APPLICATION FOR ASSEMBLY

Name:
Street Address:
City, State & Zip Code:
Social Security Number:
Daytime Telephone Number:

How did you hear about Signal Dynamics Corporation?

If you are over 18 years of age, can you provide required proof of your eligibility to work?
Yes No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Yes No
(Please note: Proof of citizenship or immigration status will be required upon employment)

Have you ever filled out an application with us before?
Yes No If "Yes", give date:

Have you ever been employed with us before?
Yes No If "Yes", give date:

Do any of your friends or relatives, other than spouse, work for us?
Yes No If "Yes", state name and relationship:

Are you currently employed?
Yes No

If yes, may we contact your present employer?
Yes No

Date available for work:

EDUCATION

High School:
Course of Study:

City/State of School:
Years Completed:

College:
Course of Study:

City/State of School:
Years Completed:

Other (verify):
Course of Study:

City/State of School:
Years Completed:

WORK EXPERIENCE
Start with your present or last job. Include any job-related military service assignments and volunteer activities.

1.

Employer: Street Address: City, State, Zip: Telephone: Dates Employed: Reason for Leaving:
May we contact? Yes No
Work Performed:

Employer: Street Address: City, State, Zip: Telephone: Dates Employed: Reason for Leaving:
May we contact? Yes No
Work Performed:

Employer: Street Address: City, State, Zip: Telephone: Dates Employed: Reason for Leaving:
May we contact? Yes No
Work Performed:

ADDITIONAL INFORMATION
State any additional information you feel may be helpful to us in considering your application:

PERSONAL / PROFESSIONAL REFERENCES
Please list the names, telephone numbers and occupations of three (3) people you have known for at least one (1) year. Do not include the names of friends or family members.

1.

Name:
Occupation:
Telephone Number:

APPLICANT'S STATEMENT
Please read and indicate at the bottom of this form whether or not you accept.

I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signal Dynamics Corporation has established and maintains a drug-free workplace program. This drug-free workplace program is in conformity with chapter 440.102, Florida Statues, its implementing regulations, and Federal Law. I understand that receiving a conditional offer of employment, failure of a drug test or refusal to submit to drug testing when required by Signal Dynamics Corporation shall cancel or terminate any job offer. For an employee, failing a drug test or refusing to submit to a drug test will result in action against an employee up to and including termination of employment. I understand that if I receive a conditional offer of employment, I will: sign a consent form, provide an official photo ID (i.e., state-issued driver’s license or military ID card), I will be given an opportunity to confidentially report to the Medical Review Offer (MRO) both before and after being tested regarding the use of prescription or non-prescription medications. I understand that if I fail a drug test, I many challenge or explain the result within five (5) working days after written notification of the test result. I understand that will also have an opportunity to request a retest (at my expense). I understand that if my explanation or challenge is unsatisfactory, I may contest the drug test result pursuant to rules adopted by the Department of Labor and Employment Security or the Florida Agency for Health Care Administration. I understand that I also have the responsibility to notify the laboratory or clinic conducting the drug test of any administrative or civil action brought involving the drug test conducted by that laboratory or clinic. All test results will remain confidential except as allowed by law. Nothing in this notice will affect these right provided in any collective bargaining agreement between Signal Dynamics Corporation and its employees. Refusal to accept this notice will result in a withdrawal of any offer of employment.

I Accept I Do Not Accept

Thank you for your interest in Signal Dynamics Corporation! We will contact you if your skills and qualifications meet our needs.