Application For Employment

APPLICATION FOR EMPLOYMENT

Please complete and return to [email protected] or fax to (408) 328-8001

PERSONAL DATA Last Name

First Name

M.I.

Street Address

City

Other Names Used

Social Security No.

State

Business Phone ( ) May we call you at work? Yes No Residence Phone ( ) Cell Phone ( ) Alternate Phone ( ) E-mail Address

Zip

If employed by ATR, can you provide documents establishing your legal right to work in the United Yes No States as required by law?

Are you under 18 years of age?

Yes

No

TYPE OF WORK DESIRED Please indicate the type of position(s) you desire

Salary desired Date Available

Type of Employment:

Have you previously applied for employment at ATR?

Full Time Part Time (hours

)

Summer Only If required, will you be willing to work: Overtime Shift: Day

Yes

No

If yes, Date

Have you previously been employed by ATR?

If Yes, Date

How were you referred to ATR? Ad Employee College

Agency

State EDD

Self

Other:

Name of Employee/Source Swing

Grave

1) Have you ever been convicted of a misdemeanor or felony other than: • minor traffic citations, • convictions for which the record has been judicially expunged, sealed or eradicated, • convictions for marijuana-related offences which occurred more than two years ago? 2) Are you pending trial for a criminal offense for which you are out on bail on your own recognizance?

Yes

No

Yes

No

If yes, list dates, places, charges and disposition. (A conviction that is disclosed herein is NOT an automatic disqualification from employment.)

TRAINING AND EDUCATION Name and Location

Did you graduate? Yes No

Diploma/ Degree

Field of Study

Overall Scholastic Average

High School Business College College / University College / University

Additional training/classes/qualifications.

Date Revised: 051806

Page 1 of 8

CONFIDENTIAL

EMPLOYMENT HISTORY Please list your employment history beginning with your most recent position. This MUST be completed whether or not you attach a resume. Employment dates must be consecutive and all times accounted for. Please use additional sheets if necessary. Include Military Service if applicable. Most Recent Employer

Address

From (mo./yr.)

Starting Position

Last Position

Starting Base Salary per

Name of Supervisor

Title

Telephone No./Ext.

Description of Duties

To (mo./yr.)

Final Base Salary per May we contact this employer? Yes No

Reason for leaving

Previous Employer

Address

From (mo./yr.)

Starting Position

Last Position

Starting Base Salary per

Name of Supervisor

Title

Telephone No./Ext.

Description of Duties

To (mo./yr.)

Final Base Salary per May we contact this employer? Yes No

Reason for leaving

Previous Employer

Address

From (mo./yr.)

Starting Position

Last Position

Starting Base Salary per

Name of Supervisor

Title

Telephone No./Ext.

Description of Duties

To (mo./yr.)

Final Base Salary per May we contact this employer? Yes No

Reason for leaving

Date Revised: 051806

Page 2 of 8

CONFIDENTIAL

Previous Employer

Address

From (mo./yr.)

Starting Position

Last Position

Starting Base Salary per

Name of Supervisor

Title

Telephone No./Ext.

Description of Duties

To (mo./yr.)

Final Base Salary per May we contact this employer? Yes No

Reason for leaving

INDICATE SKILLS IN THE FOLLOWING AREAS IF APPLICABLE Type

What office equipment can you operate proficiently? WPM

Can you perform the essential functions of the position applied for, with or without reasonable accommodations?

Yes

No

If no, please explain the functions that cannot be performed.

In order of proficiency, list your technical skills: 1.

4.

2.

5.

3.

6.

