1

Now that you have received a conditional offer of employment, please fill out the following new hire packet. In order for CoWorx to begin processing your payroll you will need to fill out this new hire packet in its entirety and return it to us via fax or mail. No paychecks can be processed until we receive your complete documents. Important: You must complete and submit all of the following documents in order for us to begin processing your payroll. If we receive your packet with any of the following required forms missing, we will need to wait until we receive the form(s) in question before processing your first paycheck. We thank you in advance for your cooperation: Required Documents:

Responsibility And Release Program Confidential Employee Application U.S. Department of Justice, Form I-9 The enclosed I-9 Form will be completed within three (3) business days of your first day of work and you must produce satisfactory documentation verifying your identification and

U.S. employment eligibility. This means you need to send a photocopy of the required identification with the complete form I-9.

Form W-4 Notice to Employees of Potential Denial or Worker’s Compensation Claims Drug and Alcohol Policy Statement Employee Acknowledgement of Auto Insurance CoWorx Staffing Overtime Policy Background request form Confidentiality and Client Work Product Agreement Optional Benefits Plan * Note: You have only 30 days from your date of hire to elect benefits. You must send this form to us whether or not you elect coverage.

Optional Documents: Direct Deposit Authorization (Strongly Recommended)

o Photocopy of voided check or deposit slip Paycard Authorization

Thank you for working for CoWorx. We appreciate your hard work!

CoWorx Staffing Services is an Equal Opportunity Employer. It does not discriminate against applicants or employees on the basis of race, religion, color, national origin, age, sex, sexual orientation, disability,

veteran status or any other basis protected by law.

WELCOME TO COWORX STAFFING SERVICES

Please submit your completed application via fax or mail to: FAX: 1-877-769-2775 CoWorx Staffing Services

Attention: Client Services PHONE: 908-757-7979 (ext. 6991) or PO Box 7130 800-754-7000 (ext. 6991) Watchung, NJ 07069-0798

2

COWORX STAFFING SERVICES FREQUENTLY ASKED QUESTIONS

Who do I work for? Even though you are doing work associated with a different company, you still are an employee of CoWorx Staffing Services – not the company who assigns you work.

What is a state W4 form? You only need to check the “State W4” box on the application if you’d

like to claim a different filing status or numbers of dependants for your state taxes than you are claiming for your federal taxes

Who fills out the “Company Information” section? Your Supervisor or Account Exec.

What parts of the W4 form do I need to fill out? It is important to make sure you check your filing

status on line 3 and fill in the number of exemptions you’d like to claim on line 5. In addition, please make certain you sign the form.

Do I really need to sign all of these forms? Yes. We apologize for the length of the application

packet, but all forms are required for us to begin processing your payroll.

How fast will my funds be available if I opt for direct deposit? Your funds will be available 2 banking days after your timesheet has been processed. In many cases, this is faster than your check can be delivered to you via the mail. This an optional service provided by us for you but we highly recommend you take advantage of it. See the Direct Deposit Authorization form for more details.

How can I insure speedy processing of my paycheck? Make sure they are filled out completely

and accurately. Timesheets submitted with wrong or missing information will cause delays. Timesheets that do not include a supervisor’s approval signature will not be processed. Timesheets submitted by 12:00 Noon Eastern Time will be processed and the corresponding check mailed the same day they are received. Timesheets submitted after this deadline will be processed and mailed the next business day.

How do I get reimbursed for expenses? If the company you are working at allows for expense

reimbursements, you must mail your original receipts to us accompanied by a signed reimbursement form. Ask your Supervisor or Account Exec for a copy of the form.

There is a lot of information in this packet. How can I remember it all? We suggest that you

make and keep a photocopy of your completed application prior to submitting it us so that you can reference it later should you need to.

Who will send me my W2 and when will I get it? Since you will be an employee of CoWorx (and

not the company you will be working at), you will receive your W2 from us. Your W2 will be mailed by January 31st of the year following a year you are employed by us. If you move, please inform us of your new address – even if you have completed your employment with us, so we may send your W2 to the correct location.

What if I have a question that wasn’t answered on this FAQ? WE’RE HERE TO HELP! Should

you have any questions now or during the course of your employment with us, please do not hesitate to contact our Client Services Department: 908-757-7979 (ext. 6991) or 800-754-7000 (ext. 6991)

CONFIDENTIAL NEW EMPLOYEE FORM COWORX STAFFING SERVICES PLEASE DO NOT ABBREVIATE Have you reached your 18th birthday?

Yes No

Mail or fax completed application to CoWorx

Today’s Date

/ /

CoWorx Staffing Services Attention: Client Services-RMX

PO Box 7130 Watchung, NJ 07069-0798 Fax: 908-756-2295

Or 800-864-3117 Social Security Number (SS#)

_

_

Social security numbers beginning with 000, 666, 729-749 or 764-999 are not

valid for work and will not be processed for payment.

Email Address Mr. Mrs. Ms.

First Name (as it appears on SS card)

M.I. Last Name (as it appears on Social Security card)

Daytime Phone Number Residence Address (where you live): # & Street

Apartment # _ _

Zip Code City

County (not country)

State _

Evening/Alternate Phone Number Mailing Address (if different from residence): # & Street

Apartment # _ _

Zip Code City

County (not country)

State _

Where do you want your W-2 to be mailed?

Residence Address Mailing Address

Check here if you’d like us to mail you a state W4 form.

For Residents of: Kentucky Ohio Pennsylvania Please indicate: School District Township

Supervisor/Account Exec Phone # Company You Will Be Working At

Supervisor/Account Exec Name

_ _

COMPANY INFORMATION (TO BE FILLED OUT BY CLIENT) Hourly Pay Daily Pay Weekly Pay

Pay Rate $

Start Date / /

Cost Center Department Purchase Order #

Work Location Address: # and Street

Suite/Building

Township

Zip Code City

County (not country)

State _

Supervisor Name (Please Print) Supervisor Title Supervisor Signature

Date

FOR COWORX INTERNAL USE

Company Number _

BR Other

PREVIOUS EMPLOYMENT (INCLUDING STAFFING SERVICE / TEMPORARY AGENCY) If you have been employed by any other staffing service (temporary agency) in the past 5 years,

please fill out that employment history in this section. For Massachusetts’s residents only: You may include any verified work performed on a voluntary basis.

ASSIGNMENT # 1 Agency (Staffing Service Name) Company Name (Where You Worked) Month

Year

From /

To /

Position Address of Company

Hourly Rate: $ Supervisor’s Phone Number Supervisor at Company Would you Return?

_ _ Yes No

ASSIGNMENT # 2 Agency (Staffing Service Name) Company Name (Where You Worked) Month

Year From

/ To

/ Position Address of Company

Hourly Rate: $ Supervisor’s Phone Number Supervisor at Company _ _

Would you Return?

Yes No _ _

Have you ever pled guilty or “no contest” to a crime or been convicted of a crime? Yes No If Yes, please give details: Please note: You should omit any information or answer “no record” with regard to any conviction which was expunged or pardoned or for which there is a sealed record on file with the court or for adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the Massachusetts superior court for criminal conviction. You should also omit first convictions for drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace and misdemeanor convictions older than two years for violation of the California Health and Safety Code as related to marijuana use or possession or marijuana drug paraphernalia possession or Massachusetts misdemeanor convictions older than five years.

Prior conviction of a crime is not an automatic bar to employment. 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.

