Action Staffing Services, Inc.

1001 West Main Street, D Lebanon, OH 45036

Equalaccess to programs, services and employment opportunities is available to all persons without regard to race, color, religion, sex (including pregnancy), military status, national origin, disability, age, ancestry, genetic information, or any other basis protected by federal, state, and/or local law. In accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonable accommodations for the application and/orinterview process should notify the Human Resources Department. Examples of reasonable accommodations include making a change to the application process; providing written materials in an alternate format such as braille, large print, or audio recording; using a sign language interpreter; using specialized equipment; or modifying testing conditions.

Applicant Statement and Signature

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete, and correct. I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering, and using truthful and non- defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law. I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered foremployment, it will be necessary for me to reapply and fill out a new application. If am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. Iunderstandthat reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with the employer's affiliate(s) and third parties engaged by the employer to perform services for the employer. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer. This Companydoesnot tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her race, color, religion, sex (including pregnancy), military status, national origin, disability, age, ancestry, genetic information, or any other protected status under applicable federal, state, or local law. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, résumé, or job

Due to the unprecedented crisis at hand from COVID, Action Staffing has adopted a new Strike/Suspension policy going forward. This is enacted in order to increase the number of employees working in the field and in order to help our clients maintain their production and manufacturing requirements. This strict policy is enforced due to the significant demand for jobs, expiring unemployment bonuses and high number of people that are unemployed.

If you commit any of the following violations, you will be put under Suspension for a minimum of 30 days and potentially for the remainder of 2022. This policy will help us insure that we are helping as many people ready to work as possible. Violations may include but are not limited

No Call No Show on any day of employment in your first week Calling off any day of work in your first week Walking off the Jobsite at anytime Quitting a job at any time without previously calling/contacting our office to resign

NOTE: Suspension can be avoided by calling your dedicated Recruiter before missing a shift or quitting employment. These will be handled on a case by case basis, but suspensions will be automatic if you do not contact us before your shift.

Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services

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: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

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

4.An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in the expiration date field. (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.

QR Code Section 1 Do Not Write In Ihis Space

(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.

Employee's Withholding Certificate

Department of the Treasury Internal Revenue Service

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Give Form W-4 to your employer. Your withholding is subject to review by the IRS. (a) First name and middle initial

Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.

TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholdingwill be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job

If your total income will be $200,000 or less ($400,000 or less if married filing jointly):

(c) Extra withholding. Enter any additional tax you want withheld each pay period

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

1. For state purposes, an individual may claim only natural de- pendency exemptions. This includes the taxpayer, spouse and each dependent. Dependents are the same as defined in the Internal Revenue Code and as claimed in the taxpayer's federal income tax return for the taxable year for which the taxpayer would have been permitted to claim had the tax- payer filed such a return.

For further information, consult the Ohio Department of Taxa- tion, Personal and School District Income Tax Division, or your employer.

3. If you expect to owe more Ohio income tax than will be withheld, you may claim a smaller number of exemptions; or under an agreement with your employer, you may have an additional amount withheld each pay period.

2. You may file a new certificate at any time if the number of your exemptions increases. You must file a new certificate within 10 days if the number of exemptions previously claimed by you decreases because: (a) Your spouse for whom you have been claiming exemp- tion is divorced or legally separated, or claims her (or his) own exemption on a separate certificate. (b) The support of a dependent for whom you claimed ex- emption is taken over by someone else. (c) You find that a dependent for whom you claimed exemp- tion must be dropped for federal purposes. The death of a spouse or a dependent does not affect your withholding until the next year but requires the filing of a new certificate. If possible, file a new certificate by Dec. 1st of the year in which the death occurs.

4. A married couple with both spouses working and filing a joint return will, in many cases, be required to file an indi- vidual estimated income tax form IT 1040ES even though Ohio income tax is being withheld from their wages. This result may occur because the tax on their combined in- come will be greater than the sum of the taxes withheld from the husband's wages and the wife's wages. This requirement to file an individual estimated income tax form IT 1040ES may also apply to an individual who has two jobs, both of which are subject to withholding. In lieu of filing the individual estimated income tax form IT 1040ES, the individual may provide for additional withholding with his employer by using line 5.

Under the penalties of perjury, I certify that the number of exemptions claimed on this certificate does not exceed the number to which I am entitled.