-None- Beth Dina Kiesha Meri Michelle Mike Will

-None- AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY

-None- Male Female Prefer not to answer

-None- Yes, I have a valid Drivers License No, I do not have a valid Drivers License

-None- Yes No

Where would you prefer to work?: *

-None- Car Truck Public Transportation

Transportation (more details):

-None- Yes No

-None- Yes No

-None- Yes No

-None- Yes No

-None- Yes No

-None- Office Maintenance

Roles that you have worked in the past: *

Software Experience:

-None- Yes No

-None- Yes No

-None- None Some High School GED High School Diploma Some College Associate's Degree Bachelor's Degree Advanced Degree

-None- Yes No

-None- Yes No

1. I consent to electronic communication with BeMore Staffing (BMS) which may include text, email, and calls to my cell phone.

2. BMS EEOC policy is that all employees are protected from discrimination under the laws we enforce. EEOC employees and applicants for employment are covered by federal laws and Presidential Executive Orders designed to safeguard federal employees and job applicants from discrimination on the basis of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit based factors.

3. I have reviewed the BMS Employee Handbook and I understand that BMS prohibits harassment or intimidation by a supervisor, fellow employee, client, vendor, or any other person in connection with my employment. In additional, I understand the compliant procedure under this policy.

4. A BMS representative has reviewed with me the Drug and Alcohol Policy. I understand that even though I may not be requested to submit to a drug test at the start of my employment with BMS, if I incur an on-the-job injury or am suspected of using drugs or alcohol, or customer of BMS requests that I be tested. I will submit to such a drug test. I also understand that some jobs may require a drug test and that assignment is pending a successful outcome.

5. A BMS representative has reviewed the Workers’ Compensation and I understand that if I am injured at work I must report the incident that day to both my immediate supervisor as well as BMS. I must contact Chesapeake Employer’s Workers Compensation to find a doctor in the network. If I chose to go to a doctor outside of the network, I may be liable for medical bills. If it is an emergency, I understand that I can go to the nearest medical facility. You may contact your claims adjuster or nurse case manager regarding treatment. I understand that a false claim can result in fines and/or imprisonment. You may call the Chesapeake Employers’ Contact Center at 1-800-264- 4943, Monday through Friday, from 8:00 a.m. - 5:00 p.m.

6. I understand that I am an at will employee of BMS and that only BMS or I can terminate my employment. When an assignment comes to an end I must email or text BMS for my next job assignment between 8:00 A.M. and 9:00 A.M. the next business day following the last day of the assignment. I understand that failure to call in or my refusal of my next assignment will be deemed to be a voluntary quit and may make me ineligible for unemployment compensation benefits. I understand that a no call/no show qualifies as quitting.

7. A BMS representative has reviewed with me the policies outlined in the BMS Policy and Procedures Manual. I understand that I am expected to comply with all policies and procedures.

8. I have reviewed with me the polices outlined in the BMS Guide to Safety and Workers’ Compensation Handbook. I understand that I am expected to comply with these policies and procedures and that if I fail to do so I may jeopardize any Workers’ Compensation Benefits that I might be eligible to receive. Injury Report

9. A BMS representative has reviewed with me the qualifications and physical requirements for the position in which I am applying. I meet the qualifications and physical requirements in order to perform the job.

10. I understand that I am responsible for clocking in or texting when I arrive on site, recording my time, having it signed weekly (daily if a short-term assignment) and sending it in no later than noon on Monday or my pay may be delayed or reduced to minimum wage.

11. I give BMS permission to use my image in promotional marketing that may include but not limited to LinkedIn, Facebook, Twitter, and SnapChat.

12. I understand that if I intentionally or unintentionally remove any property from the client, my pay may be withheld or garnished until they are returned.

13. I agree, if employed by you, that if my employment may be terminated by you at any time without liability to me except for wages as have been earned by me as of the date of such termination. I understand that if accepted for employment, I will be working for you on your payroll, at your clients' premises.

14. I also agree to call the BMS office between the hours of 8:00 a.m. and 9:00 a.m. the next regular work day following the completion of my assignment to make myself available for work. If I fail to do so, BMS may assume that I'm not available for work, that I voluntarily quit, and that unemployment benefits may be denied