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY Name Phone Number Alternate Phone Number _ _ _ _

I understand that nothing in this employment application, the company’s statements or personnel guidelines, or in my communications with any company official is intended to create an employment contract between the company and me. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the company unless it is made in writing and signed by the company President. I understand that if an employment relationship is established, I have a right to terminate my employment at any time. I also understand that the company retains the absolute right to terminate my employment at any time with or without cause and with or without prior notice. I also understand that the company has the right at any time, with or without notice, in an individual case or generally, to unilaterally change, modify, revoke, suspend or terminate its policies. Subject to applicable state law, CoWorx will deny worker’s compensation claims made by employees to the full extent permitted by law, where such injury, illness or death was the result of or caused by the employee’s own willful or intentional misconduct, including but not limited to injury, illness or death resulting from intoxication from the unlawful use of controlled substances. Accordingly, in the event of a work-related injury, CoWorx requires an employee to submit to a post-accident drug test in accordance with its established employment policies to the extent permitted by applicable law. I hereby certify that the statements made by me in this employment application are true and accurate, and I further understand that CoWorx has and will rely upon the statements made by me in this employment application in securing a temporary or permanent job position, as the case may be. In the event that CoWorx determines that I have made any false statements, misrepresentations or failed to disclose any information requested herein, CoWorx reserves the right in its sole and absolute discretion to decline further consideration of my job application, rescind any job offer, terminate my employment or deny a worker’s compensation claim, if appropriate. __________________________________________ _______/_______/_______ (PRINT NAME) (DATE) __________________________________________ (SIGNATURE)

OMB No. 1115-0136

U.S. Department of Justice Employment Eligibility Verification

Immigration and Naturalization Service

INSTRUCTIONS

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. Anti-Discrimination Notice. It is illegal to discriminate against any individual (other than an alien not authorized to work in the U.S.) in hiring, discharging, or recruiting or referring for a fee because of that individual’s national origin or citizenship status. It is illegal to discriminate against work eligible individuals. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because of a future expiration date may also constitute illegal discrimination. Section 1 – Employee. All employees, citizens and noncitizens, hired after November 6, 1986, must complete Section 1 of this form at the time of hire, which is the actual beginning of employment. The employer is responsible for ensuring that Section 1 is timely and properly completed.

If an employee is rehired within three (3) years of the date this form was originally completed and the employee’s work authorization has expired or if a current employee’s work authorization is about to expire (reverification), complete Block B and:

-

Preparer/Translator Certification. The Preparer/Translator Certification must be completed if Section 1 is prepared by a person other than the employee. A preparer/translator may be used only when the employee is unable to complete Section 1 on his/her own. However, the employee must still sign Section 1. Section 2 – Employer. For the purpose of completing this form, the term “employer” includes those recruiters and referrers for a few who are agricultural associations, agricultural employers or farm labor contractors. Employers must complete Section 2 by examining evidence of identity and employment eligibility within three (3) business days of the date employment begins. If employees are authorized to work, but are unable to present the required document(s) within three business days, they must present a receipt for the application of the document(s) within three business days and the actual document(s) within ninety (90) days. However, if employers hire individuals for a duration of less than three business days, Section 2 must be completed at the time employment begins. Employers must record: 1) document title; 2) issuing authority; 3) document number, 4) expiration date, if any; and 5) the date employment begins. Employers must sign and date the certification. Employees must present original documents. Employers may, but are not required to, photocopy the document(s) presented. These photocopies may only be used for the verification process and must be retained with the I-9. However, employers are still responsible for completing the I-9. Section 3 – Updating and Reverification. Employers must complete Section 3 when updating and/or reverifying the I-9. Employers must reverify employment eligibility of their employees on or before the expirations date recorded in Section 1. Employers CANNOT specify which document(s) they will accept from an employee.

If an employee’s name has changed at the time this form is being updated/ reverified, complete Block A.

If an employee is rehired within three (3) years of the date this

form was originally completed and the employee is still eligible to be employed on the same basis as previously indicated on the form (updating), complete Block B and the signature block.

- Photocopying and Retaining From I-9. A blank I-9 may be reproduced, provided both sides are copied. The Instructions must be available to all employees completing this form. Employers must retain completed I-9s for three (3) years after the date of hire or one (1) year after the date employment ends, whichever is later. For more detailed information, you may refer to the INS Handbook for Employers, (Form M-274). You may obtain the handbook at your local INS office. Privacy Act Notice. The authority for collecting this information is the Immigration Reform and Control Act of 1986, Pub. L. 99-603 (8 USC 1324a). This information is for employers to verify the eligibility of individuals for employment to preclude the unlawful hiring, or recruiting or referring for a fee, of aliens who are not authorized to work in the United States. This information will be used by employers as a record of their basis for determining eligibility of an employee to work in the United States. The form will be kept by the employer and made available for inspection by officials of the U.S. Immigration and Naturalization Service, the Department of Labor and the Office of Special Counsel for Immigration Related Unfair Employment Practices. Submission of the information required in this form is voluntary. However, an individual may not begin employment unless this form is completed, since employers are subject to civil or criminal penalties if they do not comply with the Immigration Reform and Control Act of 1986. Reporting Burden. We try to create forms and instructions that are accurate, can be easily understood and which impose the least possible burden on you to provide us with information. Often this is difficult because some immigration laws are very complex. Accordingly, the reporting burden for this collection of information is computed as follows: 1) learning about this form, 5 minutes; 2) completing the form, 5 minutes; and 3) assembling and filing (recordkeeping) the form, 5 minutes, for an average of 15 minutes per response. If you have comments regarding the accuracy of this burden estimate, or suggestions for making this form simpler, you can write to the Immigration and Naturalization Service, HQPDI, 425 I Street, N.W., Rook 4034, Washington, DC 20536.

examine any document that reflects that the employee is authorized to work in the U.S. (see List A or C), record the document title, document number and expiration date (if any) in Block C, and complete the signature block.

Form I-9 (Rev. 11-21-91) N

EMPLOYERS MUST RETAIN COMPLETED FORM I-9 PLEASE DO NOT MAIL COMPLETED FORM I-9 TO INS

OMB No. 1115-0136

U.S. Department of Justice

Employment Eligibility Verification Immigration and Naturalization Service

Please read instructions carefully before completing this form. The instructions must be available during completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work eligible individuals. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because of a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Verification. To be completed and signed by employee at the time employment begins.

Print Name: Last First Middle Initial Maiden Name

Address (Street Name and Number Apt. #) Date of Birth (month/day/year) City State Zip Code Social Security # I am aware that federal law provides for I attest, under penalty of perjury, that I am (check one of the following): imprisonment and/or fines for false statements or A citizen or national of the United States use of false documents in connection with the completion of this form. A Lawful Permanent Resident (Alien # A___________ An alien authorized to work until ____/____/____

(Alien # or Admission #) ____________________ Employee’s Signature Date (month/day/year)

Preparer and/or Translator Certification. (To be completed and signed if Section 1 is prepared by a person other than the employee.) I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.

