RESEARCH ANALYSIS AND MAINTENANCE, INC.

An Equal Opportunity Employer

EMPLOYMENT APPLICATION

Position Desired / Location Desired / Salary Required / Date Available
PERSONAL
Last Name / First / Middle / Other Last Name
Current Address / City / State / Zip / Telephone Number
Previous Residences (Last Five Years)
Address / City / State / Dates at this Address
From: / To:
From: / To:
From: / To:
From: / To:
Social Security Number / Under 18 / E-mail Address / Driver’s License Number / Issuing State
Yes No
How or by who were you referred?
Previously employed by RAM / If so, where / From (M/Y) / To (M/Y)
Yes No
To your knowledge do you have any relatives working for this company or applying for work with this company? Yes No
If Yes, please provide the full name of the relatives / Where Employed
List below the names of current and former RAM employees who know you / Where Employed
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Yes No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
Yes No If no, describe the functions that cannot be performed:
(Note: We comply with the Americans with Disabilities Act (ADA) of 1990 as amended, and as such, we will consider making a reasonable accommodation to the known disability of a qualified applicant or employee. A job offer may be conditioned on the results of a medical examination, but only if the examination is required for all entering employees in similar jobs.)
Would you be willing to relocate? Yes No
EDUCATION AND TRAINING
If not a high school graduate, indicate highest grade completed:
High School Name and Address / Number of years completed / Diploma
Yes No
Military Service School / Location / Degree or Diploma
Apprentice, Business, or Technical School / Location / Degree or Diploma / Certificate
Yes No
Licenses Held: (Professional Engineer, Electrician, etc.)
Have you attended college? Yes No If yes, fill out following section:
COLLEGES ATTENDED
College or University / No. of years completed / Did you graduate? / Degree Conferred
Yes / No / No. of hrs taken / Title
Name
Location
Name
Location
List publications, inventions, awards received
List professional organizations to which you belong
1. / 2. / 3.
Hobbies:

HR 14, page 1 of 3

18 May 2009

EXPERIENCE
Employer / Address / From (M/Y) / To (M/Y)
Name of Supervisor / Title / Telephone No. / Ext. / Starting Base Pay (per)
Starting Position / Current or Last Position / Current Base Pay (per)
Description of Duties: / Reason for Leaving
May we contact this employer?
Yes No
Employer / Address / From (M/Y) / To (M/Y)
Name of Supervisor / Title / Telephone No. / Ext. / Starting Base Pay (per)
Starting Position / Current or Last Position / Current Base Pay (per)
Description of Duties: / Reason for Leaving
May we contact this employer?
Yes No
Employer / Address / From (M/Y) / To (M/Y)
Name of Supervisor / Title / Telephone No. / Ext. / Starting Base Pay (per)
Starting Position / Current or Last Position / Current Base Pay (per)
Description of Duties: / Reason for Leaving
May we contact this employer?
Yes No
Employer / Address / From (M/Y) / To (M/Y)
Name of Supervisor / Title / Telephone No. / Ext. / Starting Base Pay (per)
Starting Position / Current or Last Position / Current Base Pay (per)
Description of Duties: / Reason for Leaving
May we contact this employer?
Yes No
Employer / Address / From (M/Y) / To (M/Y)
Name of Supervisor / Title / Telephone No. / Ext. / Starting Base Pay (per)
Starting Position / Current or Last Position / Current Base Pay (per)
Description of Duties: / Reason for Leaving
May we contact this employer?
Yes No
U.S. MILITARY
Past / Branch of Service / Separation / Highest Rank
Discharged Retired
Present / Check appropriate box if you are a member of: / Branch / Rank / Unit / Address
National Guard Ready Reserve Standby Reserve
Have you obtained any special skills or abilities as the result of service in the military? / Yes No
If so, describe:
If you are applying for a position requiring a DoD Security Clearance, are you a U.S. Citizen? Yes No
Have you ever been denied a security clearance? Yes No / Do you hold or have you held in the last 24 months a security clearance? Yes No
Clearance level: / Granting agency: / Company where cleared:
1. Have you been convicted of any offense (except for minor traffic conviction) within the last 10 years? / Yes No
2. Have you ever been convicted by a general court-martial? / Yes No
If "YES", please describe below, giving the charges, the date and location of conviction (or the date you pleaded no contest), and the sentence imposed.
NOTE: A “YES” answer to these questions will not automatically bar you from employment. The nature, job-relatedness, severity and date of the offense in relation to the position for which you are applying are considered.
PLEASE ENTER INFORMATION IN THE SPACE BELOW ON ANY ITEM IN THE FORM REQUIRING FURTHER EXPLANATION
REFERENCES
List below three persons not related to you who have knowledge of your work performance within the last three years.
Name: / Occupation:
Address: / City / State / Zip Code
Telephone number: / Work phone: / Number of years acquainted:
Name: / Occupation:
Address: / City / State / Zip Code
Telephone number: / Work phone: / Number of years acquainted:
Name: / Occupation:
Address: / City / State / Zip Code
Telephone number: / Work phone: / Number of years acquainted:
PLEASE READ CAREFULLY BEFORE SIGNING, INITIAL EACH PARAGRAPH AND SIGN BELOW
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission of misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize RAM to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to RAM any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release RAM, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.
I understand that nothing contained in the application, or conveyed during any interview, which may be granted, or during my employment, if hired, is intended to create an employment contract between RAM and me. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company's designated representative.
I agree that any claim or lawsuit relating to my service with RAM or any of its subsidiaries must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.
Applicant's Signature: Date:

HR 14, page 1 of 3

18 May 2009