<p> APPLICATION FOR EMPLOYMENT</p><p>Date: </p><p>Name Last First Middle Initial Present Address </p><p>No. Street</p><p>City State Zip Phone Number</p><p>Position(s) applying for </p><p>Rate of pay desired $ (annualized) or $ per hour</p><p>If your application is considered favorably, date available for work </p><p>Do you have a valid Florida driver’s license: Yes No . If No and position applying for requires a driver’s license, are you eligible to obtain a Florida driver’s license Yes No </p><p>Do you have any physical or health conditions which may limit your ability to perform the particular job for which you are applying? If yes, describe such condition </p><p>Were you previously employed by us? If yes, when? </p><p>Are you legally eligible for employment in the United States? Yes No </p><p>Are there any educational or other experiences, skills or qualifications which make you uniquely qualified to fill the position(s) you are applying for? </p><p>(additional pages may be attached to this application, if necessary)</p><p>If applying for engineer position, are you licensed in the State of Florida? If yes, give license number . Are you licensed in any other states? </p><p>If yes, give state and license number 04/21/15</p><p>04/21/15 List below all present and past employment, beginning with your most recent Additional information may be provided on supplemental sheets or by attaching a Resume. I From To Describe the Weekl Weekl Name & address of work y y Reason Name of Company & type of Mo. Yr. Mo. Yr you did Starti Last for Supervisor business ng Salary Leaving Salary</p><p>Phone:</p><p>II From To Describe the Weekl Weekl Name & address of work y y Reason Name of Company & type of Mo. Yr. Mo. Yr you did Starti Last for Supervisor business ng Salary Leaving Salary</p><p>Phone:</p><p>III From To Describe the Weekl Weekl Name & address of work y y Reason Name of Company & type of Mo. Yr. Mo. Yr you did Starti Last for Supervisor business ng Salary Leaving Salary</p><p>Phone:</p><p>IV From To Describe the Weekl Weekl Name & address of work y y Reason Name of Company & type of Mo. Yr. Mo. Yr you did Starti Last for Supervisor business ng Salary Leaving Salary</p><p>Phone:</p><p>DO NOT CONTACT We may contact the employers listed above unless Employer(s) ______you indicate those you do not want us to contact. Reason:</p><p>PERSONAL REFERENCES (Not Former Employers or Relative(s)) Name and Occupation Address Phone Number</p><p>04/21/15 The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause of dismissal. You are hereby authorized to make any investigation of my personal history, references and others with whom I am acquainted.</p><p>Signature of Applicant (emailing this document constitutes a legal signature)</p><p>04/21/15</p>