/ DATE:______
PLEASE...
READ CAREFULLY, WRITE CLEARLY,
AND TRY TO ANSWER ALL QUESTIONS
We appreciate your interest in our organization and assure you that we are sincerely interested in you and your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best suits your qualifications and assist us in your possible future upgrading. Every effort has been made to comply with all federal and state laws. All qualified applicants will be considered without regard to race, color, religion, sex, national origin, age, marital and veteran's status, or disability.

PERSONAL

/ Name
DATA / Address
Home Phone / ( ) / Best Time
To Call
Day Phone / ( ) / Best Time
To Call
Social
Security #
Are you over 18 years of age? / Y / N

EMPLOYMENT

/ Position Sought
DESIRED / Desired Start Date
Have you ever applied at AstenJohnson before? / Y / N
If yes, when and where?
Have you ever worked at AstenJohnson before? / Y / N
If yes, when and where?
Do you have relatives working at AstenJohnson? / Y / N
Is overtime acceptable? / Y / N
Is weekend work acceptable? / Y / N
Is shift work acceptable? / Y / N
Do you want to work full-time? / Y / N
Would you consider part-time work? / Y / N
Are you legally eligible for employment in the United States? / Y / N
Are you employed now? / Y / N
If yes, may we inquire of your present employer? / Y / N
If hired, do you have reliable transportation? / Y / N
Summarize skills, experience, special training which will be of special benefit in the job for which you are applying.

OTHER

/ Have you ever been convicted of a felony? / Y / N
INFORMATION / If yes, please explain fully. (A criminal record will not necessarily disqualify you from employment with AstenJohnson, but will be considered as it relates to the job being applied for.)

EMPLOYMENT

/ List all Employment History, starting with most current.
HISTORY / Company Name and Phone / Start
Date / Starting
Salary / Immediate
Supervisor
Location and Type of Business / End
Date / Ending Salary / Reason for
Leaving
Description of the work you did
Company Name and Phone / Start
Date / Starting
Salary / Immediate
Supervisor
Location and Type of Business / End
Date / Ending Salary / Reason for
Leaving
Description of the work you did
Company Name and Phone / Start
Date / Starting
Salary / Immediate
Supervisor
Location and Type of Business / End
Date / Ending Salary / Reason for
Leaving
Description of the work you did
NOTE: Use a separate piece of paper for previous employment information (if necessary).
By signing above, I hereby give permission to contact the employers listed above concerning any information you deem relevant. If there are particular employers I do not wish you to contact, I have indicated them below.

MILITARY

/ Branch of
Service / Rank at
Discharge
INFORMATION / Period of Active Duty
(month & year) / From / To
Describe your duties and special training

EDUCATION

/ High School Name and Location
Highest Grade Completed / 8 / 9 / 10 / 11 / 12 / GED? / Y N
College Name and Location
Highest Year Completed / 1 / 2 / 3 / 4 / 5 / 6 / +
Degree(s) Earned
Describe Any Other Training, Education, or Certificates You Have:

REFERENCES

/ Give the names of three people that you have known at least one year and who are not related to you.
Name / Phone Number / Profession / Years Known
( )
Name / Phone Number / Profession / Years Known
( )
Name / Phone Number / Profession / Years Known
( )
In submitting this application for employment, I hereby authorize AstenJohnson to conduct a routine inquiry into my personal and employment history concerning my qualifications, skill, character, general reputation, personal characteristics, and mode of living. I further authorize the companies, schools, persons, and other organizations named above to give any information regarding my employment together with any other information they have regarding me, whether or not it is in their written records and hereby release said companies, schools, persons, or organizations from all liability and damage for issuing this information.
I understand that actual employment will be conditioned on results of a medical examination taken by physicians after an official offer of employment. I also understand that any employment offer and/or actual employment will be conditioned on results of a mandated drug and alcohol test specified by AstenJohnson. I also understand that, as a condition of employment, and prior to beginning work, I may be required to sign a standard Associate Agreement of ideas, inventions, and patents, and non-disclosure and non-use of confidential information.
I also understand that should I be employed by the Company, my employment relationship will not be contractual, except to the extent that it is governed by any collective bargaining agreement. If the position being applied for is covered by a collective bargaining agreement, I understand that the terms and conditions of my employment will be controlled by such agreement. In the absence of a collective bargaining agreement, I understand that my employment will be at-will, meaning that neither the Company nor any associate are bound to any specific rules, policies, procedures, benefits, working conditions, or privileges of employment or to a specific or definite period of employment. Rather, any employment relationship that arises may be ended at any time by me or the Company for any reason.
With my signature below, I certify that I am not a party to any contract or agreement that would limit or restrict me in any way in performing any job duties with AstenJohnson., or its affiliates, could assign to me. Additionally, I certify that I do not have any business or financial interest that could create a conflict of interest with my being employed by AstenJohnson, or any of its affiliates.
I certify that the facts set forth in my application for employment are true and complete to the best of my knowledge. I understand that any false statements, misrepresentations, or omission of facts called for, may result in refusal to hire or my dismissal if discovered after hired.

* THIS APPLICATION VOID AFTER 30 DAYS UNLESS RENEWED BY THE APPLICANT *

SignatureDate

FORM-Application

Rev. 10/1/99