APPLICATION FOR EMPLOYMENT

REF 042 Rev J (12/14) Page 1 of 4

It is the policy of this company to provide equal employment opportunities to all qualified persons without regard to race, creed, color, religious belief, gender, sexual preference, age, national origin, physical or mental handicap or veteran status and to satisfy the requirements of The Americans with Disabilities Act of 1990 (as amended) as well as state laws governing the employment of individuals with disabilities.

Note: Please type or print your answers. If you print, please do so in blue or black ink and write neatly. An illegible application may preclude you from consideration.

Position Applying For: ______________________________________________________________________ Application Date: __________________________________________________________________________ Are you at least 18 years of age? Yes No Personal Information ________________________________________________________________________________________ First Name Middle Initial Last Name Current Address: __________________________________________________________________________________________________________ Street and Apt. # City State Zip Code Permanent Address (if different from above): __________________________________________________________________________________________________________ Street and Apt. # City State Zip Code Telephone: __________________ Cell Phone: ________________ E-Mail: _________________________

Please provide an email address that the company may utilize to provide notifications.

Person to be notified in case of an accident or emergency: Name Relationship Telephone / Cell Phone Number For positions requiring driving or operating a vehicle for business use:

Do you have a valid Driver’s License? Yes No Driver’s License #: ________________State:_______ Have you ever served in the U.S. Military? Yes No If yes, please provide the following information:

Branch of Service: _______________________ Rank at Time of Separation: ________________ Service Dates: __________________________ Special Honors: __________________________

APPLICATION FOR EMPLOYMENT

REF 042 Rev J (12/14) Page 2 of 4

First Name: Middle Initial: Last Name: Employment History

Has Resume Been Submitted: Yes No Present or Most Recent Employer: (if yes, skip to page 3) Employer: _________________________________ Address: ______________________________________________ Position: __________________________________ Salary: ________________________________________________ Duties: Dates of Employment: From _________________________ To ______________ May we contact? Yes No Supervisor: _________________________________ Title: _________________________________________________ Reasons for Leaving: Prior Employer: Employer: _________________________________ Address: ______________________________________________ Position: __________________________________ Salary: ________________________________________________ Duties: Dates of Employment: From _________________________ To ______________ May we contact? Yes No

Supervisor: _________________________________ Title: _________________________________________________ Reasons for Leaving: Prior Employer: Employer: _________________________________ Address: ______________________________________________ Position: __________________________________ Salary: ________________________________________________ Duties: Dates of Employment: From _________________________ To ______________ May we contact? Yes No Supervisor: _________________________________ Title: _________________________________________________ Reasons for Leaving:

APPLICATION FOR EMPLOYMENT

REF 042 Rev J (12/14) Page 3 of 4

First Name: Middle Initial: Last Name: Education High School: _____________________________________________________________________________ Address: ________________________________________________________________________________ Technical or Vocational School: ________________________________ Specialty:_____________________ Did you graduate? Yes No Attended From ______________ To _________________________ If you did not graduate, did you receive your GED? Yes No Special honors or awards: ___________________________________________________________________ College or University: ______________________________________________________________________ Address: ________________________________________________________________________________ Did you graduate? Yes No Attended From ______________ To __________________________ Degree: _______________________________ Major: ____________________________________________ Special honors or awards: __________________________________________________________________ Position Information Position Applying For: ______________________________________________________________________ How did you hear about this job? _____________________________________________________________ What hours are you willing to work? ___________________________________________________________ Would you be able to work weekends? Yes No Are you willing to travel for the job? Yes No When would you be able to start? _____________________________________________________________ Desired Salary: _____________________________ Per Diem: ________________________________

APPLICATION FOR EMPLOYMENT

REF 042 Rev J (12/14) Page 4 of 4

First Name: Middle Initial: Last Name: Skills

Please describe any skills you have in the following areas:

Computer: ________________________________________________________________________________________ Languages Spoken (other than English): ________________________________________________________________ Additional Skills: ____________________________________________________________________________________ Certifications: ______________________________________________________________________________________

