Employment Application

You must fill in your own application. All questions must be answered for this application to be considered. This application will be considered current for 30 days from the date below. To be considered after that time you must renew your application in writing or fill out a new employment application. Martin & Bayley, Inc., is a drug free workplace and random drug testing may be required.

Personal Information Name: Date:   Last   First   Middle     Address: UNK AL AK AB AS AZ AR AA AE AP BC CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MB MD MA MI MN MS MO MT NE NV NB NH NJ NM NY NF NC ND MP NT NS OH OK ON OR PW PA PE PQ PR RI SK SC SD TN TX UT VT VI VA WA WV WI WY YT       Street Address City State Zip Code Phone:     Social Security Number: Are you 18 years or older: Yes No      Date of Birth: Do you have the legal right to work in the United States? Yes No  (upon employment you will be required to furnish written proof of citizenship or immigration status and written photographic proof of identification.) Position applied for: Rate of Pay Expected $: Do you prefer: Full Time Part Time Date available to start: Are you available to work all shifts: Yes No If not, specify days and hours available: What times of the day, days of the week or days during the year can you not work?

Do you intend to work anywhere else in addition to working at this company? YesNo  If Yes, where? How did you learn of this opening? Are you presently employed? YesNo  Name & Address of Employer: Why do you want to change jobs? Have you worked for the Company before? YesNo  If Yes, When? Where? Have you applied for work with the Company before? YesNo  If Yes, When? Where? Are you related to anyone employed by us? YesNo  If Yes, Name of relative, relationship, and location where relative works? If hired, how will you get to work? Have you ever been convicted of a crime?* Yes No  If Yes, Describe in full(dates, offense, punishmenet or outcome: * A conviction will not necessarily bar an applicant from employment. Are you able, with reasonable accommodation if necessary, to perform all of the duties of the job for which you are applying?  YesNo If No, explain:

Person to be notified in case of an accident or emergency: Name: Phone:   Last First     Address: UNK AL AK AB AS AZ AR AA AE AP BC CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MB MD MA MI MN MS MO MT NE NV NB NH NJ NM NY NF NC ND MP NT NS OH OK ON OR PW PA PE PQ PR RI SK SC SD TN TX UT VT VI VA WA WV WI WY YT     Street Address City State Zip Code

Educational Background   No. of Years Completed Name and Address of School Date of Graduation Course of Study or Degree Earned High School   College Other Government equivalent degree earned? If Yes - Where? When?

Employment and Armed Forces Experience From Mo./Yr. To Mo./Yr. Employer's Name, Address and Telephone No. Supervisor's Name Position Held and Rate of Pay Reason for Leaving List any other experiences, skills, or qualifications you feel are pertinent. Exclude any information which would denote race, sex, marital status, national origin, religious or political affiliations.

Please Read Before Submitting Martin & Bayley, Inc., is an Equal Opportunity Employer. All applicants are considered for employment without regard to race, color, sex, gender, marital status, age, religion, national origin, disability that can be reasonably accomodated without undue hardship or any other legally protected status. I give my permission to investigate my credit record, education, employment experience, criminal conviction records and all other aspects of my background relevant to my proposed employment. I hereby indemnify the Company and any person or company contacted from any liability arising out of such inquiry. I understand that if any false or misleading information or omission on this application is discovered it will be reason for rejection or dismissal. I understand that I have a right to make a written request within a reasonable period of time for a complete and accurate disclosure of information concerning the nature and scope of the investigation. Upon termination of my employment for whatever reason, I release this Company from all liability for supplying any information concerning my employment to any potential employer. At the request of the Company, I agree to provide transcripts from educational institutions attended and to submit to any further testing for employment (after a conditional offer of employment is made if required by law), continuation of employment or advancement with the Company. I acknowledge, if employed, my employment is for no fixed period of time. This application or offer of employment is not binding on the Company in any way and is not to be construed as a contract. Personnel practices, policies and procedures, employment, benefits, and/or compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the Company or myself. No representative of the Company, other than its President, has the authority to enter into any agreement for employment of any specified period of time, or to make any agreement contrary to the foregoing, and such agreement to be enforceable, must specifically acknowlege that it is a modification of this policy must be in writing and must be signed by the President of the Company. All newly hired employees are required to serve an introductory period of 60 calendar days. Employees who fail to demonstrate the ability to meet acceptable standards of performance and/or behavior during their introductory period may be terminated immediately. I Agree