`!es`!sd]w^sr!o[r!`vs! ]^\]\_SR!SZ]Y\eZS[`!W_![\`!W[! Q\[TYWQ`!cW`V!O[e!^S_`^WQ`W\[_!\^! YWZW`O`W\[_!WRS[`WTWSR!\[!`VS!T\^Z) 6. EO ]\^`!T^\Z!`VS!<SRS^O`SR!H`O`S_!\T! BWQ^\[S_WO!%<HB&!\^!`VS!GS]aPYWQ!\T! `VS!BO^_VOYY!?_YO[R_!%GB?&!cW`V!<\^Z!?(3/!\^!<\^Z!?(3/6!W[RWQO`W[U! [\[WZZWU^O[`!ORZW W\[!a[RS^!`VS! 8\Z]OQ`!\T!<^SS!6 \QWO`W\[!7S`cSS[! `VS!J[W`SR!H`O`S_!O[R!`VS!<HB!\^!GB? 1. 9^WbS^$_!YWQS[_S!\^!?9!QO^R!W asr!pe!o! H`O`S!\^!\a`YeW[U!]\ S W\[!\T!`VS! J[W`SR!H`O`S_!]^\bWRSR!W`!Q\[`OW[_!O! ]V\`\U^O]V!\^!W[T\^ZO`W\[!_aQV!O_! [OZS'!RO`S!\T!PW^`V'!US[RS^'!VSWUV`'!SeS! Q\Y\^'!O[R!ORR^S 2.?9!QO^R!W asr!pe!tsrs^oy'!_`o`s!\^!y\qoy! U\bS^[ZS[`!OUS[QWS_!\^!S[`W`WS_'! ]^\bwrsr!w`!q\[`ow[_!o!]v\`\u^o]v!\^! W[T\^ZO`W\[!_aQV!O_![OZS'!RO`S!\T!PW^`V'! US[RS^'!VSWUV`'!SeS!Q\Y\^'!O[R!ORR^S 3. HQV\\Y!?9!QO^R!cW`V!O!]V\`\U^O]V 4.!!!K\`S^$_!^SUW_`^O`W\[!QO^R 5.!!!J)H)!BWYW`O^e!QO^R!\^!R^OT`!^SQ\^R 6.!!BWYW`O^e!RS]S[RS[`$_!?9!QO^R 7. J)H)!8\O_`!=aO^R!BS^QVO[`!BO^W[S^! 8O^R 8.!!!CO`WbS!6ZS^WQO[!`^WPOY!R\QaZS[` 9. 9^WbS^$_!YWQS[_S!W asr!pe!o!8o[orwo[! U\bS^[ZS[`!Oa`V\^W`e For persons under age 18 who are unable to present a document listed above: 10. HQV\\Y!^SQ\^R!\^!^S]\^`!QO^R 11.!!!8YW[WQ'!R\Q`\^'!\^!V\_]W`OY!^SQ\^R 12. 9Oe(QO^S!\^![a^_S^e!_QV\\Y!^SQ\^R 1. 6!H\QWOY!HSQa^W`e!6QQ\a[`!CaZPS^! QO^R'!a[YS!`VS!QO^R!W[QYaRS_!\[S!\T! `VS!T\YY\cW[U!^S_`^WQ`W\[_4 %,&!!CDI!K6A?9!<DG!;BEADMB;CI %-&!!K6A?9!<DG!LDG@!DCAM!L?I>!?CH!6JI>DG?N6I?DC %.&!!K6A?9!<DG!LDG@!DCAM!L?I>! 9>H!6JI>DG?N6I?DC 2. 8S^`WTWQO`W\[!\T!^S]\^`!\T!PW^`V!W asr! Pe!`VS!9S]O^`ZS[`!\T!H`O`S!%<\^Z_! 9H(,.0+'!<H(0/0'!<H(-/+&! 3.!!!D^WUW[OY!\^!QS^`WTWSR!Q\]e!\T!PW^`V!!!!!!!!!QS^`WTWQO`S!W asr!pe!o!h`o`s'!!!!!!!!q\a[`e'!za[wqw]oy!oa`v\^w`e'!\^!!!!!!!!`s^^w`\^e!\t!`vs!j[w`sr!h`o`s_!!!!!!!!pso^w[u!o[!\ttwqwoy!_soy 4.!!!CO`WbS!6ZS^WQO[!`^WPOY!R\QaZS[` 5.!!!J)H)!8W`WfS[!?9!8O^R!%<\^Z!?(,32& 6.?RS[`WTWQO`W\[!8O^R!T\^!J_S!\T! GS_WRS[`!8W`WfS[!W[!`VS!J[W`SR! H`O`S_!%<\^Z!?(,23& 7. ;Z]Y\eZS[`!Oa`V\^WfO`W\[! R\QaZS[`!W asr!pe!`vs! 9S]O^`ZS[`!\T!>\ZSYO[R!HSQa^W`e Examples of many of these documents appear in Part 13 of the Handbook for Employers (M-274). Refer to the instructions for more information about acceptable receipts. Form I-9 07/17/17 N Page 3 of 3

8 EMPLOYEE ACKNOWLEDGEMENT AND AGREEMENT I, the undersigned individual, in consideration of my being placed in an employee leasing/professional employer relationship with ( HROI ), acknowledge and agree to the following: "'# At all times during my relationship with HROI, I understand and agree that I will remain an employee of the client company for which I am working ( Client ) that has contracted with HROI and, to the extent allowed by law, Client will continue to have sole and exclusive control over my day-to-day job duties and over the worksite(s) where I perform services. Additionally, to the extent allowed by law, Client will continue to provide all onsite supervision, including, but not limited to, determining my job assignments and training requirements and evaluating my performance. Also, to the extent allowed by law, Client will determine my job duties, rate of pay, hours worked, continued employment opportunities, and other terms and conditions of my employment; "(# I understand and agree that my status with HROI is at-will. I further understand and agree that there is no contract of employment which exists between HROI and me and I understand and agree that HROI will not become a party to any contract of employment which I have already entered into or which I may in the future enter into with Client. Additionally, I understand and agree my at-will status with HROI does not change the employment status I had with Client prior to the existence of the employee leasing/professional employer relationship between HROI and Client and that HROI is not responsible for any contractual obligations which may exist between Client and me; ")# I understand and agree that I am performing services within an employee leasing/professional employer organization relationship where the duties and responsibilities applicable to me are set forth in a service agreement entered into between Client and HROI; "*# I understand and agree that, unless otherwise required by law if HROI does not receive payment from Client for services which I perform as a utilized individual, HROI may, where allowed by law, pay me the applicable minimum wage (or the legally required minimum salary) for any such pay period, and I