Preparer’s/Translator’s Signature

Print Name

Address (Street Name and Number, City, State, Zip Code)

Date (month/day/year)

Section 2. Employer Review and Verification. To be completed and signed by employer. Examine one document from List A OR examine one document from List B and one from List C, as listed on reverse of this form, and record the title, number and expiration date, if any, of the document(s) List A OR List B AND List C Document title: ______________________ ____________________________ ______________________________ Issuing authority: ____________________ ____________________________ ______________________________ Document #: ______________________ ____________________________ ______________________________ Expiration Date (if any): ___/___/___ ___/___/___ ___/___/___ Document #: ______________________

Expiration Date (if any): ___/___/___ CERTIFICATION – I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, that the above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on (month/day/year) ___/___/___ and that to the best of my knowledge the employee is eligible to work in the United States. (State employment agencies may omit the date the employee began employment.) Signature of Employer or Authorized Representative Print Name Title Business or Organization Name Address (Street Name and Number, City, State, Zip Code) Date (month/day/year)

Section 3. Updating and Reverification. To be completed and signed by employer. A. New Name (if applicable) B. Date of rehire (month/day/year) (if applicable)

C. If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment eligibility. Document Title:______________ Document #: ____________ Expiration Date (if any): ___/___/___ I attest, under penalty of perjury, that to the best of my knowledge, this employee is eligible to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual Signature of Employer or Authorized Representative Date (month/day/year)

Form I-9 (Rev. 11-21-91)N Page 2

LISTS OF ACCEPTABLE DOCUMENTS

Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274)

LIST B LIST C LIST A

Documents that Establish Documents that Establish Documents that Establish Both Identity and Employment

Eligibility Identity

Employment Eligibility

1. U.S. Passport (unexpired or expired)

2. Unexpired foreign passport,

with I-551 stamp or attached INS Form I-94 indicating unexpired employment authorization

3. Alien Registration Receipt

Card with photograph (INS Form I-551)

4. Unexpired Temporary Card

(INS Form I-688) 5. Unexpired Employment

Authorization Card (INS Form I-688A)

6. Unexpired Employment

Authorization Document issued by the INS which contains a photograph (INS Form I-688B)

7. Employment Authorization

Document (INS Form I-766)

OR

AND 1. Driver’s license or ID card 1. U.S. social security card

issued by the Social Security Administration (other than a card stating it is not valid for employment)

issued by a state or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, sex, height, eye color and address

2. Certification of Birth Abroad issued by the Department of State (Form FS-545 or Form DS-1350)

2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, sex, height, eye color and address

3. Original or certified copy of a

birth certificate issued by a state, county, municipal authority or outlying possession of the United States bearing an official seal

3. School ID card with a

photograph 4. Voter’s registration card 5. U.S. Military card or draft record 4. Native American tribal

document 6. Military dependant’s ID card 7. U.S. Coast Guard Merchant

Mariner Card 5. U.S. Citizen ID Card (INS

Form I-197) 8. Native Tribal document 9. Driver’s license issued by a

Canadian government authority 6. ID Card for use of Resident

Citizen in the United States (INS Form I-179)

For persons under age 18 who are unable to present a 7. Unexpired employment

authorization document issuedby the INS (other than those listed under List A)

document listed above:

10. School record or report card 11. Clinic, doctor or hospital record 12. Day-care or nursery school

record

COWORX STAFFING SERVICES (“COWORX”) RESPONSIBILITY AND RELEASE PROGRAM

CoWorx Staffing Services (“CoWorx”) has been contracted by our client to provide you with a job and our payroll service. As your employer, CoWorx will be responsible for all your deductions and tax reporting. This application is designed to acquaint you with CoWorx and provide you with information about employee benefits and some of the policies affecting the terms and conditions of your employment. You should read and understand the provisions of this application. You may direct any questions regarding this application to the Director of Human Resources at CoWorx (800-754-7000). It describes many of your responsibilities as an employee and outlines the programs developed by CoWorx to benefit employees. No employee application can anticipate every circumstance or question about policy. As CoWorx continues to grow, the need may arise, and CoWorx expressly reserves the right to revise, supplement, modify or rescind any policies or portions of this application without prior notice as it deems appropriate in its sole and absolute discretion. The policies and procedures described in this application should not be interpreted as creating any promise of any kind by CoWorx. All CoWorx employees are employed at-will and, therefore, either you or CoWorx may terminate the employment relationship at any time with or without cause and with or without advance notice. This application is not a contract of employment. No one other than the President of CoWorx may alter or modify any of the policies in this application and only written agreements signed by the President with respect to the terms and conditions of employment will be acknowledged by CoWorx. No statement or promise by a supervisor, manager or department head may be interpreted as a change in policy nor will it constitute an agreement with an employee. I, the undersigned, an employee of CoWorx Staffing Services or any subsidiary, affiliate or related company (hereinafter “the Agency”), agree to accept a temporary assignment to _________________________ or any subsidiary or affiliate (hereinafter “the Client”). As a precondition to receiving such an assignment, I acknowledge the following:

1. I understand that I am an employee of the Agency and not of the Client and that I will not participate in the Client’s pension plan or any other employee benefit plans established by the Client for its employees. I will be paid directly by the Agency.

2. I understand that the assignment is a temporary one, the length of which may be increased or decreased or

terminated at any time for any reason with or without advance notice to me.

3. I acknowledge that I have not been guaranteed any specific length of assignment by the Agency.

4. I understand that I am an at-will employee. Either the Agency or I can terminate my employment at any time, for any reason, with or without advance notice.

5. I understand that any problems or complaints I may have regarding the assignment must be directed to my

supervisor and CoWorx’s Director of Human Resources at 800-754-7000 extension 3039.

6. I understand that my rate of pay from the Agency may be greater or lesser than that received by other individuals who are performing similar services for the Client, regardless of whether they are employees of the Client.

7. I understand that no promotions or other forms of advancement or transfer by the Client may be available now or

in the future.

8. All work hours outside of my normal work assignment, whether overtime or not, must be pre-approved by my supervisor before being worked. While the company does and will comply with all applicable state and federal laws concerning the payment of overtime, violation of this policy will subject me to discipline up to and including discharge.

9. When my assignment ends I am required to notify CoWorx within 24 hours of my assignment’s completion and

availability for work prior to collecting Unemployment Insurance Benefits. Upon learning of my separation from the Client for any reason, I must contact CoWorx. Reasons for separation include but are not limited to a satisfactorily completed assignment, termination, lay off, separation due to lack of work, etc. I am required to contact CoWorx a minimum of once a week thereafter to inform CoWorx of my availability for employment. If I do not notify CoWorx that my assignment has been completed, it will be considered that I have "voluntarily quit" working for CoWorx and my eligibility to collect Unemployment Insurance Benefits may be affected as determined by applicable state law.

California residents must notify us under California Unemployment Law.

10. Should I have a work related injury while employed by CoWorx, it is my responsibility to immediately notify my

supervisor and CoWorx’s Workers Compensation Department at 1-800-754-7000 extension 3038. If I am unable to notify CoWorx, my supervisor can do so for me. Failure to do this immediately or as soon as practical after sustaining an injury could jeopardize my claim to any benefits. When I notify CoWorx, I will be directed to one of their medical care providers (this applies only in states that allows CoWorx to direct medical care). If I choose not to use the medical care providers chosen by CoWorx, it could jeopardize my right to any benefits for medical treatment.

I hereby authorize and agree to submit to a drug and alcohol test to be administered at the time of treatment for a work-related injury in the states that permit CoWorx to require such testing. I understand that positive test results could negatively effect my eligibility for workers’ compensation benefit subject to applicable state law and pursuant to CoWorx’ Drug and Alcohol Policy, which is included in the Employment Package.

