Employment Application First Name * Middle Name Last Name * Primary Phone * Secondary Phone Date of Application * Position Applied to * Email Address * Street Address * City * State * Zip Code Referral Source Referral Name Education Institution Attended As Major/Minor Degree Graduated —Please choose an option—YesNo Employment History Please start with your current or most recent job Employer* Provide dates of employment From * To * Job Title * Pay Rate Job Duties Can Contact? *—Please choose an option—YesNo Reason for Leaving * Current Employer *—Please choose an option—YesNo Employer Provide dates of employment From To Job Title Pay Rate Job Duties Can Contact? —Please choose an option—YesNo Reason for Leaving Current Employer —Please choose an option—YesNo Employer Provide dates of employment From To Job Title Pay Rate Job Duties Can Contact? —Please choose an option—YesNo Reason for Leaving Current Employer —Please choose an option—YesNo References Please provide 3 professional references, two of which should be your former supervisors. Take note that we do contact references. Reference 1 Name * Company * Title * Relationship * Email Address * Time Known * Phone * Reference 2 Name Company Title Relationship Email Address Time Known Phone Reference 3 Name Company Title Relationship Email Address Time Known Phone Questions Are you eligible to work in the United States? *—Please choose an option—YesNo Are you 18 years of age or older? *—Please choose an option—YesNo We are a drug-free workplace. If you are offered a position with Tzadik, will you consent to a drug-screening and background check? *—Please choose an option—YesNo What is your minimum salary requirement? * Have you been convicted of a crime in the last (7) years? If so, please explain the circumstances. *—Please choose an option—YesNo Fill this out if you answered yes on the question above. Statement Tzadik Management is an equal opportunity employer. Tzadik Management does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Tzadik Management to hire me. If I am hired, I understand that either Tzadik Management or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Tzadik Management has the authority to make any assurance to the contrary. I attest with my signature below that I have given to Tzadik Management true and complete information on this application. No requested information has been concealed. I authorize Tzadik Management to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. Name * Date * Signature 26810 52546