AppLrcATroN. Fon EnnrtoYMEhIT. z?)jt. I Inquiry IJ Other. il Advertisement I Relative. X Employment Agency I Friend. fl Yes. I Yes. -lr, n Yes.

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1 AppLrcATroN Fon EnnrtoYMEhT We consider applications for all positions without sex, national origin, disability, sexual orientation, protected status. regard to race, color, reiigion, creed, citizenship status or any other legally z?)jt Position(s) Applied For Date of Application How Did You Learn About Us? il Advertisement Relative X Employment Agency Friend nquiry J Other Last Name First Name Middle Name AdAr.tt N"*b", Street City State Zip Code Best time to contact you at home is: f you are under 18 years of age, can you provide required proof of yor-rr eligibiliry to work? Have you ever filed an application with us before? f Yes, give date Have you ever been employed with us before?... f Yes, give date Do any of your friends or relatives, Are vou currently employed?... May we conlact your present employer? other than spouse, work here? Social Security Number (Voluntary) Are you prevented from iawfully becoming employed in this country because of Visa or mmigration Status Proof of citirynship or immigration status will be required upon employnlent. "...' What is vour desired salary range? -..-*--.- fl Yes U Yes n Yes f.] Yes t Yes li Yes Alv. PM J i-l Date available forwork -)-l- Are you available to rvork: Full-Time (please indicate shift) :-l Part-Tjme (please indicate Mornings Afternc-'on Evenings) f Temporary (please indicate dales available -.-lj-) Are you currerrtly on "lay-off" status and subject to recall?...".. -l-l- L-l Yes t-l Can you travel if a job requires it?... f-l Yes Have you been convicted of a felgny r.r,ithin the last five years?.. [l Yes L-' A cintinal record does not codtilzt.e an autanlatic bar ro ernployntenr and t ill be cor.sidered only u it relates to rhe job in q.lesliotl. WE ARE AN EOUAL OPPORTUNTY EMPLOYER Yes L] tl ll a H 7 P -lr,

2 ! EnucarroN ; _l

3 EnnproYMENr H,xpERrENcE Start with your present or iast job. nclude any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. 1. ob Tide Supewisor Reason for l-eaving 2. Supervisor Reason for Leaving 3. Supervisor Reason ior Leaving 4. Employer Supen'isor Reason for Leaving f you need additional space, please continue on a separate sheet of paper. List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestly, disr'lbility or other protected status:

4 AnnrrroNAl fmponuatron Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience. Spgcrarrzs,n Sxnrs (Cuecr SrnrslEourpMENT Ornnarnn) -Termina] _PC/MAC _Typewriter WPM -Spreadsheet _Word Processing _Shorthand WPM Production/Mobile Machinery 0ist) Other (list) ie to Applicants: DO NOT ANSWER THS QUESTON UNLESS YOU HAVE BEEN NFORMED ABOUT THE REQUREMENTS OF THE JOB FOR WHCH YOU ARE APPLYNG. Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation? YES NO RErpnr,NcEs (_) (Name) Phone # () (Name) (_) Phone #!l :l 3. () (Narne) (--) ( )

5 ApprrcaNT's STaTEMENT cerlify that answers given herein are true and complete. authorize investigation of all statements contained in this application for employment as may be ecessary in arriving at an emplo5rment decision, is application for empios'rnent sfuall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as t whether or not applications are being accepted at that time. hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment tionship with this organization is of arr"at will" nature, which means that the Employee may resi t any time and the Employer may discharge Employee at any time with or without cause. t is furt understood that this 'at will" employment relationship may not be changed by any written document by conduct unless such change is specifically acknowledged in writing by an authorized executive of this nization. the event of employrnent, understand that false or misleading information given in my application interview(s) may result in discharge. understand, also, that am required to abide by all rules and ations of the employer. Signature of Applicant Date Arrange nterview Yes X Remarks Employed [] Yes Date of Employment Hourly Rate/ Salary Department - 'lis Application For Employm.ent is sold for general use throughout the l nited States. Amsterdam Printing and Litho assumes no rcsponsibility lot the use of said fom or any questions which, when qsked fu the employer of the iob applicant, malt violate State andjor Federal Law. Rev 5/07 Re-ordet Form $2114 imprinred) Ocopyright 1999 Amsterdarn Prinrtng ancl Lilho, Amsterdam, N.Y t20!0 Toll Free or odline u,rw.amsteydampnntingfoms.com Amsterdam