PLEASE ANSWER THE FOLLOWING QUESTION (S):

Have you, the undersigned, worked as an employee of the Client and/or any of the Client’s subsidiaries or affiliates (please check one)? Yes No

If “Yes,” please state the date your employment ended: _______/_______/_______ If you answered “Yes” to the question above, please state in the space provided the reason why your employment ended. _____________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ I have read and received a copy of the CoWorx Responsibility and Release Program outlining certain policies and procedures of CoWorx. I hereby certify that the statements made by me in this employment application are true and accurate, and I further understand that CoWorx has and will rely upon the statements made by me in this employment application in securing a temporary or permanent job position, as the case may be. In the event that CoWorx determines that I have made any false statements, misrepresentations or failed to disclose any information requested herein, CoWorx reserves the right in its sole and absolute discretion to decline further consideration of my job application, rescind any job offer, terminate my employment and to the extent permitted by law, a workers’ compensation claim will be denied, if appropriate. __________________________________________ _______/_______/_______ (PRINT NAME) (DATE) __________________________________________ (SIGNATURE)

MCT/.0

1

CONFIDENTIALITY AND CLIENT WORK PRODUCT AGREEMENT

this

lients are in part

duced by and in consideration of my agreement to the following:

. Confidentiality.

ited to

, usiness plans and proprietary business information (AConfidential Information@).

re of arm, be prejudicial to and have an adverse effect on

oWorx and/or its Clients.

x’s

. es the

-Workers or to Client employees without authorization and/or a need to know.

and agree to comply with all policies and procedures issued by CoWorx or Clients.

. Ownership, Client Work Product, Works Made for Hire.

s

ing

I, ______________________, understand and agree that the provisions of Confidentiality and Client Work Product Agreement (“Agreement”) are part of my employment with COWORX STAFFING SERVICES LLC (ACoWorx@) and that my employment with CoWorx and all benefits and compensation received from CoWorxarising out of my employment with CoWorx and assignment to its cin 1

(a) I understand that during my employment with CoWorx, I will have access to confidential information concerning CoWorx and its clients, including but not limRetail Merchandising Xpress (“RMX”) and its clients and customers (collectively “Clients”), which are not generally known or made available to the general public and that such confidential information is the property of CoWorx and/or the Clients. This confidential information shall include but is not limited to knowledge regarding trade secrets, processes, methods, techniques, products, research, computer programs, financial data, client information and lists, client employee and business informationb

(b) I understand that as an employee of CoWorx, I am under a continuing obligation to protect and not disclose, in any unauthorized manner, such Confidential Information regarding CoWorx and/or its Clients and that the unauthorized disclosuConfidential Information will hC

(c) I will not, during my employment by CoWorx or afterwards, directly or indirectly, use or disclose for my own benefit or the benefit of another any of CoWoror the Clients’ Confidential Information. I will use my best efforts and exercise due diligence to protect, not to disclose and keep as confidential all Confidential InformationMy obligation not to disclose Confidential Information belonging to Clients includobligation not to disclose it to other Co

2. Policies and Procedures. I understand

3

(a) I shall disclose promptly to CoWorx and the Client any and all inventions, discoveries, improvements, copyrights, programs, trademarks, processes, and systemrelating to the work or the business of the Clients and any applications thereof, that I may conceive, discover or make sole or jointly during the term of this Agreement, dur

or after business hours, whether or not patentable or eligible to be copyrighted, and whether or not it involved the use of the time, facilities, equipment or personnel of thClients (AWork Product@). The provisions of this section do

MCT/.0

2

e not apply to inventions or

iscoveries which were developed entirely on my own time and do not relate to the business of th

d

ll of its right, title and interest and to them and the Client shall be entitled to obtain and hold same in its own name

on all a ca

sively to the Client all of its right, title and terest under patent, copyright, trade secret, and trademark law, in perpetuity or for the

longest period

nd

ement nd for two years following its termination. The Client shall bear all costs associated

with th se

e

m, distribute copies of and prepare derivative

orks based upon such preexisting rights; and (ii) authorize others on the Client=s behalf o a

nd

title or interest to any technology, process, material or intellectual property right that would be in conflict with the terms of this Agreement, and shall not do so in the future.

de Client or the work being performed by me.

(b) Any and all work, Work Product and resulting product related to my

assignment shall be considered works made for hire and shall, upon creation, be owneexclusively by the Client. To the extent that the work, Work Product and any resulting product of my assignment may not be considered works made for hire, I assign to the Client, without the necessity of any further consideration, ain

ppli ble patents, registrations, and/or copyrights.

(c) If and to the extent that I may, under applicable law, be entitled to claim any ownership interest in the work, Work Product or work related to the Work Product, I transfer, grant, convey, and relinquish excluin

otherwise permitted by law.

(d) I shall sign upon request, all documents necessary to vest title in theClient to any specific patent, trademark and/or copyright application prepared by theClient and covering the work, Work Product or efforts related to the work or Work Product. I shall also sign upon request, any document necessary for the filing and prosecution of patent, trademark and/or copyright applications in the United States aelsewhere, including divisional, continuation, revival, renewal or reissue application. Ishall cooperate and assist the Client in preparing, filing and prosecuting any and all such patent, trademark and copyright applications during the term of this Agrea

e pro cution of such patent, trademark and/or copyright applications.

(e) To the extent that any preexisting rights are embodied or reflected in thwork, Work Product or efforts related to the Work Product, I grant to the Client an irrevocable, perpetual, non-exclusive, world-wide, royalty-fee right and license to: (i)use, execute, reproduce, display, perforw

to d ny or all of the foregoing.

(f) I warrant that I have full right and authority to perform my obligations ato grant the rights and licenses contained in this Agreement. I further warrant that I have neither assigned nor entered into any other relationship by which I purport to transfer any right,

MCT/.0

3

. Return of Property.

e,

gible work product nor keep or take any property of ny kind belonging to the Clients.

. Remedies for Breach of this Agreement.

table relief to restrain or njoin any actual or threatened breach of this Agreement.

y

oWorx is terminated voluntarily or involuntarily, or with or without cause or notice.

Agreed to and accepted this _____ day of ____________ 200__.

____________________________

Signature

___________________________ Print name

Witness: ______________________________

4 At the conclusion of each assignment with Clients, I shall return all Clients property to the designated representative of the Client prior to my completing my assignment. I will not make or keep any copies or reproductions of correspondencmemoranda, reports, notebooks, drawings, data photographs or other documents relating to any invention and/or tana 5 I further understand that CoWorx and/or Clients may seek and obtain in addition to all other remedies available at law, any appropriate equie

I understand that I may be asked to sign a separate agreement regarding my placement with and work for Clients and that my refusal to sign such an agreement willresult in my inability to be placed at such Client location. I further understand that mobligations under this Agreement will continue whether or not my employment with C

By:_________ __________

COWORX STAFFING SERVICES

NOTICE OF POTENTIAL DENIAL

OF WORKER’S COMPENSATION CLAIMS

To the extent permitted by applicable law, worker’s compensation claims will be denied where an employee has willfully provided false information or intentionally failed to disclose information relating to the employee’s prior injury that has become aggravated or the subject of a subsequent injury. Accordingly, in accordance with the Americans With Disabilities Act, following an offer of employment, CoWorx may request that employees identify whether they are able to perform the essential functions of the job to which they are assigned, with or without a reasonable accommodation. Rhode Island Residents Only: Under Rhode Island state law, CoWorx is permitted to deny worker’s compensation claims within the first two years of your employment, should you provide false information or intentionally fail to disclose your prior worker’s compensation history, if the false or omitted information is directly related to the injury which is the basis of your new worker’s compensation claim. NOTICE OF RHODE ISLAND LAW Pursuant to Rhode Island General Statutes, 28-35-57.1 Bar of Claims, an employee’s claim for compensation from any employer under Chapter 29 to 38, inclusive of this title, shall be barred from the date the employee commences employment for a period of two (2) years in the event that said employee has willfully provided false information as to his or her ability to perform the essential functions of the job, with or without reasonable accommodation, on an employment application requesting that information, if the information is directly related to the personal injury which is the basis of the new claim for compensation. This section shall not apply unless the employment application advises the employee of the substance of this section. Nothing herein shall exempt any employer from or excuse full compliance with any applicable provisions of the Americans with Disabilities Act and Chapter 42-87 (Discrimination Against the Handicapped) of the General Laws. 1. Have you ever received workers compensation payments (please check one)? □ Yes □ No 2. If so, list the date, precise nature of the injury and employer for whom you worked for each such injury or occurrence

Date of Injury Nature of Injury Employer

____________ _____________________________________ ________________________ ____________ _____________________________________ ________________________ ____________ _____________________________________ ________________________

I acknowledge that I have received a conditional offer of employment and that I have read the above stated section regarding the potential denial of worker’s compensation claims for providing intentionally false information relating to a claim, (including the notice of Rhode Island law for Rhode Island residents). I further understand that should an investigation reveal any falsification, misrepresentations or intentional omissions, my conditional offer of employment may be rescinded, my employment terminated or my worker’s compensation claim may be denied.

