The Dubin Group. Name Means of transportation? Address City State Zip Code Primary phone #: Secondary phone #:

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1 The Dubin Group Name Means of transportation? Address City State Zip Code Primary phone #: Secondary phone #: In what industries have you previously worked? Ideal position/title Are you currently working? If yes, what is your current position title? If no, are you open to temporary opportunities? Temp to Hire positions? Current salary Ideal salary Minimum salary req C heck all locations in which you are willing to work: Center City King of Prussia South Jersey Trenton/Princeton Bucks County Delaware Delaware County Northeast Philadelphia Other: Max commute time Notice needed to give current employer: Can you work overtime? What is your interview availability? What level of education have you completed? Are you currently enrolled in school? Anticipated graduate date/degree: Know of anyone looking? We pay referral fees! Please list below. Name Phone number City of residence Type of work Have you ever been convicted of a felony? Have you ever had a background check performed? Emergency Contact Relationship: Daytime phone: Evening phone:

2 Employment: Starting with your most recent employer, please list your last 3 employers (full-time, permanent work only) Job title: Supervisor (name/title): Job title: Supervisor (name/title): Job title: Supervisor (name/title): The information I have presented/supplied is accurate to the best of my ability. I understand that false information may result in immediate termination of employment at any point in the future if I am hired. Furthermore, I authorized The Dubin Group (its clients and/or agents) to conduct a background investigation, drug test, credit report and/or reference check(s) for the purposes of securing employment for my behalf. I agree to release The Dubin Group (its clients/agents) from any liability or action that may result from such investigation. If I agree to complete a video interview, upon my verbal approval of said video, it can be sent to a Dubin Group client for the purposes of evaluation and consideration of employment. I understand under the terms of agreement between The Dubin Group and their clients, I cannot accept any position at a company to which I have been submitted as a candidate through The Dubin Group for a period of six (6) months. Should I work with a client during this time both the client and myself will be liable for a conversion/placement fee and any legal fees associate with collection of such fee. Signature Date

3 ADMINISTRATIVE SKILLS (please check what you have ON THE JOB experience with): DICTAPHONE DICTATION MAIL MERGE SHORTHAND SWITCHBOARD TRANSCRIPTION REAL ESTATE LICENSE TRAVEL ARRANGEMENTS ADMINISTRATIVE SOFTWARE (please check what you have experience with an knowledge of): ACT ADOBE AMI PRO ELITE FOXPRO GOLDMINE GREAT PLAINS DYNAMICS HTML HRIS IDX JURIS LEXIS NEXIS LOTUS LOTUS FREELANCE LOTUS NOTES MAS 90 MS ACCESS MS EXCEL MS WORD MS POWERPOINT MS PROJECT MS PUBLISHER MS OUTLOOK OTHER DATABASE PEOPLESOFT PAGEMAKER PHOTOSHOP QUARK EXPRESS SAP VISIO WESTLAW WORDPERFECT WPM ACCOUNTING SKILLS (please check what you have ON THE JOB experience with): ACCOUNT RECONCILIATION AP AR ANALYSIS AUDIT BANK RECONCILIATION BILLING BOOKKEEPING BUDGETING CASH APPLICATION CASH MANAGEMENT COLLECTIONS CONSOLIDATION COST ACCOUNTING FEDERAL TAX FINANCIAL ANALYSIS FINANCIAL RECONCILIATION FINANCIAL REPORTING FINANCIAL STATEMENT PREPARATION FIXED INCOME SECURITY FIXED ASSETS FORECASTING GAAP GENERAL LEDGER INTERNATIONAL TAX INVENTORY JOB COSTING JOURNAL ENTRIES LEGAL BILLING MEDICAL BILLING MERGERS & ACQUISITIONS MODELING MONTH END CLOSE MUTUAL FUND ACCOUNTING NONPROFIT ACCOUNTING PAYROLL PAYROLL TAX PURCHASING SEC REPORTING STANDARD COST STATE AND LOCAL TAX TREASURY

4 ACCOUNTING SOFTWARE (please check what you have ON THE JOB experience with): ACCPAC ADP AMSI ARGUS AS400 AXIUM BEST FIXED ASSET CERIDIAN ELITE FAS109 FAS FIXED ASSET FAST TAX FOXPRO GREAT PLAINS HRIS HYPERION JD EDWARDS KRONOS LAWSON MACOLA MAPIC MAS90 MAS200 MRI MSA MYOB ORACLE OTHER PAYROLL SYSTEM PAYCHECK PEACHTREE PEOPLESOFT PLATINUM QUICKBOOKS QUICKEN REAL ESTATE SOFTWARE REAL WORLD RENT ROLL SAP SIEBEL SKYLINE SOLOMON SQL TIMBERLINE TURBO TAX VERITAS YARDI MAY WE CONTACT YOU THROUGH (please check if you would like us to contact you this way for networking purposes): TEXT MESSAGE LINKED IN FACEBOOK TWITTER OTHER

5 Professional References Please list the names and contact information for three (3) professional references. List only those to whom you directly reported, or with whom you have/had a direct working relationship. Job Title/Position w/ Secondary Job Title/Position w/ Secondary Job Title/Position w/ Secondary