Strategic Systems Technology, Inc. Employment Application

(PLEASE PRINT IN BLACK INK OR TYPE) Personal . Last Name: First Name: Middle Initial: Date:

______Street Address: City: State: Zip Code

______Home Phone: Work Phone: Social Security Number:

Email Address: ______Please state name, relationship and company location of any relatives employed by Strategic Systems Technology, Inc. Name: Relation: Location: ______How did you learn of employment opportunities at Strategic Systems Technology, Inc.? __ Advertisement: ______Date ______

Referred By: ___ Walk-in ___ Friend ___ Employment agency ___ Relative ___ College Recruiter ___ Staff Member (Please specify): ______Type of Position Applied for/desired: Geographic Preference: Date available: Salary Desired: ______Have you ever worked for Strategic Systems Technology ? ___ Yes ___ No If yes, please indicate: Division: Location: Dates of employment: .. .. Have you ever applied for a position with Strategic Systems Technology ? ___ Yes ___ No If yes, please indicate: Position applied for: Division/Location: Date of application: ______Education .

Name of School Location From To Major/Courses Credits Degree

High School

College/University

Business/Tech School

Other education or special training including military service schools, etc. ______

0c6ba17b45434d6a4d1377bbf8e15f88.doc 1 Honors & Achievements . Professional/Technical Societies affiliations:

______Professional/Technical publications of which you are the author or patents that you hold:

______Honors & Awards

______Professional licenses held (i.e. Professional Engineer):

______Security . Are you a citizen of the United States? ___ Yes ___ No ______Have you ever held a Federal Government security clearance? ___ Yes ___ No If yes, indicate date, agency and current status below: ___ Confidential ___ Secret ___ Top Secret ___ SCI ___ Other ______

Have you ever had a security clearance denied, revoked, ___ Yes ___ No Or suspended? If yes, give details.

Are you aware of anything which might adversely affect your ___ Yes ___ No Obtaining a security clearance? If yes, explain:

______Have you ever been convicted for violating any federal, state, county or municipal law, regulation or ordinance which might prevent you from obtaining a security clearance? If yes, give date, place, charge and disposition. Do not include traffic violations for which the only penalty was a fine. ___ Yes ___ No

______Have you ever signed an employment agreement which would preclude or restrict your employment with Strategic Systems Technology in any way/ ___ Yes ___ No If yes, explain: Employment agreement signed with ______Date ______Conditions of the agreement ______Agreement period ______Geographic territory covered ______Products covered ______Military . Veteran ___ Yes ___ No Branch of Service: ______Dates of Service: ______

Highest Rank or Grade Type of discharge Draft status Anticipated release date

Member of Reserve ___ Yes ___ No ___ Ready Reserve ___ Standby National Guard (active) (inactive) ______Duties and responsibilities:

______

0c6ba17b45434d6a4d1377bbf8e15f88.doc 2 If additional space is needed please use reverse side of page. Employment History . Start with your present or most recent employment. Include any job-related military service assignments – treat each permanent change of duty as a separate job entry. Account for all periods of employment and unemployment. DO NOT REFERENCE YOUR RESUME.

Employer: Dates Employed Job Responsibilities/ From To Significant Accomplishments Address:

Telephone number(s) Hourly Rate/Salary Starting Final Job Title: Supervisor:

Reason for leaving: Full Time Part Time

May your present supervisor/employer be contacted: ___ Yes ___ No

If More space is needed for Employment History , please attach additional sheets.

0c6ba17b45434d6a4d1377bbf8e15f88.doc 3 Employment History continuation sheet

0c6ba17b45434d6a4d1377bbf8e15f88.doc 4 Job-Related Volunteer Activities .

Professional References .

These should be persons who are familiar with your qualifications. Please complete all sections

Name/Title Organization where Years Address Phone Number person is employed Known

Permission is granted to contact the above references other than the current employer: ___ Yes ___ No

Current Employer: ___ Yes ___ No

Applicant’s Pre-Employment Statement .

I authorize Strategic Systems Technology, Incorporated to obtain information regarding my employment and academic records from former employers, education officials and persons listed herein as references, and I release Strategic Systems Technology, Inc. from any liability in connection therewith.

I understand that employment with Strategic Systems Technology, Inc. is conditional upon a federally approved laboratory test for the detection of controlled substances or other illegal drugs, the presence of which may be used as grounds to deny me employment. I further understand that, should I be employed by Strategic Systems Technology, Inc., my continued employment shall be conditioned upon the successful completion of drug screening tests upon the request of the company.

I understand that should I be employed by Strategic Systems Technology, Inc., I will be required to provide, on my first day of employment, documents providing proof of my identity and employment eligibility status in accordance with the Immigration Reform and control Act of 1986 (IRCA). I acknowledge that this verification is a condition of employment and that failure to comply will void any offer of employment. I understand, also, that I may be required to receive and retain security clearances if and as required by government regulations, and further, that such employment is subject to the policies and regulations of Strategic Systems Technology.

I understand that in order to comply with company policy, Strategic Systems Technology’s offers of employment are limited to those contained in written offer letters to prospective employees. I also understand that any verbal discussions of terms or conditions of employment by the company representatives are not binding upon the company unless confirmed in such offer letters.

I certify that the information contained in this application or any supplement thereto, is correct and complete to the best of my knowledge. I understand that any false statements or misrepresentations made by me on this application or any supplement thereto, will be sufficient grounds for rejection of the application or immediate discharge after employment.

I understand and agree that employment with Strategic Systems Technology, Incorporated is on an “at will” basis and I can be terminated or my position can be terminated, with or without cause, and without prior notice, at any time at the option of either the company or myself.

0c6ba17b45434d6a4d1377bbf8e15f88.doc 5 Applicant’s signature ______Date ______

0c6ba17b45434d6a4d1377bbf8e15f88.doc 6