__________________________________________ _______/_______/_______ (PRINT NAME) (DATE)

__________________________________________ ___________________________ (SIGNATURE) (SOCIAL SECURITY NUMBER) _______________________________________________ (SIGNATURE OF COMPANY REPRESENTATIVE)

DRUG AND ALCOHOL POLICY STATEMENT

DRUG AND ALCOHOL POLICY POLICY STATEMENT CoWorx is committed to providing a workplace free of alcohol misuse and illegal drug use. Our commitment to a safe workplace is jeopardized when any CoWorx employee abuses drugs or alcohol on the job, comes to work under the influence of such substances, or possesses, distributes or sells illegal substances in the workplace. Therefore, CoWorx has established the following policy: It is a violation of company policy for any employee to possess, sell, trade or offer for sale any narcotics, drugs, alcohol or other controlled substances on the job, on the premises of CoWorx or any of its clients. Any illegal substances that are discovered in the possession of employees immediately will be turned over to the appropriate law enforcement agencies and may result in criminal prosecution as well as disciplinary action, including but not limited to termination of employment. Employees who are under the influence of illegal drugs or alcohol, or who possess or consume alcohol on the job, have the potential for interfering with their own as well as their co-workers’ safe and efficient job performance. Accordingly, any employee who reports to work under the influence of drugs and/or alcohol will be subject to disciplinary action, including but not limited to termination of employment. If an employee appears to be under the influence of drugs or alcohol, either CoWorx or its client may, as state law permits, require that an employee submit to a drug and/or alcohol test, at CoWorx’ expense, to determine the presence of alcohol and/or illegal drugs in the employee’s system. If the employee tests positive for alcohol or drugs, or if the employee refuses to take the test, CoWorx may impose disciplinary action up to and including termination of employment. This policy applies to the abuse by any employee of legally prescribed drugs as well as drugs without a prescription. If an employee is prescribed a drug for medical reasons, he or she will be required to document that fact with the Medical Review Officer by supplying an appropriate doctor’s note, at the time, if any, when a drug and alcohol test is required. The Medical Review Officer will maintain such records as confidential, notifying CoWorx only on a need-to-know basis, e.g. to provide a reasonable accommodation for a disability. To the extent permitted by law, employees convicted of sale or possession of illegal substances may be terminated regardless of whether or not their misconduct occurs on or off the premises of CoWorx or its client. CoWorx further reserves the right to decline payment of workers’ compensation benefits to any employee who tests positive for drugs or alcohol in connection with any work-related injury. DRUG AND ALCOHOL TESTING Pre-Employment Drug Testing: After a conditional offer of employment is made, CoWorx may require a candidate for employment to submit to a drug and alcohol screen. Any conditional offer of employment made by CoWorx shall be subject to and contingent upon the successful completion of a drug and alcohol screen, where applicable. Post-Accident Drug Testing: Subject to applicable State and Federal law, CoWorx will require employees injured on the job to submit to a drug and alcohol test to confirm that the accident or injury

was not caused by the use of alcohol or controlled substances. In the event that the drug and/or alcohol test is positive, CoWorx will deny any worker’s compensation claim filed by the injured employee to the extent permitted by state law and also may impose other disciplinary action up to and including termination. Reasonable Suspicion Drug Testing: As permitted CoWorx will require employees to submit to a drug and/or alcohol test when the company has received information or observed behavior that would cause a reasonable person to believe that the employee is demonstrating signs of impairment due to the use of alcohol or illegal drugs Follow-Up Testing: If and when an employee shall be referred to an employee assistance program or to rehabilitation as a result of a violation of this policy, CoWorx shall conduct follow-up testing (as permitted) once per year for a two-year period following the completion of the program. CONFIDENTIALITY

CoWorx will endeavor to protect each employee’s privacy by maintaining confidentiality with respect to actions taken pursuant to this policy. Information relating to investigations, possible employee violations, and medical tests will be communicated only to those persons with a need to know. To the extent that CoWorx must discuss any issue under this policy with employees, those employees shall be instructed to keep confidential any information so discussed. Any notes, reports or other records generated and all information gathered under this policy will be treated as confidential with disclosure limited to those with a need to know.

REFUSAL TO SUBMIT TO A DRUG/ALCOHOL TEST

Any employee who refuses to submit to a drug and/or alcohol test under this policy may be subject to disciplinary action up to and including termination of employment. In the event that an employee refuses to submit to post-accident drug and/or alcohol testing, CoWorx will, to the extent permissible under state law, deny that employee’s claim for worker’s compensation benefits or other medical benefits. MEDICAL REVIEW OFFICER CoWorx has contracted with a Medical Review Officer who has been designated by CoWorx to advise employees and job applicants relative to substance abuse testing and possible safety impairment from the use of legally prescribed medications. The Medical Review Officer shall be available to receive confidential reports from employees and applicants of prescription and non-prescription medications both before and after a drug/alcohol test. Employees and applicants have the right to consult with the Medical Review Officer for technical information regarding prescription and non-prescription medications. The Medical Review Officer shall be available to assist CoWorx and the employee or applicant in interpreting the results of any drug and/or alcohol screen and/or advise CoWorx relative to reasonable accommodations for disabilities. Employees with technical questions regarding prescription and non-prescription drugs may contact, anonymously, CoWorx’ Director of Human Resources at 800 754 7000 extension 2103 for phone number of our Medical Review Officer.

SUBSTANCES In its drug and alcohol screen, CoWorx will test for the presence of the following substances: Cannabinoids, Cocaine, Opiates, Benzodiazepines, Amphetamines, Barbiturates, Phencyclidine, Methaqualone and Propoxyphene. Other drugs and/or substances may affect the outcome of a drug test conducted in accordance with this policy. Prescribed medication could affect the results of the drug test.

Please contact our Medical Review Officer to determine what affect, if any, your prescribed medication may have on the drug test. Presently over the counter medication will not have any affect on the drug test. POSITIVE RESULTS AND CONFIRMATORY TESTING In the event that an employee’s drug test produces a positive result, CoWorx will arrange for the specimen previously provided by the employee to be re-tested. The results of the initial and confirmed test shall be submitted to the Medical Review Officer, who shall within 5 working days of the confirmed result, notify the employee or applicant of the result, the consequences and the options available to such person. Within 5 working days of notice of a confirmed positive result, the employee may submit information to the Medical Review Officer explaining or contesting the result and the reasons why such result is not a violation of CoWorx’ policy. In the event that the Medical Review Officer shall determine that the employee’s explanation is unsatisfactory, he/she shall notify CoWorx of a positive confirmed test result. EMPLOYEE ASSISTANCE PROGRAMS AND LOCAL REHABILITATION PROGRAMS In an effort to provide employees with resources available to assist with rehabilitation, please contact CoWorx’ Human Resources at 800-754-7000 extension 2103 to determine if a local employee assistance and drug rehabilitation program(s) is available, to provide employees guidance. FOR FLORIDA RESIDENTS ONLY This policy has been promulgated in accordance with Florida Statutes, F.S.A. §440.102, which sets forth the requirements of a drug-free workplace. In the event any employee or job applicant institutes a civil or administrative proceeding pursuant to this section, the employee or job applicant, as the case may be, must notify the laboratory of any such action or proceeding.

