Application for Employment s91

AHNTECH ® — — — — — — — I n n o v a t i o n T h r o u g h T e c h n o l o g y APPLICATION FOR EMPLOYMENT

Position Date INSTRUCTIONS: Fill in all information. If something is not applicable, please write “N/A”. Incomplete applications will not be considered for employment. Complete the form using Microsoft Word 97 or print in ink. Upcoming graduates attach a course work transcript. Overflow information may be put in the remarks section. Return via E-mail, fax, US mail or other means.

Last Name First Name Middle Name Social Security Number

Current Address City State Zip Code Telephone

Full-time Part-time Temporary Other

Date Available for employment: Are you available to work any shift? Yes No Are you available to work part-time? Yes No Will you work overtime? Yes No

COMPUTERS Can you utilize computers? Yes No Which Operating Systems? Name software/language/hardware:

YES NO GENERAL INFORMATION CHECK YES OR NO AND GIVE EXPLANATIONS WHERE APPLICABLE Upon hire, can you submit verification of your legal right to work in the U.S.? U. S. Citizenship may be required if access to Classified information is necessary in performance of job duties. Are you under 18 years of age? Have you ever applied to AHNTECH, Inc. before: If so, date(s): Do you have relatives employed at AHNTECH, Inc.? If so, give name(s): Are you a former DOD civilian employee? If yes, give date of retirement/separation, agency/grade:

If former DOD, did you perform procurement-related functions in connection with AHNTECH, Inc.? Have you ever served or are you currently serving in the U. S. Armed Forces? If yes, designate; branch, Rank/Grade, and Length of Service: Were you separated for any reason other than honorable discharge? Do you currently, or have you in the past held a security clearance? If so, give level, agency, and last date held:

Have you ever had a security clearance suspended, denied or revoked? If yes, where employed and date:

Are you available to relocate: If so, list geographical preferences:

3333 Camino del Rio South, Suite 120, San Diego, CA 92108-3836 * (619) 516-5900 * Fax: (619) 516-5955 * www.ahntech.com

1 EMPLOYMENT HISTORY Show all employment you have held during the past 10 years starting with the most recent. Include periods of unemployment and military service. Indicate number of hours per week for employment. In order to verify education and employment, please list any other former legal names by which you have been known, where applicable. Salary means current salary as of the application date. Do not include bonuses. This information will be verified prior to employment. Dates of Employer, Complete Address Employment & Phone No. Title/Duties Performed Reason for Leaving From: To: Phone No: Salary: Start: /yr Supervisor: End: /yr OK to Contact? Yes No From: To: Phone No: Salary: Start: /yr Supervisor: End: /yr OK to Contact? Yes No From: To: Phone No: Salary: Start: /yr Supervisor: End: /yr OK to Contact? Yes No From: To: Phone No: Salary: Start: /yr Supervisor: End: /yr OK to Contact? Yes No SERVICE CONTRACT ACT (SCA) EMPLOYEES How long have you been continuously employed by an SCA contractor at your present site, regardless of the name of the contractor? years (whole years only). EDUCATION Indicate highest grade completed in the block provided: Grade School: 1, 2, 3, 4, 5 , 6, 7, 8 High School: 9, 10, 11, 12 College: 1, 2, 3, 4, 5 Graduate School: 1, 2, 3, 4, 5 Post Graduate: 1, 2, 3, 4

Name & Location Attended Graduated Degree*/Diploma From/To (Mo. & Yr) Certificate Major High School

College(s) to

Graduate School(s) to

Other/Military/Trade to

AHNTECH requires verification of all degrees upon employment. * Specify number of college hours earned if no degree obtained:

3333 Camino del Rio South, Suite 120, San Diego, CA 92108-3836 * (619) 516-5900 * Fax: (619) 516-5955 * www.ahntech.com

2 SCHOLASTIC & PROFESSIONAL INFORMATION Scholastic honors, scholarships, etc.: List publications, thesis, etc.: Professional licenses or certificates: Membership in Professional or Technical Associations:

PROFESSIONAL REFERENCES Do not list relatives. Please list at least 3 available employers/supervisors. Full Name Occupation-Profession Complete Address

Number of years acquainted: Relationship: Telephone:

CONVICTION RECORD Have you ever been convicted by any law enforcement authority for any violation of any law, regulation or ordinance? Include any court-martial while in the military. Do not include violations for which the only penalty imposed was a fine for $50.00 or less: Offense Date City State Final Action

LICENSES EXPIRATION CURRENTLY TYPE STATE DATE ISSUING AUTHORITY VALID? YES NO Auto ATV Special Permit (Describe below under “Remarks”. Other

SPECIAL NON- VEHICULAR LICENSE: Crossover HAZMAT High Voltage Waste Water Other

REMARKS

3333 Camino del Rio South, Suite 120, San Diego, CA 92108-3836 * (619) 516-5900 * Fax: (619) 516-5955 * www.ahntech.com

3 EEO/AFFIRMATIVE ACTION VOLUNTARY INFORMATION

AHNTECH, Inc. is an Equal Opportunity/Affirmative Action Employer dedicated to a policy of non discrimination in all of its employment practices and does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, age, handicap or veteran status. In accordance with the various EEO and Affirmative Action statutes, we encourage all applicants to provide the information requested below. Submission of this information is entirely voluntary, and refusal to provide it will not subject you to any adverse treatment at any time prior to or during employment. All information provided will be kept in strict confidence.

Date of Birth: Race or National Origin

Sex: Male Female White (Non Hispanic) American Indian or Alaskan Native Disabled 1: Yes No Black (Non Hispanic) Asian or Pacific Islander Vietnam Vet 2 : Yes No Hispanic Disabled Veteran 3: Yes No 1 DISABLED: means an Individual with a disability, any person who (1) has a physical or mental impairment which substantially limits one or more of such person's major life activities, (2) has a record of such impairment or (3) is regarded as having such an impairment. 2 VIETNAM ERA VETERAN: means a person who served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975 or was discharged or released from active duty for a service connected disability if any part of such active duty was performed between August 5, 1964 and May 7, 1975. 3 DISABLED VETERAN: means a person entitled to disability compensation under laws administered by the VA for disability rated at 30 percent or more, a person whose discharge or release from active duty was for a disability or aggravated in the line of duty. REFERRED BY: Walk-In School/College Other (Please specify:) Newspaper Ad Agency Employee Referral State Employment Dept

I understand and agree that the information provided in this application will be relied upon by AHNTECH in considering me for employment, and I certify that all information provided is true, complete and correct and that I have not knowingly omitted any requested information. I further understand that any false or misleading statements or omissions made by me on this application or on any other Company records may subject me to immediate dismissal at any time during my employment.

I hereby authorize AHNTECH, Inc. to make a thorough investigation of my past employment and activities. I agree to cooperate in such investigation and I release AHNTECH, Inc. in connection with the furnishing or use of such information.

If employment is obtained under this application, I will willingly comply with all orders, rules, regulations and standards of conduct required by AHNTECH, Inc. and will agree to abide by AHNTECH standards of Business Ethics and Conduct.

I further understand that as a condition of employment by AHNTECH, Inc., I must comply with security procedures of the Company. For a position requiring a governmental security clearance, I must receive and retain the necessary clearance. This may require completion of a Government Personal Security Questionnaire and fingerprinting.

I understand that AHNTECH, Inc. is committed to maintaining a Drug Free Workplace, and I agree to comply with its Drug Free Workplace policy as a condition of employment.

I voluntarily submit this application and have read the above statements.

Signature (Leave blank if submitting via E-mail) Date

3333 Camino del Rio South, Suite 120, San Diego, CA 92108-3836 * (619) 516-5900 * Fax: (619) 516-5955 * www.ahntech.com