I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge. If I am employed, I understand that any false statements on this application shall be considered sufficient cause for my dismissal. I understand that I may be required to submit to a background screening process during the next step of pre-employment testing and evaluation and that I will be given the opportunity to discuss any concerns that I may have with regards to this screening process during a personal interview (conducted either in person or via telephone). If I choose to continue in the screening process, I understand that I may be required to sign a release authorizing a background screening company designated by the Employer noted on this application and or its clients to whom I may be assigned to investigate my personal information for the sole purpose of determining employment eligibility. The personal information investigated may include but is not limited to, employment history, educational verifications, drug testing, credit reports (subject to all Fair Credit Reporting Act requirements) motor vehicle screens and criminal records investigation. I understand that in order to be made an offer of employment, any and all required screens that I submit to must meet the requirements of the Employer and or their clients to whom I would be assigned. I release and forever discharge the Employer noted on this application, its clients, the background screening company, laboratories and the agents and employees of all noted from any lawsuits, proceedings, claims or causes of action arising from the test or tests and from any action or inaction of the Employer and or its clients based on the results of the testing. I understand that should I become employed in Massachusetts and should my assignment/employment end that MA Employment and Training Law requires that I contact my Employer for possible reassignment prior to filing for unemployment insurance benefits. Failure to do so may result in a denial of those benefits. Furthermore I understand that if I am hired, employment with the Employer noted on this application is "at will," which means that either the Employer or I can terminate my employment for any reason not prohibited by state or federal law. Signature: _________________________________________________ Date: ________________________ Print Name: ________________________________________________

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REF 072 Rev B (11/15) Page 1 of 1

Madison Resource Funding is a proud participant of the Federal WOTC (Work Opportunity Tax Credit) program. The WOTC program is a Federal tax credit available to employers in an effort to incentivize workplace diversity and facilitate access to good jobs for American workers. Each year, employers claim over $1 billion in tax credits under the WOTC program. The success and growth of this program has been beneficial to increasing America’s economic growth and productivity.

This program requires that employers have all potential new hires complete a screening process. We have partnered with Equifax, utilizing a convenient phone screening method that is secure and efficient.

• Please complete the screening by calling the below number. You will then be prompted for the Employer Code and Location Code. After entering you will then answer a series of automated questions to determine eligibility for the tax credits.

• Once you have completed the process, you will be given a confirmation code. Please record that number below where indicated

WOTC Screening Toll Free Number 1-800-552-5469 Client Name Madison Resource Funding

Employer Code 72820

Location Code 72820

Confirmation Number

We thank you for your participation!

DIRECT DEPOSIT FORM

CALIFORNIA

MAF 307-A CA (01/17) Page 1 of 1

NESC Staffing Corp. offers two FAST, EASY and SAFE ways to get paid in California: • Option 1 - Direct Deposit to a Personal Bank Account: If you have a personal checking or saving

account, your pay can be delivered to that account via direct deposit every payday. • Option 2 - Money Network® Service: If you don’t have a personal bank account, your pay will be loaded

directly into your Money Network Account every payday. This easy-to-use payroll solution enables you to access your funds by using Money Network™ Checks or an optional Money Network® Paycard. Write a Check to yourself and cash it for free to get up to 100% of the funds in your account, make free cash withdrawals at In-Network AllPoint ATMs and Bank of America ATMs nationwide (at least one free withdrawal per pay period), pay bills, make purchases and more.

Take Charge of your Pay. Whether you choose Direct Deposit or Money Network, you get more control over your pay. Among key benefits you’ll be able to count on:

• Save time: your pay is automatically deposited into your personal bank account or your Money Network account every payday. Rain, snow or shine, you’ll be able to access your pay immediately on payday, instead of waiting to pick up your check or standing in line to cash it.

• Save money: every penny of your hard-earned money counts. These payroll options give you instant and convenient ways to access to your pay for free 24/7, so you can say goodbye to check cashing and/or money order fees.

• Keep it safe: your pay is automatically placed into your account, giving you peace of mind -- you don’t have to worry about lost checks or stolen cash.

