APPLICATION FOR EMPLOYMENT

Prospective employees will receive consideration without discrimination for any reason in any manner prohibited by law.

Please let us know if you need an accommodation to complete this application.

Instructions to Applicant:

APPLICATION MUST BE COMPLETED IN FULL, EVEN IF SUBMITTING A RESUME, TO BE CONSIDERED.

PERSONAL DATA


Yes No


Yes No     


Yes No     


Yes No     

Full Time Part Time             Yes No

Yes No

EMPLOYMENT DATA

Please give complete full-time and part-time employment records on application, EVEN IF RESUME IS ATTACHED. Start with present or most recent employer. Account for all time periods over the last 10 years including unemployment, self-employment and military service.

To:

To:

To:

To:

We contact previous employers for employment references. If there are any you do not want contacted, please indicate:

EDUCATION DATA

Yes No

JOB RELATED SKILLS/EXPERIENCE

PROFESSIONAL REFERENCES

Please list individuals (excluding relatives) whom you have known in a professional capacity and who are familiar with your qualifications and skills.

SPECIAL EMPLOYMENT NOTICE - DRUG FREE WORKPLACE ACT

As a Department of Defense Contractor, Micro Systems, Inc. has a Drug Free Workplace Program in effect. Part of this plan requires job applicant drug screening for all applicants being considered for employment. If you feel you would not successfully pass a drug screen test, please do not complete the remainder of this application without first discussing the matter with Micro Systems, Inc. Human Resource Department.

Upon acceptance of an offer of employment you will be required to report to a testing facility and submit to a drug screen test. Offers of employment are contingent upon successful completion of the drug screen.

SPECIAL EMPLOYMENT NOTICE TO DISABLED VETERANS, VIETNAM ERA VETERANS AND INDIVIDUALS WITH DISABILITIES

Government contractors are subject to the Vietnam Era Veterans Readjustment Assistance Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified veterans and the Americans with Disabilities Act of 1990 which requires Government contractors to take affirmative action to employ and advance in employment qualified individuals with disabilities.

If you are a disable veteran, Vietnam Era veteran or individual with a disability, you are invited to volunteer this information following an offer of employment. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your employment.

APPLICANT ACKNOWLEDGEMENT

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and correct to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and be considered justification for dismissal if discovered at a later date.

I understand that my employment (should such be offered) can be terminated, with or without cause, at any time at the discretion of Micro Systems, Inc. or myself. I understand that no management official other than the President of Micro Systems, Inc. has any authority to enter into any agreement contrary to the foregoing or make an oral assurance or promise of continued employment.

I authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and accompanying resume, if any) to provide any relevant information that may be required to arrive at an employment decision.