agree to this method of compensation. Additionally, I understand and agree that Client at all times ultimately remains obligated to pay me my regular hourly rate of pay if I am a non-exempt employee and to pay me my full salary if I am an exempt employee if HROI is not fully paid by Client for services that I render; "+# I understand and agree that, unless otherwise required by law, where payment for the following items have not been received by HROI from Client, HROI does not assume responsibility for payment of bonuses, commissions, severance pay, deferred compensation, profit sharing, vacation, sick, or other paid time off pay and compensation, benefit, or for any other payment not required by law, in any form, unless HROI has specifically, in a written agreement entered into with me, adopted Client s obligation to pay me such compensation or benefit (HROI does assume this responsibility where such payment has been received from Client encompassing such items regarding me); ",# Unless otherwise contractually agreed to by Client and HROI, HROI has agreed to maintain workers compensation insurance covering my employment. In recognition of the fact that any work-related injuries which might be sustained by me are covered by state workers' compensation statutes, and to avoid the circumvention of such state statutes which may result from suits against the customers or clients of HROI or against HROI based on the same injury or injuries, and to the extent permitted by law, I hereby waive and forever release any rights I might have to make claims or bring suit against any client or customer of HROI and/or against HROI for damages based upon injuries which are covered under such workers' compensation statutes. In the event of a work-related injury, I understand and agree that, to the extent allowed by law, my sole remedy lies in coverage under HROI workers compensation policy or Client s workers compensation policy if it maintains its own workers compensation policy; "-# I understand and agree that if I am injured on the job, even if the injury is minor or I do not want treatment, I must immediately report it to my supervisor. I also agree to comply with any lawful drug testing policy which may be adopted, and I specifically agree to post-accident drug testing in any situation where it is allowed by law; ".# In addition, I also agree that if at any time during my employment at Client I am subjected to any type of discrimination, including discrimination because of race, sex, sexual orientation, harassment of any type, disability, color, age, genetic information, national origin, citizenship status, religion, retaliation, veteran status, military status, or union status, or if I am subjected to any type of harassment including sexual harassment, I will immediately contact an appropriate person of Client. In most instances, this appropriate person will be the President of Client. Should I choose not to contact Client for any reason, I may contact HROI s Human Resources Director at 1-8**-.'&$..'( for the limited purpose of having HROI, at its option, and not as an employer, but as a possible facilitator, try in its sole discretion, to attempt to facilitate a resolution; "/# I understand and agree that Client has sole and exclusive control over my day-to-day job duties and Client has sole and exclusive control over the job site at which, or from which, I perform my services and that HROI only reserves and retains such rights and authority as is required by applicable law. I agree that HROI does not have actual control over my workplace and, as such, is not in a position to end or remediate any discrimination, harassment, unsafe working condition, retaliation, or wrongdoing which may be occurring. The responsibility to resolve and/or end such inappropriate conduct or unsafe working condition rests with Client, however, HROI may attempt to facilitate a resolution; "'&# I understand and agree that due to licensure and workers compensation restrictions applicable to employee leasing companies/professional employer organizations, if I am accepted as a utilized individual of HROI, I am expressly prohibited from performing any work outside the state in which I am currently performing services for Client ( Home State ) during my status as a utilized individual except as may be allowed pursuant to the workers compensation policy provided to me by HROI or except as may be allowed in writing