• Eco-friendly: these options require less paper, which helps minimize environmental waste and pollutants. After careful evaluation, we believe Direct Deposit and Money Network are the best available payroll solutions to help us meet our goal of delivering your pay in the quickest and most secure way possible. Due to California state law and as an employee in California I understand I have only two options to get paid. If I choose Direct Deposit, I will also include the necessary paperwork so funds can be deposited into my bank account each pay day otherwise the Money Network option is your choice. Please speak with your NESC Staffing recruiter for more information on this option. My signature below indicates that I have read, understand and authorize the mode of payment below. Direct Deposit: Money Network: Employee:

(Signature)

Print Name: Date:

DIRECT DEPOSIT FORM

MAF 307 Rev F (12/14) Page 1 of 1

Do You Want Direct Deposit? Yes No (If yes, please attach a voided check to this form and forward to your branch representative for processing). Account #1:

Employee Bank Name:

Bank Routing (ABA) #: Account No.:

Amount: Checking Savings Account #2 (optional):

Employee Bank Name:

Bank Routing (ABA) #: Account No.:

Amount: Checking Savings

Note: This Process May Take Up To 2-3 Weeks But Will Not Delay Or Hold Back Your Paycheck. I hereby authorize (the “Company”) to deposit any amounts owed me, as instructed by my employer, by initiating credit entries to my account at the financial institution (hereinafter “Bank”) indicated on this form. Further, I authorize Bank to accept and to credit any credit entries indicated by the Company to my account. In the event that the Company deposits funds erroneously into my account, I authorize the Company to debit my account for an amount not to exceed the original amount of the erroneous credit. This authorization will be in effect until the Company receives a written termination notice from myself and has a reasonable opportunity to act on it.

Signature Date

Print Name

Please submit completed form to your branch representative via fax or mail. The safety and security of your financial information is of primary importance to us. Due to the sensitive nature of the information; submitting

electronically is not advised without the use of a secure web portal, and if done so, will be at your own risk.

Office Use Only

Submitted By: Company: Date Submitted:

Office Location/Branch: Effective Date:

Direct Deposit Disclaimer: If you are eligible for and choose to enroll in Direct Deposit we recommend that you verify with your bank or financial institution when your funds would be posted to your account and made available to you. Each bank and financial institution has its own process for funds availability.

ON-LINE PAY STUB INSTRUCTIONS

MAF 312 REV C (12/14) Page 1 of 2

ThesedocumentsareProprietaryMadisonDataandprotectedbytheconfidentialityagreementpreviouslysignedbetweenClientandMadison.Nofurtherdistribution,copyingorreproductionispermittedwithouttheexpressedwrittenconsentofMadison

  

Pay stubs are now electronically available through Employee Self Service via the Internet and therefore accessible at home, the library, or wherever you may choose to access your account. In addition to making this information more convenient for employees, it also represents a significant step forward in the Company’s effort to "go green" and to conserve resources. Direct deposit employees will no longer receive a paper pay stub. Instead, each week, on the evening before your payday, (a day later on a holiday week) your pay stub information will be uploaded to the secure website where it can be easily accessed from your PC. You will be able to view and print both current and loaded historical pay stubs. As always, if you need any historical information, not accessible on the website (mortgage verification, SSA, etc.) please contact your Payroll Administrator and they can quickly provide the required information to you or the requesting agency.

Please log on to https://nescpaystubs.madisonrf.com

 ● Your User Name is your LAST NAME (first letter capitalized) and the last 4 digits of your social security

number. Example: Smith1234

● Your password is the last 4 digits of your social security number.

● Click on “Employee” on the left.

● Click on “Direct Deposit” The most current pay stub will be presented first. You can see pervious stubs by clicking the red “Previous” button at the top left of the screen. To move to the more recent pay stubs click “Next” at the top right of the screen. Click on “Change Password” at the far left to change your password at any time. If you have any technical issues relative to the website, or any questions relative to your check, hours, rate, bank information, etc., please contact your local branch representative.