I have received, read and fully understand the CoWorx Drug & Alcohol Policy and Procedures. I understand that I may be required to submit to a drug and alcohol test in accordance with CoWorx Policy. I also understand that some of CoWorx’ clients to which I might be assigned require drug testing as a precondition to working at that client’s facility. I hereby consent to permit the collection of blood, urine or other samples from me by a laboratory selected by CoWorx in order to conduct the necessary tests to determine the presence or use of alcohol, drugs or controlled substances. Further, I give my consent for the results and other medical information to be released to an authorized representative of CoWorx and/or CoWorx’ client. I understand that if I refuse to submit to a drug and/or alcohol test, that I may be subject to disciplinary action, including but not limited to termination of employment or may be ineligible to assignment at a specific Client. (CURRENT NAME) (PREVIOUS NAME) (APPLICANT’S SIGNATURE) (DATE)

SEXUAL HARASSMENT AND ANTI-DISCRIMINATION POLICY

CoWorx Staffing Services (“CoWorx”) confirms its commitment to equal employment opportunities and a workplace that is free from unlawful bias and/or discrimination. It is the policy of CoWorx to maintain a work environment free of discrimination by supervisors, co-workers or others on the basis of race, color, national origin, age, sex, sexual orientation, disability, veteran’s status, or any other basis protected by law (“Protected Categories”). Thus, all employees are expected to conduct themselves so as to maintain a work environment free of discrimination. Discrimination by an employee constitutes misconduct for which an employee may be subject to discipline up to and including termination of employment. Discrimination as used in this policy means differential treatment or harassment of an individual on the basis of such a person’s membership in a Protected Category. Harassment may take the form of verbal or physical conduct, including statements of written or displayed materials, on the basis of the Protected Categories. Sexual harassment consists of unwelcome sexual advances, request for sexual favors, or other verbal or physical conduct of a sexual nature when:

Submission to such conduct is made either an explicit or implicit term or condition of employment; Submission to or rejection of such conduct is used as a basis for an employment decision affecting an

employee; or Such conduct has the purpose or effect of interfering with an employee’s work performance or creating an

intimidating, hostile or offensive work environment. All allegations of unlawful treatment will be promptly investigated and appropriate action will be taken. Since our field offices are placed at various locations, it is vitally important for you to communicate with us when you believe you are experiencing conduct that is in violation of this policy. An employee who believes that he/she has been subject to discrimination, including sexual harassment, covered under this policy should report the incidents(s) immediately to their immediate supervisor and/or to Human Resources at our Watchung office: (908) 757-7979 or (800) 754-7000 Ext. 3039. If we do not hear from you, we will be unaware of the problem. When we learn of an allegation of unlawful treatment we will conduct a prompt and confidential investigation of the alleged incident(s) and take necessary action. The investigation will likely include interviews of the complainant, the alleged harasser and potential witness(es). All information shall be kept confidential to the extent possible. Each person with whom said allegations are discussed or each person interviewed in connection with said investigation shall be instructed to keep confidential any information discussed. All CoWorx supervisory employees must ensure that our work environment is free from conduct that constitutes harassment. Any individual found to have engaged in harassment or discrimination will be subject to discipline up to and including discharge. Further, no retaliation will be tolerated by CoWorx by either the individual(s) accused or any other employee for complaining, reporting or participating in the investigation of any incident of alleged harassment or discrimination. Massachusetts Residents Only – Massachusetts Commission Against Discrimination (MCAD) and Equal Employment Opportunity Commission are the agencies with the responsibility for enforcing employment discrimination laws (addresses follow).

US Equal Employment Opportunity Commission Massachusetts Commission Against Discrimination 10 Congress Street One Ashburton Place, Room 601

Boston, MA Boston, MA 02180 617-565-3200 617-994-6000

EMPLOYEE GUIDE TO A SAFER WORK ENVIRONMENT

3. Lock-in materials. Crosstie or use dunnage between layers so there are no unsteady stacks within the pile.

SECTION I - GENERAL RULES 1. Report every injury to your supervisor immediately regardless of its nature or

extent. 4. Maintain aisle space. Leave enough space so power trucks, fire equipment, and workers can get to the pile. Ends of material, especially bar stock and sharp objects should not protrude beyond the face of the pile.

2. Report all accidents to your supervisor immediately, whether anyone is injured or not.

3. Report unsafe conditions to your supervisor. 4. If there is any doubt as to the safe way to do a job, get additional instruction

from your supervisor before proceeding. SECTION IV: PEDESTRIANS 1. Heed warning horns of approaching vehicles & move to the side of the aisle

or street. 5. Only qualified, authorized personnel are permitted to repair machinery & equipment. 2. Stay out of areas which are restricted or barricaded.

6. Do not use unsafe tools and equipment. 3. Do not run in the plant. 4. Do not take short cuts. Stay on walks and roadways. 7. Smoking is not permitted in posted “No Smoking” areas, or in any other area

where flammables or explosives are being used, stored, or handled. 5. Walk up and down stairs one step at a time and use the handrail. 8. Never engage in any form of horseplay, such as teasing or distracting fellow

workers. SECTION V: LADDERS 1. Use a ladder when appropriate; do not improvise. 9. Wear clothing & footwear at work which is appropriate for the job you perform. 2. Don’t use metal ladders when working on or near electrical circuits. 10. No person shall report for duty or perform duties while under the influence of

intoxicants or narcotics. The possession or use of alcoholic beverages or narcotics on company property is prohibited.

3. Inspect ladders for defects before using. If the ladder is found to be defective, report it to the proper authority.

11. Use all mechanical and personal safeguards provided. 4. Place straight ladders so that the distance from the base to the wall is 1/4 the length of the ladder. 12. When transferring any material from one container to another be certain a

label or marking identifies the contents of both containers. 5. Don’t use straight ladders unless they have grippers or cleats. Lash the ladder at the top and bottom if possible.

6. Don’t use a stepladder more than 10 ft. high unless another employee holds it. Don’t climb on the two highest steps.

SECTION II: LIFTING AND CARRYING 1. If your assignment requires frequent or heavy lifting, please call the

Worker’s Compensation Department at 800-754-7000 X3038 to determine if there are any further precautionary safety measures available.

7. Do not splice short ladders together to make a longer ladder. 8. Be certain your hands and shoes are dry and free of grease before climbing a

ladder. 2. Do not lift bulky or heavy materials by yourself. Get someone to help. 3. Employees should not attempt excessively heavy lifts unassisted. 4. Inspect the object you intend to lift for sharp corners, nails, and other things

that might cause injury. SECTION VI: HOUSEKEEPING 1. Keep materials out of the aisles. 2. Return tools and other equipment to the proper storage place after use. 5. When lifting, set your feet solidly, somewhat apart. Sometimes it is best to

get down on one knee. Keep your back straight, lift and lower with your legs. 3. Oily rags, old paint cans, and other containers that have held flammable liquids are a hazard. Dispose of them as soon as you can in designated containers.

