NOTIFICATIONAIELEASE O1? INFORMATION FORM

NOTIFICATIONAIELEASE O1? INFORMATION FORM The purpose of this form is to notify you that consumer report will be conducted on you in the course of consideration for employment with: Last Name: First Name: Pi\idtu Social Security #: Current Address: City: Middle Name: State of Issue: State: al Zip: In connection with this request I authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county, and federal courts and military services to release information about my background including, but not limited to information about my employment, education, consumer credit history, driving record, criminal record and general public history to the person or company with which this form has been filed, or their agent. This releases the aforesaid parties from any liability and responsibility for collection of the above information. APPLICANT'S SIGNATURE: DATE: 1 \ 3 \ \\Lk EFTA00606108 EMPLOYMENT APPLICATION Po 'on Applying for. atom Part-Time - Srasotu Noun S C i iart:: : j r Sat and/or Ds affiliate Is an Equal Opportunity Errploym We consider appli cants for all positions without regard to race, color, religion, sex, national origin, age, veteran stunk dintniity,or arty other legally protected status. NAME Flirt Hat 6 be. Preset Street Address Middle Avdru Last Position Dertmd Soda] Security Number ' Alt you at least flyers dap )(Yes O No 210 I Ase rot. a us Vonatot OA you Alternative Phone hl .w provide verification of your right lo work in Me Urdteel ms Ste Yes 0 No •njbate Awned& Work Han you ever been noployed by . • O Part 17me -1 ?)— i4_ O Yes C. No Position: Dales Lbt TAM= a/Mends or ethane now employed by aria/or lb dna to tJn office mad‘bles you an Teem &Jude WPM and Shorthand) LW other equipment you an opera le to you ban any special dab or wining misled to the podtton acray,b17 EDUCATION Marna of Institution City k Stela r Owls LotYar Completed High School 9 10 11 12 Caller 1 2 1 Oncluste Scheel . \NA C\ tepee nolved O Yet; h/o Othcr 3/451 \ _PC VA 4 0\pic lvelLITARY SERVICE BRANCH Rank Attained Dale Emend Dwe of Disclose OW % e\ 13% N I % N \ Pr EFTA00606109 EMPLOYMDIT: Include all previous jobs starting with the present or most recent . May we conta ct your present employer? 0 Yes 0 Iskr " pnSrOuttlrol, 1 Cliletanpined 1 7 n hen Roan (at LABE soo Pooloba Held &Engem cen•qtrc 4C. (Issisioni- "Joetnra Anen, Psr isaa Thanoi Have you ever been convicted of a felony or a misdemeanor (other than minor traffic violations)? 0 Yes 2( No If yes, Please ecplain: ?LEASE READ THIS STATEMENT CAR DULLY Tepee to comply with ell rale dash Company. !understand that any hillifics bon or omission of information prenided on this 'paragon or while Interviewing will be p ounds for dismissal from employment even if nor dbowerod until after my separationfrom theebrposy. I authorize a thorough invoggagon to be made in conjunSon with this application concerning my character, general repubtion,pernmel characteristioard merle of living. whichevermayba applicable. understand this kveldption Duty Include person] interviews with third panes, such as family members, business "'sedates, financial sources, fgends,nefghbon or others with whom tam acquainted. Mon hind, I agree that my employment and compensation ranbe terminated withor without museand with or wi shout noace at anytiae.at the opgon of the Company or myself. iundostand theta* otherrepresaata tive of the Companyothertion Proidentri LA. Proper ty, 'cc. has the authority to mcdify Ws agreement In any ways and that any such rnrcligration must be In a writingsigned by both the ?resident 2nd myself. I have read and affirm the above statement as my own. gplihge Mar EFTA00606110 US. Depenmein of Amer Immiersi ion end Haw Mutton Selina Mb N. iliSaiLla Employment Eligibility Verification Please reed 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 lire an IndNiduel because of a future expiration date may also constitute Illegal diSaimlnatiOn. Section 1. Employee Information end Verification. To be completed ane venal ay moose et as Wiwainplasiiimx air Pont Name "St P\d‘u frsi--O6\be Middle Most Melee Slams Address (Se Apt e City la imprisonment and/or fines for raise statements or use of false documents in connection with the completion ofthls form Employed s Seonaiut °Meek* E A moon or nillsOnd of the then Si..., A Lavelet Permanent Regan (Aeon p A 0 An Yen sydlonad to rift .re_! (Alm, or earnissme . Dote PnaChIcteyoyaW Prepare ana/Of I ranslator Lertoication. fi b cotoptorod and wed Sector 1 I a pvpmed by • person can aen car ompara)1 Men le peaky of pow% Me how own& M she coloPtrion ol orp fain srid that to in* Mt of my knowirep• the Intortnopra tr owe and comm. Prepare(Sgliedfaton Signature ha Name Mans Muter Noes and Menke'. Cfry. Sato. ip Code) Dete evccenklay/wer) Section 2. Employer Review and Verification. To be corpOtted and signed by ereptoyer. Examine area dectunant from the A OR ~mine and down ant front Use MO hewn U.s c, a Oiled eh the scums er toi ham. and :scoot the 00a, masher and .aµedan dales a sq. or the decurrentrei List A Document day hums euthemy Document spirsuon Cons ft /NW I --/ 5xurwyt S. Exporsece Otte At eV) i_t— OR a list B AND List C cEet II CATION - I attest. under penalty of perjury, that 1 have emend the document) presented by the above.nemee employee. that the ebove.ksted document) apprise to be genuine and to relate to the employee named, Met the e nployee began employment on (monthmay/yeed and that to the best of my knowledge the employee is eligmle to work in the United Steles. (State employment egmcles may omit the dote the employes began employmtmt.) Signalise Of Employer or AuthOrsied ageteastlitiVII ems Name Title auStneSs a OrgesoratiOn Name AddrieS (Strode NOM en I Ikea* C•ry. Sins. Zip Col) Dote (enoninstteysyees) Section 3. Updating and Recertification. To be camploted led wed by Krona A Nov Mime (d appacdOW a. Dote of rare 000#MISP)T#1# *SSW --- c. inployen waylays r am ei Ingot doshoodetem has alma pee 1W inrottadOen below for the &Content that falsbilleci amen ernpopeent elletbass Document Tee Doc.min d [sprach., Date (d any):__/ / I Pints under Wildly of priory. Qui a the test a My loserdosep, the tonployee I. sews to overland* Wiled Stews. and it the airports antaaillii donsmem(S). ore documenen throe azerrdned upon's, to be 'pmtm and to note to the tressidueL Sdinsoos of tmOlo're or Atm horned ReProsainotisa 1 Date fracsniltiefinad Fern 14 Otto 11.214101PeCe 2 EFTA00606111 EFTA00606112 08/04/2014 00:59 FAX Eb0001/0002 WHITE FLEISCHNER FINO, LLP FAX COVER SHEET FAX NUMBER TRANSMITTED TO: TO: Dan-en Indyke RE: Social Security FROM: Habibe Avdiu DATE: August 4, 2014 TOTAL PAGES ( 2 ) INCLUDING COVER SHEET COMMENTS: Please see attached. THIS MATERIAL BEING TRANSMITTED IS CONFIDENTIAL AND SOLELY FOR THE PERSON OR ENTITY NAMED ABOVE AND MAY BE COVERED BY THE ATTORNEY- CLIENT PRIVILEGE. IF YOUR ARE NOT THE INTENDED RECIPIENT, PLEASE DO NOT READ THE COMMUNICATION. IF YOU HAVE RECEIVED THE MATERIAL IN ERROR PLEASE NOTIFY US BY TELEPHONE AND RETURN AT THE ABOVE ADDRESS VIA POSTAL MAIL EFTA00606113 08/04/2014 09:59 FAX 110002/0002 EFTA00606114 HABIBE AVDIU EDUCATION: •CUNY College of Staten Island: 2800 Victory Boulevard, New York. NY 10314 Date of Completion: May 2010 •C0NY Kingsborough Community College 2001 Oriental Boulevard. Brooklyn, NY 11235 CERTIFICATIONS: •American Red Crow CPR/AED Certified •Approved Medication Administration Personnel (AMAP) WORK EXPERIENCE: • January 2013 - Present White Fleischner & Fino, LIP 61 Broadway - lit LegalAssistant Defies: To enhance overall effectiveness of a successIbl law firm by developing, maintaining, and supporting case information. .A.ssisnng two partners in care development by maimaining contact with clients, documeni preparation of subpoenas and summonses, ekctronically filing court documents and receiving and transcribing legal dictation. Maintaining case casts by overseeing client relation billing and invoices. Supporting case preparation by creating case summaries and organizing matenal foer team case review. To insure overall goal achievement, accepting ownership for accomplishing requests and continually exploring opportunities to add value to job and firm accomplishments is placed on 2 level of high priority. •July 2012- December 2013 On Your Mark, Inc. Tide: Adminisuative Assistant ado: Provided assistive services for a last paced nonprofit company under the guidance of three directors. Such savices include "front of house" managements email correspondence. data entry and organization, creation of advanced fling system for employee record maintenance, and diligent oversight of budget coordination. July 2011- July 2012 On Your Mark, Inc. 77tIm Residential Habs7itation Didier Provided essential services to adult individuals with developmental disabilities. A main focus on improving and facilitating daily living skills and personal care was enforced though, assisting with developing routines, meal preparation, budgeting skills, and safety and socializing within the community. Communication with the Coordinator of Habilitation Savices about specific individual goals was the method of assessing individual progress. •July 2009- June 2010 South Shore Eyecare Tide: Administrative MedicalAssistant Duties: Prepared patients for ophthalmologists in a multi-doctoral office by performing pre-screening exams. Acted as a liaison between patient and doctor and ensured proper filing and management of important papawork and documents for entire office. Followed up with patient care by providing proper contact placement tutorials and ordering of future necessary supplier. EFTA00606115 SKILLS: Computer Skills: Microsoft Office, Windows, Mac and PC applications •Languages: Ability to read and write in Albanian OTHER QUALIFICATIONS: *Valuable communication and organization skills •Team•work mentality driven by a desire to barn and apply new ideas ;Ability to adapt quickly to challenges and changing environment •fiager and willing to take on new and increased responsibilities EFTA00606116