ON-LINE PAY STUB INSTRUCTIONS

MAF 312 REV C (12/14) Page 2 of 2

ThesedocumentsareProprietaryMadisonDataandprotectedbytheconfidentialityagreementpreviouslysignedbetweenClientandMadison.Nofurtherdistribution,copyingorreproductionispermittedwithouttheexpressedwrittenconsentofMadison

  

Paystubs Paystubs are typically uploaded to our secure website and should be available online the next business day after your payday. To access, follow the instruction above to log into your account then click on “Paystubs” located at the top of the page; then one of the choices;

“Home” will give you a list of your last 5 paystubs and their date;

 

“My Account” gives you information regarding your account and this is where you can change your password and/or email address.

“Employee Paystub” gives you a listing of all paystubs, year to date,

“YTD” will give you an overall breakdown of Current YTD

HRF 216 Rev A (12/15)

To: All Employees

RE: New Health Insurance Marketplace Coverage Options

In 2014, the health care reform law created a new type of online marketplace for purchasing health insurance coverage. This marketplace is referred to as a Health Insurance Marketplace or an Exchange. You are not required to purchase insurance coverage through the Marketplace. This letter is being sent to all employees of NESC Staffing, Corp. regardless of your current status of being eligible for health insurance through the agency.

NESC Staffing, Corp. is providing the enclosed notice to help you understand your health insurance coverage options.

If you purchase coverage through a Marketplace, you may be eligible for a federal subsidy that lowers your monthly premiums or reduces your cost sharing.

If you have any questions, additional information regarding health care reform law and the Marketplaces is available at www.healthcare.gov.

Sincerely,

Human Resources

New Health Insurance Marketplace Coverage Options and Your Health Coverage

PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health

Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic

information about the new Marketplace.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The

Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible

for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance

coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or

offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on

your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible

for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be

eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does

not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your

employer that would cover you (and not any other members of your family) is more than 9.5% of your household

income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the

Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your

employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer

contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for

Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-

tax basis.

How Can I Get More Information?

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the

Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health

insurance coverage and contact information for a Health Insurance Marketplace in your area.

1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered

by the plan is no less than 60 percent of such costs.

Form Approved OMB No. 1210-0149 (expires 1-31-2017)

INSURANCE WAIVER FORM

HRF 202 (12/14) Page 1 of 1

Plan Year: _________ To decline coverage through Employer sponsored plan, please sign and return this form to your NESC Staffing, Corp. branch.

Employee Name: Last First MI

Date of Birth: ______________ I waive my and/or my dependents’ (if any) eligibility to enroll in my employer’s group plan at this time. I understand that I and/or my dependents may enroll under this plan in the future under the terms defined in the eligibility section of the insurance carriers subscriber certificate or benefit description.

Employee Signature Date

EMPLOYEE PATENT-LICENSE-COPYRIGHT AGREEMENT

REF 052 Rev G (12/14) Page 1 of 1

In consideration of my employment with NESC Staffing, Corp. (hereinafter, the Company), I agree that as a condition of my employment as a contractor, I hereby covenant and agree that: 1. I agree that I will promptly disclose to Company, and its Client, all discoveries, processes, software, formulae,

data, know-how and techniques, whether or not patentable or protectable by copyright, made or conceived, first reduced to practice, or learned by me, either alone or jointly with others, during the period of my engagement by Company as contractor for Client that (i) relate to or are useful in the business of Company and/or its clients, (ii) are conceived, made or worked on at the expense of, or during my normal working hours for Client or using any resources or materials of Client, or (iii) arise out of tasks assigned to me by Client or, (iv) are within the scope of my duties as employee of Company while on the Client project (collectively, “Proprietary Inventions”).

2. All Proprietary Inventions shall be a work for hire and the sole property of Client and its assignees, and Client

Company and its assignees shall be the sole owner of all patents, copyrights, trademarks, and other rights in connection therewith. In consideration of my engagement by Company as an employee/contractor and regardless of any change in the wages paid to me or the nature of my duties, I hereby assign to Client, or its assignees, my entire right, title and interest in and to any and all Proprietary Inventions including all patent, trademark, copyright, and other rights therein.

