APPLICATION FOR EMPLOYMENT

Strong Industries is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the
basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.

NAME: _______________ _______________ _______________ DATE: ___________

LAST FIRST MIDDLE MM/DD/YYYY

ADDRESS: _______________ _______________ _______________ ____ ___________

NUMBER/STREET APT/PO BOX CITY STATE ZIP CODE

PHONE #’S: (___) ___ __ ____ (___) ________ (___) __________ EMAIL: ___________
HOME CELL WORK

POSITION DESIRED: ___________________________ FULL TIME [] PART TIME [ ]

DATE AVAILABLE: ___________ SALARY DESIRED: $________ HOURLY $________ ANNUALLY

MM/DD/YYYY

ARE YOU OVER 18 YEARS OLD? YES NO

HAVE YOU EVER BEEN EMPLOYED BY STRONG INDUSTRIES? YES NO IF YES, WHEN _________________________

ARE YOU LEGALLY ELIGIBLE TO WORK IN THE UNITED STATES? YES NO

IF OFFERED EMPLOYMENT, YOU WILL BE REQUIRED TO PROVIDE DOCUMENTATION TO VERIFY ELIGIBILITY.

IN THE PAST 5 YEARS, HAVE YOU BEEN CONVICTED OF A CRIME OTHER THAN MINOR TRAFFIC OFFENSE? YES NO
IF YES, PROVIDE DATES AND EXPLAIN: ________________________________________________________________________
A CONVICTION WILL NOT DISQUALIFY YOU FOR EMPLOYMENT.

HIGH SCHOOL: DIPLOMA: YES NO G.E.D.: YES NO

SCHOOL(S): ____________________________________ CITY: ____________________ STATE: ____

COLLEGE AND/OR VOCATIONAL SCHOOL:

SCHOOL(S): ____________________________________ CITY: ____________________ STATE: ____

MAJOR: ____________________________________ DEGREES EARNED: ___________________________

OTHER TRAINING OR DEGREES:

SCHOOL(S): ____________________________________ CITY: ____________________ STATE: ____

MAJOR: ____________________________________ DEGREES EARNED: ___________________________

Please list your most recent employer first.

May we contact your present employer? Yes [ ] No [ ]

1. Employer: ____________________________________ From: ______ To: ______

Mo/Yr Mo/Yr

City: ____________________ State: ____ Phone #: (___) __________

Position: ________________________________ Duties: ___________________________________

Salary $__________ Supervisor:_____________ Reason for Leaving: ____________________________

2. Employer: ____________________________________ From: ______ To: ______

Mo/Yr Mo/Yr

City: ____________________ State: ____ Phone #: (___) __________

Position: ________________________________ Duties: ________________________________ ______

Salary $__________ Supervisor:_____________ Reason for Leaving: ____________________________

3. Employer: ____________________________________ From: ______ To: ______

Mo/Yr Mo/Yr

City: ____________________ State: ____ Phone #: (___) __________

Position: ________________________________ Duties: ________________________________ ______

Salary $__________ Supervisor:_____________ Reason for Leaving: ____________________________

4. Employer: ____________________________________ From: ______ To: ______

Mo/Yr Mo/Yr

City: ____________________ State: ____ Phone #: (___) __________

Position: ________________________________ Duties: ________________________________ ______

Salary $__________ Supervisor:_____________ Reason for Leaving: ____________________________

If you wish to describe additional work experience, attach the above information for each position on a separate piece of paper.

Explain any gaps in work history: _______________________________________________________________________________

___________________________________________________________________________________________________________
REFERENCES:

Professional Personal
Name: ______________________ Name: ______________________

Phone #: (_____)________________ Phone #: (_____)________________

Relationship: ____________________ Relationship: ____________________

Name: ______________________ Name: ______________________

Phone #: (_____)________________ Phone #: (_____)________________

Relationship: ____________________ Relationship: ____________________

Name: ______________________ Name: ______________________

Phone #: (_____)________________ Phone #: (_____)________________

Relationship: ____________________ Relationship: ____________________

APPLICANT'S CERTIFICATION AND AGREEMENT

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and
authorize Strong Industries to verify their accuracy and to obtain reference information on my work performance. I hereby release
Strong Industries from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an
employment decision based on such information.

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered
sufficient basis for dismissal.

I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and
regulations of employment of the Employer. However, I further understand that the policies, rules, regulations of employment, or
anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand
that any employment offered is for an indefinite duration and at will and that either I or Strong Industries may terminate my
employment at any time with or without notice or cause.

This application will be held on file for a period of 6 months.

By providing my printed name below, I hereby certify that the data contained herein is a true and accurate representation of my
credentials.

Signature of Applicant: _____________________________ Date: __________