6. Use only the hoisting equipment you are authorized to use. Be certain the hoist and the beam are rated for not less than the amount of weight you are attempting to lift. 4. Remove or bend down nails in lumber or containers that others may have to

handle. 7. Be alert to any overhead crane movement. 5. Keep floors dry; avoid spilling liquids, wipe up all spills. 6. Dispose of trash and scrap in proper waste containers. SECTION III: PILING AND STACKING MATERIALS

1. Pile to a safe height, not so high that the pile will be unsteady. 2. Keep at least 18 in. vertical distance between the top of the pile and the

overhead sprinkler heads. SECTION VII: OFF-THE-JOB SAFETY Accidents off the job hurt, too. Practice safety on a 24-hour basis. At home, on streets, on highways and freeways, at play, safety pays for you and your family.

Employee Acknowledgement of Automobile Insurance

For your protection, all CoWorx Staffing Services, LLC (“CoWorx”) employees are covered under CoWorx’ Workers’ Compensation Coverage. However, CoWorx’ Workers’ Compensation Policy does not include, nor can we accept responsibility for, obtaining primary vehicular liability insurance protecting you against accidents which may occur as a result of your driving a motor vehicle (owned or unowned) (the “Vehicle”) while on assignment. If you agree to drive a Vehicle, it is on the condition that you accept full responsibility and liability for the Vehicle and its cargo as well as for any claims, other than direct claims for Workers’ Compensation, which might arise as a result of any accident occurring while you are on assignment. You acknowledge and agree with the understanding that your automobile insurance coverage will be the primary insurance covering any claim arising as stated above. By signing this acknowledgment you further confirm that you have in place, and will maintain so long as you are driving a Vehicle while employed by CoWorx and on an assignment, automobile coverage with policy limits and coverage meeting the minimum requirements of applicable state law and that you maintain a valid driver’s license issued by the state in which you reside. / / (Signature) (Date) - -________ (Printed name) (Social Security #)

Insurance Information:

Insurance Company: ___________________________________

Policy #: ___________________________________

Coverage Period: ___________________________________

CoWorx Staffing Services LLC CoWorx Staffing Services LLC P.O. Box 7130 P.O. Box 7130 1375 Plainfield Avenue 1375 Plainfield Avenue Watchung, NJ 07069 Watchung, NJ 07069 Together we’re better Together we’re better (908) 757-5300 (908) 757-5300 (800) 754-7000 (800) 754-7000 www.coworxstaffing.com www.coworxstaffing.com

CoWorx Staffing Overtime PolicyCoWorx Staffing Overtime Policy

All hours worked outside of your normal work schedule, whether overtime or regular time must be pre-approved by your immediate Client supervisor prior to being performed. While CoWorx is required to comply with all applicable state and federal laws concerning the payment of overtime, violation of this policy can result in disciplinary action, up to and including discharge from the work assignment as well as termination of your employment by CoWorx Staffing. I have read and agree to the above written policy. X________________________________________ (Employee Signature) Print Name: _______________________________ Date: ___________________________________

CoWorx Background Request Form

PERSONAL INFORMATION (PLEASE PRINT) ________________________________________________________________________________________________________

First Name, Middle Initial, Last Name ____________________________________________________________________________________________________________________ Street Address __________________________________________________________ __________________ _______________________ City State Zip Code ____________________________________________________ _________________________________________________ Social Security Number Date of Birth (month-day-year) ___________________________________________________ _________________ ________________________

Driver’s License Number State Expiration Date

PREVIOUS ADDRESSES (MOST RECENT FIRST) ____________________________________________________________________________________________________________________ Street Address __________________________________________________________ __________________ ___________________________ City State Zip Code

I have read, and understood and agree to the following: The background information that I supply in connection with my employment application will be verified by CoWorx Staffing Services, LLC. The information to be verified includes any and all information supplied on any application form or resume, and information provided in any conversation or interview with any employee of CoWorx Staffing Services, LLC. This may include discussions with references (personal or business) that I provide. I authorize CoWorx Staffing Services, LLC and its agents to conduct a thorough inquiry into all areas deemed necessary to arrive at a hiring decision: all employment, educational, driving, credit reports and criminal public record information relating to my application may be examined. I specifically release former employers, criminal information repositories and courts, schools, law enforcement agencies, local, personal and professional references and credit bureaus from any liability so that they may freely and completely respond to any inquiry relating to my application for employment with CoWorx Staffing Services, LLC. Signed: ____________________________________________________ Date: _________________________

DON’T MISS THE BOAT, TAKE ADVANTAGE OF OUR…

FAST� DIRECT DEPOSIT

2 banking days!With our Direct Deposit process, your funds will be available to you in just For

example, if your timesheet is processed by CoWorx on Monday, your funds will be deposited into your bank account on Wednesday morning!

ADVANTAGES OF DIRECT DEPOSIT It saves you time: No trips to cash your paycheck at the bank or check casher (and no check cashing fees). Never wait on line. Studies have shown that people spend as much as 24 hours each year

waiting in line to cash their paychecks. You don’t have to make special arrangements to pick up or cash your paycheck if you’re out sick,

on vacation or traveling. Your funds are available as cash: Direct Deposits can be withdrawn the same day they’re deposited into your account. You can start earning interest the day your money is deposited.

Direct Deposit is confidential and safe: We maintain the strictest confidentiality with your account. We will only access your account to

deposit money or to correct an erroneous deposit. You need not worry about lost, stolen or forged paychecks. You’re 20 times less likely to have a problem with a Direct Deposit than a traditional paper check.

It’s easy to get started and costs you nothing: All you need to do to activate your Direct Deposit is fill out and return (with a voided check) the

Direct Deposit Authorization form. We never charge you service fees for Direct Deposit. An Advice of Deposit will be distributed to you for your records.

With all of these advantages, why wait? Fill out and return your Direct Deposit Authorization

with your application!

Questions? Call our Client Services Department: 908-757-7979 or 800-754-7000 x6991

See the Direct Deposit Authorization form for important terms and conditions.

DIRECT DEPOSIT AUTHORIZATION

CoWorx Staffing Services (“CoWorx”) offers the convenience of direct deposit to its employees. This service will enable the funds from your paychecks to be deposited directly into your bank account. In order to be eligible for direct deposit you must meet the following requirements:

1. You must have a valid checking or savings account. 2. You must complete and submit to CoWorx the Authorization for Electronic Payment Service form (below).

Incorrect or incomplete information will delay implementation. 3. You must submit to CoWorx a copy of one of your original voided checks (for checking accounts) or preprinted

deposit slips (for savings accounts).

CoWorx will be able to pay you via direct deposit approximately 2 business days (weekends and holidays are not business days) after receiving your completed Authorization for Electronic Payment Service form and your voided check/deposit slip.