3. I, at the expense of Client, agree to assist Client and its assignees in every proper way to obtain and enforce

patents, copyrights, trademarks and other intellectual property rights in Proprietary Inventions in the United States and any and all other countries. To that end, I agree to execute all papers and perform all acts necessary to make this Agreement effective as to any particular Proprietary Inventions, application for letters of patent, registration of copyrights or trademarks, and other rights and interests of Client or its assignees, including the giving of testimony without expense to me and without further compensation. My obligations under this paragraph (3) shall continue beyond the termination of this Agreement, my assignment to Client and my duties as employee of Company.

4. I acknowledge that Company and Client have developed or acquired materials and information (whether or not

reduced to writing, patentable or protectable by copyright) relating to their business clients, customers, consultants, licensees or affiliates including but not limited to operating procedures, products, methods, service techniques, engineering and manufacturing data, machines, devices, apparatus, “know-how,” formulae, software, object and source code, processes, plans, designs, including photographic representations, specifications, trade secrets, company data regarding costs, profits, markets and sales, customer lists, plans for present and future research, development and marketing, and other proprietary information not available to the public (collectively “Proprietary Information”)and that such proprietary information may be available to me in the course of my employment. I will not, without the express written authorization from an authorized Company or Client officer, during or after the term of my engagement by Company as employee, disclose any Proprietary Information, or anything relating to it (whether or not learned, obtained or developed solely by me), to any person other than authorized Client personnel. Nor shall I use any such Proprietary Information except in the scope of my employment, for my personal benefit or disclose or use for my benefit any information furnished by a third party to Company in confidence.

5. I further agree that all of the above applies to all Company’s clients to which I am assigned.

Employee: Witness

(Signature) (Signature)

Print Name: Print Name:

Date: Date:

WORKERS COMPENSATION

MEDICAL TREATMENT PROGRAM

SAF 166 Rev G (12/16) Page 1 of 1

1-855-288-9490 When prompted for Employer Name, you will let them know that it is listed under

the “NESC Umbrella”.

The Location Code is based on what branch office you are employed out of: Portsmouth, NH: NESC PORTSMOUTH Woburn, MA: NESC WOBURN Houston, TX: NESC HOUSTON Boca Raton, FL: NESC BOCA RATON Garland, TX: NESC GARLAND Walnut Creek, CA: NESC WALNUT CREEK Scottsdale, AZ: NESC SCOTTSDALE Plymouth Meeting, PA: NESC PLYMOUTH MEETING Hartford, CT: NESC HARTFORD

Then provide your Zip Code so the nurse can locate care in your area.

Worker’s Compensation Insurance Carrier

Old Republic Insurance Company 445 South Moorland Road, Suite 300

Brookfield, WI 53005 (262) 797-3400 • (800) 766-5673

It is our hope that you will never have an injury or health problem as a result of your work. However, if you do, we at NESC Staffing, Corp. will be ready to assist you. It is extremely important that you understand and comply with the procedures that follow should you ever require medical treatment for a work related injury:

EMERGENCY CARE In the event of an emergency, please seek immediate medical care by calling 9-1-1 or going to the nearest hospital or urgent care facility. As soon as you are able, notify your branch office to report the incident.

NON-EMERGENCY CARE1. Report injury to your immediate on-site supervisor 2. Call our Priority Care Hotline (PC365) to speak with a registered nurse. PC365 has nurses available

24/7/365 to help self-treat your injuries.

3. Call your Branch Representative and report your injuries ASAP. NESC Staffing, Corp. may provide temporary alternative/transitional work opportunities to employees temporarily disabled by a work-related injury or illness. This may mean a modification of the present assignment, reassignment to different duties, or require a different work schedule. We take our responsibility as an employer very seriously. We go to great lengths and great expense to provide a safe working environment and Worker’s Compensation insurance for our employees. We deal promptly with meritorious and legitimate injuries and claims. However, we have extensive experience investigating and controverting fraudulent or malingering claims and will fight these types of claims with all available resources. I have read the above and understand it. Employee

_________________________________________ (Signature)

Print Name: ______________________________ Date: _____________________________