by HROI and the applicable workers compensation carrier; "''# If I work outside the Home State for Client or for anyone else without first securing this approval as set forth at (10), I understand and agree that I will no longer be in an employee leasing/professional employer organization relationship with HROI and may not be provided workers compensation benefits through HROI or the applicable workers compensation carrier and my employee leasing/professional employer organization relationship with HROI will be considered immediately terminated upon commencement of my trip outside the Home State to perform work where prior approval has not been received as set forth herein; "'(# I understand and agree that, to the extent allowed by law, any obligation of HROI ceases when HROI s employee leasing/professional employer organization agreement with Client terminates; "')# I understand and agree if I am eligible for any benefits it is my responsibility (and the responsibility of any family members/ dependents who wish to participate) to timely submit all required forms and information; "'*# To the extent allowable by law, by signing this Agreement, I assign to HROI, my right to assert a priority wage claim against Client under 11 2%1%0% 3+&- (a)(3) in the event that a Bankruptcy Petition is filed under the Title 7 and or Title 11 of the United States code by or on behalf of Client; and "'+# Should I sign this form and/or complete HROI s utilized individual paperwork and never be accepted as a utilized individual of HROI, this form shall be null and void. DATE SIGNATURE #)&(* "$'%

9 EMPLOYEE DIRECT DEPOSIT AUTHORIZATION Print Employee Full Name: #')&(*%% $"#: _ I wish to have my employer deposit my net pay and/or travel reimbursements and/or a fixed amount(s) each payday directly to my account(s) as indicated. I agree to notify my employer immediately of any changes to the information so that my pay may be properly distributed. I understand that in the event my employer notifies my financial institution that I am not entitled to the funds deposited to my account, my bank is authorized to debit my account for the amount of the adjustment. I understand that in the event my financial institution is not able to deposit any electronic transfer into my account due to any action I take; that I am responsible for any resulting bank fees incurred, and that my employer can not issue the payroll funds to me until the funds are returned to my employer by my financial institution. As required by the Federal Office of Foreign Asset Control in support of U.S.C. Title 50, War and National Defense, I attest that the full amount of my direct deposit is not being forwarded to a bank in another country and that if at any point I establish a standing order for my receiving bank to forward the full direct deposit to a bank in another country, I will inform my employing agency immediately. Please note that, due to timing differences, new or changed direct deposits may result in one paper check after this form has been submitted. Please do not close your account(s) without giving your payroll office two weeks prior notice. Employee Signature CHECKING ACCOUNTS. Attach a voided check for each account. If you do not have checks, you must include a letter from your banking institution. NET Direct Deposit to the following CHECKING account: Change Name of Financial Institution Routing Number Checking Account Number Net Amount Stop FIXED Amount to the following CHECKING account(s): Name of Financial Institution Routing Number Checking Account Number Amount Stop Name of Financial Institution Routing Number Checking Account Number Amount Stop Name of Financial Institution Routing Number Checking Account Number Amount Stop Date SAVINGS ACCOUNTS. Attach a voided check for each account. If you do not have checks, you must include a letter from your banking institu[pvu' /LWVZP[ ZSPW JHUb[ IL \ZLK' NET Direct Deposit to the following SAVINGS account: NET Change Name of Financial Institution Routing Number Savings Account Number Amount Stop FIXED Amount to the following SAVINGS account(s): Name of Financial Institution Routing Number Savings Account Number Amount Stop Name of Financial Institution Routing Number Savings Account Number Amount Stop Name of Financial Institution Routing Number Savings Account Number Amount Stop (2!*-!+203/-6-,!*7!HROI!')742//!&3-4)6.215$!! Updated by: Date / / Reviewed by: Date / /