Interviewer: Results: / / /

Employment Application
PLEASE DO NOT WRITE IN SHADED AREAS FOR OFFICE USE ONLY

RHII Line of Business: I9 Complete: Exp Date:

. .

First Name Street Address City Daytime Phone

M.I.

Last Name Apt. Number State Zip Personal E-Mail Address

Preferred Nickname Social Security Number Web Site Business E-Mail Address Emergency Contact Phone No. .

Night/Alternate Phone

Emergency Contact Name When are you available to start? If you do not have a specific start date, how much notice do you need to provide your current employer?

. What type of positions are you looking for? (Check all that apply) Temp Temp to Full-Time Full-Time Placement Contract Contract to Full-Time .

If you are not available after a specific date, please specify the date.

For Contract or Temp Positions:

Do you have a minimum duration of assignment? If yes, please specify: Do you have a maximum duration of assignment? If yes, please specify: No Yes . No Yes .

For Full-Time Opportunities:

Do you require relocation reimbursement? What hours do you prefer to work? In what geographical areas/locations do you prefer to work? Can you work at locations not accessible by public transportation? How much time are you willing to travel? (Select one) Up to 10% Up to 25% Yes Up to 50% No . Desired Annual Compensation: Minimum Acceptable Annual: . . . . . Over 50% Yes No Yes No . .

0% - Not willing to conduct overnight travel

Have you ever applied for a position at Robert Half International before? If yes, when: Desired Hourly Compensation: Minimum Acceptable Hourly: Desired Position(s): What other resources are you using for your job search? How did you hear about us? , and where:

Have you ever been convicted of a felony or misdemeanor? Yes No (Do not answer this question if you are applying for employment in Hawaii, Newark, NJ, Massachusetts or Philadelphia, PA) If yes, please explain (see notes below) : Are you legally authorized to work in the United States? Yes No .

Additional Information regarding Convictions and Work Experience: A conviction does not automatically bar you from employment. Applicants in CA, CO, CT, DE, HI, IL, MD, OH, OK, UT and VA do not need to disclose information pertaining to sealed or expunged conviction records. California applicants do not need to disclose information: (a) regarding marijuana-related misdemeanor convictions that occurred over two years ago; or (b) regarding any misdemeanor or conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed pursuant to Penal Code Section 1203.4. Hawaii applicants do not answer any question or provide any information regarding criminal history, including arrests, charges, or convictions until a conditional offer of employment has been made. Inquiry into and consideration of conviction records for prospective employees may take place only after the prospective employee has received a conditional offer of employment, which may be withdrawn if the prospective employee has a conviction record that bears a rational relationship to the duties and responsibilities of the position. This section applies only to convictions within the past 10 years (excluding periods of incarceration), and does not include final judgments required to be kept confidential by the courts. Massachusetts applicants, if this is your initial application, do not answer any question or provide any information regarding criminal history, including arrests, charges, or convictions. Applicants from Massachusetts may include volunteer positions in describing prior work experience. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Maryland applicants, please note that under Maryland law, an employer may not require or demand, as a condition of employment, prospective employment, or continued employment, that an individual submit to or take a lie detector or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100. 2012 Robert Half International Inc. All rights reserved. Equal Opportunity Employer Page 1 of 2

IN ADDITION TO ATTACHING YOUR RESUM, please list your work experience below. (Last job first.) COMPANY NAME AND LOCATION
1. WHAT DOES COMPANY DO? 2. # EMP 1) 2) 1) 2) 1) 2) 1) 2) 1) 2) REV IN MIL

POSITION OR DUTIES

1. SALARY 2. BONUS 1) $ 2) $ 1) $ 2) $ 1) $ 2) $ 1) $ 2) $ 1) $ 2) $

DATES
FROM TO FROM TO FROM TO FROM TO FROM TO

REASON FOR LEAVING

# EMP SOFTWARE/ SUPV. SYSTEMS USED

Education
Degree Pursued Percent Complete College/School & Location Major Field of Study GPA (4.0 Scale) Class Rank %

Professional Organizations, Affiliations, and/or Memberships

References (Please include at least two supervisors)

Persons Name Company Title Phone

Do you have any friends who might like to apply with us? If so, please provide names and phone numbers. . .

CERTIFICATE OF CANDIDATE
(To Be Completed By All Candidates)
General: I have submitted the attached form to one of the divisions of Robert Half International Inc. (RHI) for the purpose of obtaining assistance in securing full-time, temporary, or contract employment. I understand that I will never be charged a fee by RHI or any of its divisions. I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate RHI or any of its divisions to further process my application. I certify as to the accuracy of the matters set forth herein and in any resume and understand that any misstatement of fact may cause me to be refused employment or to lose my employment. References: I hereby authorize RHI and its divisions and agents to make such investigations and inquiries into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquiries connected with my application and I specifically authorize the release of information by any schools, businesses, individuals, services or other entities listed by me in this form. Furthermore, I authorize RHI and its divisions and agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications. Authorization & Release: As a registered candidate of RHI, I may elect to participate in certain programs, including, but not limited to, training, assessment, and certification programs and courses ("Programs"). As a condition of my participation in the Programs, I authorize RHI to release certain data, including, but not limited to, exam scores, testing data, and personal data related to my participation in the Programs ("Data"). I hereby release RHI, its divisions, and their employees, agents, and affiliates from any and all liability relating to my participation in the Programs and RHIs release of Data. Temporary/Contract Employment: If employed as a temporary or contract employee, I understand that I will be an employee of my RHI division and not of any client. If employed, I further understand that my employment is not guaranteed for any specific time and may be terminated at any time for any reason with our without cause or advance notice. I acknowledge that job assignments may be sporadic, intermittent, unpredictable, and irregular. As a result, significant gaps may occur between assignments. The mere end of one assignment will not, by itself, constitute or be considered a discharge, release, resignation, or termination of the employment relationship. While the employment relationship continues, I understand that I will remain eligible for consideration by my RHI division for future suitable assignments, even if I am currently between assignments. I understand that I may take advantage, on a purely voluntary basis, of training resources offered by my RHI division between assignments. I understand that I will not earn wages except when I perform actual work on assignments given by my RHI division or when otherwise required by law. During and after assignments, I will be paid in accordance with the regular payday rules. If I expressly notify my RHI division of my decision to quit, or if I am terminated, I understand that my final wages may be paid on an alternative schedule if the law requires. I further understand that a contract will exist between my RHI division and each client to whom I may be assigned which will require the client to pay a fee to the RHI division in the event I accept direct employment with the client. I agree to notify my RHI division supervisor immediately should I be offered direct employment by a client (or by a referral of the client to any subsidiary or affiliated company), either for a full-time, temporary (including assignments through another agency), or consulting positions during my assignment or after my assignment has ended. RHI or any of its divisions are not professional accounting firms. I will not render an opinion on behalf of RHI on financial information (i.e. financial statements, tax returns, etc.) I will not sign the name of RHI or any of its divisions on any document or my name to financial information or tax returns for any client. Under no circumstances will I sign, endorse, wire, transport, or otherwise convey cash, securities, checks, or any other negotiable instruments or valuables of any client without the prior written consent of my RHI division supervisor.

SIGNED: (candidate) 2012 Robert Half International Inc. All Rights Reserved. Equal Opportunity Employer.

DATE:

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