PROFESSIONAL REFERENCES Please give the names of three people in your field (past managers or supervisors) who know you and can provide information regarding your jobrelated capabilities. Name

Title

Company (

Date Revised: 051806

Page 3 of 8

Telephone )

(

)

(

)

CONFIDENTIAL

- IMPORTANTPLEASE READ CAREFULLY AUTHORIZATION AND RELEASE CERTIFICATION I certify that my answers in this application and in my personal interview are true and correct. I agree that any omissions, misrepresentations or falsifications of information may disqualify me from employment and, if hired, may be grounds for termination of employment. I understand this application is not an employment contract nor can it be used to create a contract. Employment by ATR has no specific term, regardless of length of service, and may be terminated at the will of either party on notice to the other. I acknowledge that ATR has not made any promises or representations that differ from those contained in this paragraph. Promises or guarantees of employment on any other basis are not binding for ATR unless they are written and signed by the President of the Corporation. I hereby authorize ATR to conduct background investigations and check references in association with this application for employment. Further, I authorize any individual, company, business entity, institution, or government agency having relevant information to furnish ATR with that information. I hereby release and agree to hold harmless any individual, company, business entity, institution, or government agency from all liability with regard to furnishing that information to ATR. Further, I hereby agree to release and hold ATR harmless from all liability with respect to the receipt of such information. I have read and understand all the above limitations on and conditions of my employment and authorize the investigation, etc. referred above. Date: Date:

I Agree I Disagree

Signature

Date

Thank you for your interest. Advanced Technical Resources, Inc. is an equal opportunity/affirmative action employer.

Copyright © 2000 ATR International, Inc. All rights reserved

Date Revised: 051806

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CONFIDENTIAL

EQUAL EMPLOYMENT OPPORTUNITY DATA To be completed by applicant. Completion of this form is entirely voluntary and all information will remain confidential and will not affect your application for employment. We are required by law to collect this information for equal opportunity employment purposes. It will not become part of your personnel record if you are hired by this company.

Name:

Please indicate your gender by checking the applicable box: male female Please check next to your race/ethnic group: White/Caucasian (Not of Hispanic Origin) - All persons having origins in any of the original people of Europe, North Africa or the Middle East. Black

(Not of Hispanic Origin) - All persons having origins in any of the black racial groups of Africa.

Hispanic

All persons having origins in Mexico, Puerto Rico, Cuba, Central or South America or other Spanish culture, regardless of race.

Asia/Pacific Islander

All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent or Pacific Islands. This area includes China, Japan, Korea, the Philippines and Samoa.

American Indian/Eskimo

All persons having origins in any of the original peoples of North America, and who have maintained cultural identification through tribal affiliation or community recognition.

Please check the boxes next to any of the following items that are applicable to you: Vietnam Veteran A person who (a) served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was discharged or released there from with other than a dishonorable discharge, or (b) was discharged or released from active duty for a service-connected. Disabled Veteran

A veteran entitled to a disability compensation under laws administered by the Veteran’s Administration for disability rated at 30 percent or more, or a person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty.

Disabled

Any individual who has a physical or mental impairment which substantially limits one or more of the major life activities, has a record of such an impairment, or is regarded as having an impairment. ________________________________________________________________________________________________________

To be completed by Employer. EEO-1 Category: 1. Officials and managers 2. Professionals 3. Technicians 4. Sales 5. Office and clerical

6. Crafts - skilled 7. Operatives - semi-skilled 8. Laborers - unskilled 9. Service Workers

Employer information completed by: Name:

Date Revised: 051806

Date:

