Position Desired: HR Specialist Full-Time Part-Time

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

APPLICANT’S STATEMENT
I understand that Advantage Sales & Marketing LLC (including its direct and indirect subsidiaries and affiliated entities and divisions) (hereinafter, the
“Company”) is committed to providing equal opportunity in all employment practices, including, but not limited to selection, hiring, promotion, transfers,
and compensation to all qualified applicants and associates without regard to age, race, color, national origin, sex, religion, physical or mental
disability, or any other category protected by applicable local, state, or federal law. I understand it is this Company’s policy not to refuse to hire a
qualified individual with a disability because of that person’s need for a reasonable accommodation to apply for employment or to perform the essential
functions of the job as required by the Americans with Disabilities Act or applicable state law.
I understand that nothing contained in this employment application or conveyed during any interview, which may be granted, or during my employment,
if hired, is intended to create an employment contract between the Company and me. I further understand that if I am hired, my employment and
compensation are terminable at-will, is for no definite period, and may be terminated at any time, with or without cause or prior notice, at the option of
either myself or the Company No one other than the CEO of the Company has the authority to modify this relationship or to make any agreement to
the contrary. Any such modification must be in writing. Oral representations made before or after employment, if I am hired, do not alter the at-will
nature of employment.
I understand that the Company reserves the right to require me to submit to a drug and/alcohol test, prior to employment and/or at any time during my
employment, to the extent permitted by applicable law.
I understand that depending on my position, and subject to any restrictions or limitations of applicable law, I may be required to sign a confidentiality,
non-competition, loyalty, and/or non-solicitation agreement.
I understand that, to the extent permitted by applicable federal and state law, the Company may investigate my references, work record, educational
background, professional licenses, public records and other matters related to my suitability for employment and otherwise to verify the accuracy of
any and all information provided by me in this application, resume or job interview. I understand that, to the extent required by applicable law, I will be
provided with additional materials by which I may authorize the Company to obtain certain such information and which permit me to receive a written
disclosure of the nature and scope of such investigation. I hereby release the Company and its representatives from all liability arising out of or in any
way related to such investigations or disclosures.
I authorize former and present employers, professional references listed in this application, and any other individuals I may name, to give the Company
or its designee any and all information concerning my previous employment and any pertinent information they may have related to my suitability for
employment and, to the fullest extent permitted by law, release such parties from all liability arising out of or related in any way to such investigation or
disclosures. I also authorize the Company to provide truthful information concerning my employment, if any, to future employers and, to the fullest
extent permitted by law; I release and hold the Company harmless for any liability arising out of or related to providing such information.
I certify that I have completed this application personally or with assistance as an accommodation of a disability. I further certify that the information I
have given in this application and during the interview process is true and complete in all respects. I understand and I agree that if the information is
found to be false, incomplete, misleading, or unsatisfactory in any respect that I will be disqualified from consideration for employment or subject to
immediate termination if such omissions or misstatements are discovered after I am hired.
DO NOT SIGN THIS APPLICATION FOR EMPLOYMENT UNTIL YOU HAVE READ AND UNDERSTAND THIS STATEMENT.

Signature of Applicant Date ____

NOTICE TO APPLICANTS IN MARYLAND:  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.

NOTICE TO APPLICANTS IN MASSACHUSETTS:  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.

NOTICE TO APPLICANTS IN RHODE ISLAND:  The Company is subject to Chapters 29-38 of Title 28 of the
General Laws of Rhode Island, and is therefore covered by the state's workers' compensation law.

ASM Application for Employment 1 of 4 rev. 12.5.08

Each inquiry on this application must be fully answered or completed.

If offered the position when How were you

would you be able to start? Immediately referred to us?      

PERSONAL DATA

Name Lipinski, Ken S

(Print) Last First Middle

Present Address 6207 Archway, Irvine CA 92618 How long? 3

Number, Street, and Apt.# City State Zip

Telephone Number ( 714 ) 747-9483 Mobile Number ( 714 ) 747-9483

Email Address janos@fearlessnet.net Are you 18 years of age or older? Yes No

If hired, can you submit verification of your legal eligibility for employment in the United States? Yes No

Have you filed an application here before? Yes No If Yes, give dates      

Have you ever worked for this Company before? Yes No

If Yes, give dates and position      

Do you have any relatives currently working for the Company? Yes No If Yes, Name      

Have you been convicted of a felony in the last seven years? Yes No

If Yes, please give dates and details of each      

(NOTE:  You need not disclose convictions which have been erased, annulled, pardoned, expunged,
impounded or sealed by a court.  Further, a criminal conviction does not necessarily disqualify an applicant
from employment).*
*For Hawaii applicants only:  Do not respond to this question unless and until you receive a conditional offer of employment.  

