CAREER

Application For Employment

ABOUT OUR COMPANY

Date of Application

PERSONAL INFORMATION

First Name

Last Name

Middle Initial

Address (Street)

City

State

Zip Code

Telephone

Social Security Number

If you are under 18 years of age, do you have a work permit?

YesNo

If you have ever worked under another name, please identify

YOUR JOB INTERESTS

Position Desired

Date you can start work

What starting salary or wage do you expect

/hour /week /month

Are you available for full-time work?

YesNo

Are you available for part-time work?

YesNo

Are you willing to work any shift?

YesNo

Are there any days of the week when you would not be available to work? Please specify

YOUR EDUCATION AND TRAINING

Please Select Highest Grade Completed

Grade Schoo

12345678

High School

9101112

College

12345

Trade/Tech

1234

What was the last school you attended?

What extracurricular activities did you participate in, or special skills did you acquire, at the above-circled
school(s) which might be helpful for the job in which you are applying?

YOUR WORK EXPERIENCE

Beginning with your present or more recent employer, describe your employment experiences below:

Are you presently employed?

YesNo

Are you on layoff and subject to recall?

YesNo

If yes, to where?

1. Present or Last Employer

Address

Kind of Business

Phone

Starting Position

Pay $

Final Position

Pay $

Dates Employed: From

Dates Employed: To

Name & Title of Supervisor

Description of Your Work and Responsibilities

Reason for Leaving

Will you receive a satisfactory reference from this employer?

YesNo

If "No", please explain

May we contact your present employer at this time

YesNo

If "No", please explain

2. Next Previous Employer:

Address

Kind of Business

Phone

Starting Position

Pay $

Final Position

Pay $

Dates Employed: From

Dates Employed: To

Name & Title of Supervisor

Description of Your Work and Responsibilities

Reason for Leaving

Will you receive a satisfactory reference from this employer?

YesNo

If "No", please explain

May we contact your present employer at this time

YesNo

If "No", please explain

3. Next Previous Employer:

Address

Kind of Business

Phone

Starting Position

Pay $

Final Position

Pay $

Dates Employed: From/p>

Dates Employed: To

Name & Title of Supervisor

Description of Your Work and Responsibilities

Reason for Leaving

Will you receive a satisfactory reference from this employer?

YesNo

If "No", please explain

May we contact your present employer at this time

YesNo

If "No", please explain

4. Next Previous Employer:

Address

Kind of Business

Phone

Next Previous Employer:

Address

Kind of Business

Phone

PERSONAL INFORMATION

Do you have, or have you applied for the legal right to remain permanently and work in the United States?

YesNo

Have you ever been discharged or asked to resign by an employer?

YesNo

If yes, please explain

A record of criminal conviction will not necessarily be a bar to employment, since the Company will consider factors such as age, time of the offense, the nature and seriousness of the violation, and the evidence of rehabilitation in making any employment decision.

Have you ever been convicted of a crime, other than minor traffic violations?

YesNo

If your answer is yes, please explain

Please complete this section if the job for which you are applying might require you to drive Company vehicles

Do you have a valid driver's license?

YesNo

License number and state

Have you had any accidents in the last five years?

YesNo

If yes, please give details

Have you been cited for any moving violations in the last five years?

YesNo

If yes, please give details

Has your driver's license ever been suspended, revoked, denied or cancelled?

YesNo

Yes please explain

YOUR MILITARY EXPERIENCE

Completing this section of the application is optional. Leave this area blank if you do not wish to answer.

Have you ever been in the United States Armed Services?

YesNo

What branch?

Describe any skills you acquired in the Service which would be useful to the job for which you are applying

YOUR REFERENCES

Completing this section of the application is optional if you have listed at least two (2) available work references.

List the names of any professional or personal character references who have known you for the last three years and from whom you can obtain letters of recommendation. Please do not list relatives:

1- Name

Occupation

Address

City

Phone

Relationship to Applicant

2- Name

Occupation

Address

City

Phone

Relationship to Applicant

3- Name

Occupation

Address

City

Phone

Relationship to Applicant

PLEASE READ THE FOLLOWING PARAGRAPHS CAREFULLY

By signing below, I certify that I have read, understand, and agree to each of the following statements:

All of the information I have supplied on this application is true, accurate, and complete, to the best of my knowledge, and I have not knowingly withheld any information which, if know to the Company, would affect my application unfavorably.

If I am hired by the Company, and if the Company discovers at any time during my employment that any of the statements or answers on this application are false, misleading, or incomplete, I may be dismissed immediately from my job.

This employment application will be considered active for ninety (90) days from the date below. If I want to be reconsidered for a job with the Company after this period of time, I must fill out another application.

I agree to submit to a medical examination which may include testing for drugs or alcohol prior to beginning work with the Company. I understand that any job offer I may receive is contingent upon the successful completion of the medical exam and a background check. If the results of either the medical exam or the background check are unsatisfactory to the Company, I understand that the offer will be withdrawn. I understand that if I am employed by the Company, I may be required, when job related and consistent with the Company's business needs, to undergo a medical examination or testing for alcohol. I further understand that I may be required to submit a test for the use of illegal drugs at any time.

In consideration of my employment with the Company, I agree to abide by all the Company's rules and regulations.

I understand that nothing in this employment application creates a contract of employment between me and the Company. If ! am hired by the Company, my employment and compensation are "at will," which means that my employment can be terminated, either by the Company or me, with or without cause, and with or without notice. I understand that no manager or supervisor has the authority to make any employment agreement with me, either orally or in writing, that is not an at will agreement. Only the President of the Company has the authority to enter into an employment agreement with me for any specified period of time.

I agree to release the Company or its designated agents of all medical information, including but not limited to files, reports, X-rays, evaluations, and opinions held by medical personnel, to the extent such information is job related and consistent with the Company's business needs. I acknowledge that this is a general release and that if hired, it remains in effect for the duration of my employment.

In the event of my personal indebtedness to the Company, I authorize the Company to withhold from my wages such amounts as permitted by law to satisfy my obligation to the Company.

I give the Company permission to contact any of my previous employers, schools, colleges and other references I have listed on this application to determine my qualifications for assuming a job with the Company.

Date

Signature

GENERAL PLUG & MANUFACTURING CO.

FAIR CREDIT REPORTING ACT DISCLOSURE AND AUTHORIZATION STATEMENT

TO: ALL APPLICANTS FOR EMPLOYMENT

PLEASE READ CAREFULLY BEFORE SIGNING BELOW.

In processing my application for employment, I understand that General Plug & Manufacturing Co. may obtain or have prepared a consumer or investigative consumer report for employment purposes, concerning my prior employment, military record, education, credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, criminal background record, driving record, or mode of living.

I understand that upon written request to General Plug & Manufacturing Co., I will be informed whether an investigative consumer report was requested, and given full information as to the nature and scope of this investigation. (I understand that an investigative consumer report is a report in which information concerning my character, general reputation, personal characteristics, or mode of living, is obtained through personal interviews or reports with, neighbors, friends, associates with whom I am acquainted or any other third party.)

By signing below, I am authorizing General Plug & Manufacturing Co. to obtain a consumer or investigative consumer report on me as part of the General Plug & Manufacturing Co. pre-employment background screening process. If I am offered employment by General Plug & Manufacturing Co., I further authorize General Plug & Manufacturing Co. to obtain additional consumer or investigative reports on m employment purposes at any time during my employment.

Name of applicant

Signature of applicant

Date signed