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CONFIDENTIAL

DISCLOSURE AND AUTHORIZATION TO OBTAIN INVESTIGATIVE CONSUMER REPORT As part of the Advanced Technical Resources, Inc. (ATR) employment screening and selection process, a background and reference check is required for all employees. The objective of this process is to verify the accuracy of information provided in the application process, check references and identify other factors that might be relevant to ATR’s employment requirements. You have the right, upon written request made within a reasonable period of time (not to exceed 30 days) after receipt of this notice to receive a written disclosure of the nature and scope of nay investigation conducted by a Consumer Reporting Agency. If an Investigative Consumer Report (ICR) is obtained and an adverse decision is made affecting your employment, ATR will provide to you, before making the adverse decision, a copy of the ICR and a copy of your rights under the Fair Credit Reporting Act. ATR reserves the right to run an ICR and/or drug screen as ATR deems necessary at any time during your employment with ATR. You have a right to obtain a copy of your ICR by checking the box provided below. By signing this form, I authorize ATR to obtain an Investigative Consumer Report, and/or drug screen as necessary at any time during my employment with ATR. I understand that these reports may include and is not limited to information as to my character, general reputation, personal characteristics, mode of living, work habits, including oral assessments of my job performance, experiences and abilities, along with reasons for termination of past employment. Further, I understand and authorize ATR to request information from various federal, state, and other agencies, including public and private sources which maintain records concerning my past activities relating to my driving record, credit history, criminal record, civil matters, previous employment (including salary), educational records and professional licensing if any. I further authorize that ATR and its agents may disclose any information submitted for employment including, but not limited to information from my employment application, testing results, results of reference checks, credit, criminal or driving record reports to client-companies as necessary.

Consumer Reporting Agency:

APPLICANT INFORMATION

First Name (please print)

Middle Name

Last Name /

Social Security Number

Issuing State

Year Issued

Maiden or other names used /

Date of Birth*

Driver’s License Number

State

PLEASE PROVIDE 7 YEARS OF ADDRESS HISTORY

Current Street Address

City

State

Zip

Length: yr./mos.

Previous Street Address

City

State

Zip

Length: yr./mos.

Previous Street Address

City

State

Zip

Length: yr./mos.

Previous Street Address

City

State

Zip

Length: yr./mos.

Current Phone Number I HAVE RECEIVED A COPY OF THIS NOTICE AND AUTHORIZATION FORM:

I AGREE

Signature

I wish to be furnished with a Copy of my Consumer Report should one be ordered. Date

*The Age Discrimination Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.

Date Revised. 03/06

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CONFIDENTIAL

Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C. 20580. A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.ftc.gov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580. •

You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.

•

You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: • a person has taken adverse action against you because of information in your credit report; • you are the victim of identify theft and place a fraud alert in your file; • your file contains inaccurate information as a result of fraud; • you are on public assistance; • you are unemployed but expect to apply for employment within 60 days. In addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit for additional information.

•

You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.

•

You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.ftc.gov/credit for an explanation of dispute procedures.

•

Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

Date Revised. 03/06

Page 7 of 8

CONFIDENTIAL

•

Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.

•

Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.

•

You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.ftc.gov/credit.

•

You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-800-567-8688.

•

You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

•

Identity theft victims and active duty military personnel have additional rights. For more information, visit www.ftc.gov/credit.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are: TYPE OF BUSINESS:

CONTACT:

Consumer reporting agencies, creditors and others not listed below

Federal Trade Commission: Consumer Response Center - FCRA Washington, DC 20580 1-877-382-4357

National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after bank's name)

Office of the Comptroller of the Currency Compliance Management, Mail Stop 6-6 Washington, DC 20219 800-613-6743

Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks)

Federal Reserve Board

Savings associations and federally chartered savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name)

Office of Thrift Supervision Consumer Complaints Washington, DC 20552 800-842-6929

Federal credit unions (words "Federal Credit Union" appear in institution's name)

National Credit Union Administration 1775 Duke Street Alexandria, VA 22314 703-519-4600

State-chartered banks that are not members of the Federal Reserve System

Federal Deposit Insurance Corporation Consumer Response Center, 2345 Grand Avenue, Suite 100 Kansas City, Missouri 64108-2638 1-877-275-3342

Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Activities subject to the Packers and Stockyards Act, 1921

Date Revised. 03/06

Division of Consumer & Community Affairs Washington, DC 20551 202-452-3693

Department of Transportation , Office of Financial Management Washington, DC 20590 202-366-1306 Department of Agriculture Office of Deputy Administrator - GIPSA Washington, DC 20250 202-720-7051

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CONFIDENTIAL