* For California applicants only:  Do not answer yes if you were referred to or participated in a diversion program, or if your conviction
was solely for a marijuana-related offense more than 2 years old.

* For Massachusetts applicants only:  An applicant for employment with a sealed record on file with the commissioner of probation may
answer no record with respect to an inquiry herein relative to prior arrests, criminal court appearances, or convictions.  In addition, any
applicant for employment may answer no record with respect to any inquiry relative to prior arrests, court appearances and adjudications
in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for
criminal prosecution.
In order to permit a check of your work and educational records, should we be made aware of any change in name or assumed name
that you previously used? Yes No
If Yes, identify names and relevant dates.      

Are you capable of performing, with or without a reasonable accommodation, the essential job duties of the position for which you are
applying? Yes No

Do you have the ability to work overtime, if required? Yes No

Do you have the ability to travel, if required? Yes No

EDUCATION & EXPERIENCE High School College / University Graduate / Professional

School Name Mater Dei CSU Fullerton      

Years Completed: 9, 10, 11, 12?       1, 2, 3, 4, 5?       1, 2, 3, 4?      

Diploma / Degree High School Diploma B.A. Organizational Psychology      

Describe Course of Study or Major B.A. Organizational

Psychology
Please describe any specialized training or experience, that you have which would be relevant to the job for which you are
applying, including areas of computer proficiency: HR Certificate, ADP, Ceridian, Peoplesoft, JD Edwards, Workstream, MS Office
Suite, Adobe Suite (Acrobat, Photoshop, Illustrator)

ASM Application for Employment 2 of 4 rev. 12.5.08

RECORD OF PREVIOUS EMPLOYMENT

Please list the names of your present and previous employers in reverse chronological order, starting with your current
employer.  Be sure to account for all periods of time, including periods of unemployment.  If self-employed, give firm’s
name and supply business references where “last supervisor” is requested.
Present or Last Employer Employed Pay Your Title or Position Major Job Duties
Hoffman Southwest Corp. From (mo/yr) Start Recruiting & Training Full-Cycle Recruiting, Employee
Address 06/2006 $45000 Specialist Relations, Training management &
23311 Madero development, HR Compliance

City, State, Zip To (mo/yr) Final Name of Last Supervisor Reason for Leaving
Mission Viejo, CA 92618 02/2009 $52000 Wendy Creamer Layoff - Lack of Work
Telephone: 949-380-4161

Name of Previous Employer Employed Pay Your Title or Position Major Job Duties
The Shaw Group, Inc From (mo/yr) Start Recruiter Full-Cycle Recruiting, Employee
Address 11/2004 $38,000 Relations, Compensation, staffing plans,
      recruitment events

City, State, Zip To (mo/yr) Final Name of Last Supervisor Reason for Leaving
Irvine, CA 06/2006 $42,000 Norwood Banon Career Advancement
Telephone: 949-660-5357

Name of Previous Employer Employed Pay Your Title or Position Major Job Duties
ServiceCraft Logistics From (mo/yr) Start HR Representative Recruiting, Employee Relations, Benefits
Address 06/2002 $30,000 (Internship) Enrollment, HR Auditing & Compliance
     
City, State, Zip To (mo/yr) Final Name of Last Supervisor Reason for Leaving
Buena Park, CA 05/2003 $30,000 Michael Cutuli Internship
Telephone: 714-690-6500

Please explain any gaps in your employment history:

05/2003 - 11/2004 Non-HR Related Work, Office Manager, TransWestern Publishing, Santa Ana, CA

EMPLOYMENT HISTORY
Are you currently employed? Yes No
Are you on layoff? Yes No Are you subject to recall? Yes No

Have you ever been terminated or asked to resign from any job? Yes No

If Yes, please explain circumstances:      

May we contact your current employer? Yes No

If No, please explain:      

Do you have any commitments to any other employer, which may affect your employment? Yes No

If Yes, please explain:

ASM Application for Employment 3 of 4 rev. 12.5.08

PROFESSIONAL REFERENCES
Address Telephone Years
Name Occupation (Street, City, State, and Zip) Number Known

Mike Wayne Payroll Manager       949-380-4161 3

Michele Cooke HR Manager       949-660-5312 6

Norwood Banon Regional Recruiting       949-660-5357 6

Manager

ASM Application for Employment 4 of 4 rev. 12.5.08