Engineered Arresting Systems Corporation

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Application for Position

ESCO - Zodiac Aerospace

2550 Market Street
Aston, PA 19014

AN EQUAL OPPORTUNITY EMPLOYER

PLEASE COMPLETE ALL INFORMATION REQUESTED IN THIS APPLICATION

PERSONAL DATA
Last First Middle
Name Date
Social Security Number Telephone Number
Address City State Zip
Position Desired Salary Requirement $
If employed, when could you start?   Are you between the ages of
18 and 70? Yes No
It is the intention of ESCO-ZA to hire only legally authorized workers. If requested, can you provide proof of your legal right to work and remain in the United States?
Yes No
Do you have any relatives employed with this company? Yes No
If Yes, whom? Relationship
How were you referred to ESCO-ZA? If responding to ad, which paper?
Are you willing to travel? Yes No
If Yes, % of time Overnight Weekends Overseas
May we contact your present employer prior to any employment offer? Yes No
May we call you at your current employer? Yes No
EMPLOYMENT HISTORY
Starting with your present or most recent employer, list all positions held.
Employer (Present
or Most Recent)		 Telephone #
Address
Position Title Immediate
Supervisor
Reason for Leaving
Describe your main
responsibilities
and achievements
Date Started Date Terminated
Starting Salary $ Per Final Salary $ Per
Employer (Next
Previous)		 Telephone #
Address
Position Title Immediate
Supervisor
Reason for Leaving
Describe your main
responsibilities
and achievements
Date Started Date Terminated
Starting Salary $ Per Final Salary $ Per
Employer (Next
Previous)		 Telephone #
Address
Position Title Immediate
Supervisor
Reason for Leaving
Describe your main
responsibilities
and achievements
Date Started Date Terminated
Starting Salary $ Per Final Salary $ Per
Employer (Next
Previous)		 Telephone #
Address
Position Title Immediate
Supervisor
Reason for Leaving
Describe your main
responsibilities
and achievements
Date Started Date Terminated
Starting Salary $ Per Final Salary $ Per
EDUCATION
Name and Location of High School Diploma Received?
Yes No
Names and Locations of
Colleges, Universities
and Institutes		 No. of
Years
Attended		 Degree
Received		 Curriculum
1) Major
Minor
2) Major
Minor
3) Major
Minor
Trade or Business School (or Other Special Training)
Name and Location
of School		 Did You
Graduate?		 Major Course
of Study		 Average
Grade		 Certificate
Awarded?
1) Yes No Yes No
2) Yes No Yes No
3) Yes No Yes No
REFERENCES
List three (3) people, preferably past supervisors, who can tell us about your qualifications. Do not include relatives.
Name Business Address
Telephone # Occupation Years Known
Name Business Address
Telephone # Occupation Years Known
Name Business Address
Telephone # Occupation Years Known
GENERAL
Ever convicted for other than traffic violations? Yes No
If so, where? When?
Nature of Offense
Do you have any impairments, physical, mental, or medical which would interfere with your ability to perform the job for which you applied? Yes No
If Yes, explain
Are there any positions or types of work for which you should not be considered because of the above? Yes No
If Yes, explain
Have you signed an agreement with your past or present employer not to work for a competitor? Yes No
Have you signed an agreement with your past or present employer assigning any inventions you have or will make or conceive during a specified period following termination of employment? Yes No
PROFESSIONAL ACHIEVEMENTS
Please describe patent activity and/or major papers which you may have had published in professional journals and/or any other significant achievements related to your profession.
Please describe your professional activities outside of employment. Name professional and technical societies including offices held. List any honors, awards or other professional recognition.

U.S. MILITARY SERVICE
Branch of Service Rank at Discharge
Serial or File No. Are You a Vietnam Era Veteran? Yes No
Type of Training and Experience (Service Schools, Special Training, U.S. or Foreign Duty, Etc.)
SKILLS INVENTORY
If you are applying for either a CLERICAL/OFFICE or MANUFACTURING/SHOP position, please check the equipment you can operate with some level of proficiency as listed in the appropriate section below.
CLERICAL/OFFICE MANUFACTURING/SHOP
Typewriters   WPM:
Dictaphone Transcribing Machine
Telex
Facsimile
PBX Telephone Switchboard Console
PC Computer
Identify System(s):
Software Programs Used:
Dedicated Word Processing Systems
Identify System(s):
Options: (i.e.—equations,
communication, etc.)
Calculator
Blueprint Machine
Take Shorthand   WPM:
Torque Wrench
Tube Benders
Tube Cutters
Flare & Flareless Fittings
Air Power Tool
Electric Power Tools
Taps
Milling Machine
Lathe
Drill Press
Grinder
Punch and Shear
Table or Floor Saw
Forklift
Read Blueprints
Air Spray Equipment
Airless Spray Equipment
Grit Blast and Recovery System
Enamel Paint Application
Polyurethane Paint Mixing & Application
Knowledge of Basic Rigging

READ CAREFULLY BEFORE SIGNING

I certify that the information contained in this Application and other required documents is true and accurate to the best of my knowledge. I understand that any misrepresentation of such information or any false statements made by me shall be sufficient cause for denial of employment or discharge.

I grant the Company permission to check any of the information submitted by me and to make a thorough investigation of my past employment, education and activities. I authorize all persons, companies and organizations, (including credit bureaus, schools and law enforcement agencies) to furnish any information about me requested by the Company. I release the Company and all persons or entities supplying such information from all liability for any damage which may result from furnishing information to the Company. The use of a reproduced copy of this document will also be recognized as the original.

I understand that nothing contained in the Application or in the granting of an interview is intended to create an employment contract. No promises regarding employment have been made to me. I further understand that any offer of employment is subject to signing of the Company's Invention and Proprietary Agreement and satisfactory completion of a physical examination.

I also understand that, for reasons of health, safety and security, the Company requires me to submit to a substance abuse testing as part of the required medical evaluation. My urine specimen will be screened for drugs including, but not limited to, THC (marijuana), cocaine, opiates and PCP. If my test result indicated traces of drugs other than drugs prescribed under medical supervision, I understand that the result will affect my employment status with the Company.

If employed, I agree to abide by all Company policies and procedures which are in effect or may be established in the future. I also understand that my employment can be terminated at any time with or without cause, and with or without advance notice, at the option of the Company or myself.

By clicking the Applicant Signature checkbox below, you signify that you have read, understand and agree to these terms.

Applicant Signature

Applicant Data Record

Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or disability.

As employers/government contractors, we comply with government regulations and affirmative action responsibilities.

Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Applicant Data Record. We appreciate your cooperation.

This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.

Name:
Last First Middle
Date:
Position(s) Applied For:
Referral Source: Advertisement
Friend
Relative
Walk-in
Employment Agency
Other  

AFFIRMATIVE ACTION SURVEY

Government agencies require periodic reports on the sex, ethnicity, disability and veteran status of applicants. This data is for analysis and Affirmative Action only. Submission of information is voluntary.

Check one: Male
Female
Check one of the following: White
Black or African American
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaskan Native
Hispanic or Latino (White Race)
Hispanic or Latino (All Other)
Check if any of the following
are applicable:		 Vietnam Era Veteran
Disabled Veteran
Disabled Individual