You will continue to receive normal paychecks should you submit a timesheet during this implementation period. Once implemented your funds should be available in your bank account 2 banking days (weekends and bank holidays are not banking days) after the day CoWorx processes your timesheet. You will receive an Advice of Deposit in the mail, which will provide you with the information normally found on your check stub. IMPORTANT: CoWorx can not guarantee that your funds will always be available 2 banking days after your timesheet is processed. In addition, in the unlikely event that your funds are not available in 2 banking days, CoWorx will not refund any fees incurred by you due to the drawing of checks prior to the funds needed to cover them becoming available. It is recommended that you confirm with your bank that your funds have been received and are available before drawing checks against or withdrawing funds from your account. Please fax or mail your completed Authorization for Electronic Payment Service form and voided check/deposit slip to:

COWORX STAFFING SERVICES ATTENTION: CLIENT SERVICES

PO BOX 7130 WATCHUNG, NJ 07069-0798

FAX: 1-877-769-2775

IF YOU HAVE ANY QUESTIONS, PLEASE DO NOT HESITATE TO CONTACT OUR CLIENT SERVICES DEPARTMENT AT: PHONE: 908-757-7979 EXTENSION 6991 OR 800-754-7000 EXTENSION 6991

PLEASE VERIFY ALL INFORMATION WITH YOUR BANK PRIOR TO SUBMITTING TO COWORX

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZATION FOR ELECTRONIC PAYMENT SERVICE

INITIAL AUTHORIZATION

CHANGE OF FINANCIAL INSTITUTION

CHANGE OF ACCOUNT NUMBER

NAME OF FINANCIAL INSTITUTION (BANK)

BANK PHONE NUMBER

FINANCIAL INSTITUTION ROUTING NUMBER (SEE BELOW)

MAILING ADDRESS

CITY STATE ZIP

EMPLOYEE NAME (PLEASE PRINT) EMPLOYEE SOCIAL SECURITY NUMBER (SS#)

TYPE OF ACCOUNT CHECKING SAVINGS

EMPLOYEE DAYTIME PHONE NUMBER

COMPANY EMPLOYEE IS WORKING AT RMX

EMPLOYEE CHECKING/SAVINGS ACCOUNT NUMBER

Your financial institution’s routing number is generally the first set of numbers on the bottom left of your checks. Confirm with your bank. I authorize CoWorx Staffing Services, hereafter referred to as EMPLOYER, to deposit my periodic pay into my account identified as and held at the FINANCIAL INSTITUTION name above, and I acknowledge that such account exists and that the FINANCIAL INSTITUTION can make deposits without responsibility for correctness of such amounts. My authorization will remain in effect until I give a written notice to terminate this authorization (even after experiencing gaps in employment with CoWorx) to my EMPLOYER in sufficient time and manner as to allow my EMPLOYER to act upon it. In addition, either my EMPLOYER or the FINANCIAL INSTITUTION can terminate this agreement by providing me with their written notice at least 10 days prior to actual termination. I have provided my EMPLOYER with a copy of a voided check/deposit slip solely for the purposes of verifying my account number and the FINANCIAL INSTITUTION’S routing number. I understand that the EMPLOYER cannot guarantee the availability date of my funds and that they will not reimburse me should I incur any fees due to the writing of checks prior to the funds needed to cover those checks becoming available. The Federal Banking Commission permits the reversal of direct deposit transactions in the event a deposit is made in error. I understand my signature authorizes CoWorx to recover any erroneous wages deposited in my account which I was not entitled to receive. __________________________

______/______/_____

EMPLOYEE SIGNATURE DATE

The Preferred Mortgage Program Exclusively For CoWorx Employees

We are pleased to offer CoWorx employees The Chase Preferred Mortgage Program which entitles you to cost savings on mortgage financing not available to the general public. Whether you are purchasing your first home, a vacation residence, or refinancing your current mortgage, this program is tailored specifically to help make your transaction as quick, convenient and as affordable as possible.

Benefits Include:

• Closing cost savings of $500 on home purchases and refinances

• Free affordability estimates

• Jumbo loans available for up to $1.5 million or more

• Vast array of mortgage products and services, including programs which feature low down payment

options

• Personal service

Call Today!

If you reside in NJ, PA, CT, MA: 1-888-546-4545

All other areas: 1-800-242-7382

Down payments less than 20% require Mortgage Insurance (MI) and MI charges apply. Closings cost savings are automatically applied at closing. The borrower is responsible for all other closing costs. This program cannot be combined with any other promotional offers or rebates, is not transferable, and is only available only to bona-fide employees or members of groups that participate in The Chase Preferred Mortgage Program. All loans are subject to credit and property approval. Program terms and conditions are subject to change without notice. Not all products are available in all states or for all loan amounts. Other restrictions and limitations apply. Other program Except in New York, all loans offered through Chase Manhattan Mortgage Corporation (“CMMC”). Licensed by the Department of Corporations under the California Residential Mortgage Lending Act; Georgia Residential Mortgage Licensee; Illinois Residential Mortgage Licensee; New Hampshire License #5677-MB; Licensed Mortgage Banker-New Jersey Department of Banking; Rhode Island Licensed Lender and Loan Broker. This does not represent an offer to enter into an agreement with CMMC. Corporate headquarters: 343 Thornall St., Edison, NJ 08837 (732)205-0600. In New York, New Jersey, Connecticut and Pennsylvania, loans also offered through The Chase Manhattan Bank. © 2001 J.P. Morgan Chase & Co. All Rights Reserved.

CREDIT UNION FOR COWORX

FIELD EMPLOYEES All CoWorx field employees are eligible to enjoy the benefits provided by the Picatinny Federal Credit Union of Dover, NJ, one of America’s premier credit unions. CoWorx chose Picatinny because they offer many different ways for you to access your accounts from wherever you are. Remote access is one of their specialties. Once you sign up for credit union membership, you will be able to access your accounts through Picatinny’s free web-site, the use of a toll-free touchtone phone line, ATM card (NYCE network), mail or fax. Using the internet, you will be able to apply for loans, check rates, review special offers, apply for a Visa card and so much more! Sign up today and start enjoying the benefits of credit union membership. It’s easy! You can sign up online at our special website, or call Picatinny and they’ll mail you a membership packet! There is no obligation to join, the choice is yours. But, why wouldn’t you? To sign up, or for more information… www.picatinnycu.org 973-361-5225

Accounts

Shares (Savings Accounts) Share Drafts (Checking Accounts) IRA Accounts Kids Stuff Youth Savings Program Share Certificates Vacation Club Holiday Club

Loans

Auto Loan Motorcycle Loan Balloon Car Loan Boat Loan Mobile and Motor Home Loan Reddi-Monni (overdraft protection) First Mortgage Products Home Equity Loan Loan Express 1-800-774-LOAN (5626) Holiday Loan Home Equity Line of Credit Share Secured Loans Vacation Loan L.O.N.E Loan Signature Loan

Electronic Services

PC Home Banking/Bill Payer PFCU Automated Teller (PAT) Machines QUE - Banking using the phone Wire Transfers PFCU Web Page Direct Deposit Payroll Deduction Global ATM Network (Requires Share Draft

Account) Cross Account Transfers

Insurance Life insurance up to $3,500 on Share Accounts

Temporary disability insurance on loans Credit, life and total disability insurance

Additional Products & Services

Notary Public Service U.S. Savings Bond Redemption Travelers' checks Money Orders U.S. Savings Bonds Signature Guarantee Certified and Cashiers Checks

401K PLAN FOR COWORX FIELD EMPLOYEES

Tax deductible / tax deferred deductions directly from paycheck. Offered through Manulife in associations with Fidelity, T. Rowe Price, Vanguard, Templeton, PBHG, AIM, Franklin, Nueberger & Berger and Sogen.

Plan Highlights ■ 37 Different Plan Accounts ■ Loan Options ■ Account Transfers by Phone ■ Guaranteed Accounts to Highly Speculative

Eligibility Requirements ■ 1 Year Service With CoWorx ■ 21 Years of Age or Older ■ Legal Resident Status or US Citizen ■ Worked 1000 Hours Previous Year ■ Non-Union

FOR AN ENROLLMENT KIT, FAX REQUEST TO:

908-226-1360

FOR ANY OTHER 401K FINANCIAL QUESTIONS CALL THE PLAN ADMINISTRATOR:

908-754-2103