Employment

Falsification, misrepresentation and/or omission of criminal conviction is grounds of refusal to hire, or if hire, for dismissal. (note: a conviction does not automatically disqualify an applicant from employment. The date, nature, and seriousness of the offense will be considered). If answer is yes, indicate date(s) of conviction and the type(s) of offense(s).

Should you have a criminal conviction or a pending charge involving a breach of trust or dishonest act, Emery Telcom may be required to suspend or terminate your employment pursuant to Federal regulations.

Job Interest

Education

High School

College or University

Other

Employment History

Provide the following information of All your past and current employers, assignments or volunteer activities, starting with the most recent (use additional sheets if necessary). Explain any gaps in employment in comments section below.

Additional Information

Certification

Please read carefully. If you have any questions regarding this statement, please discuss them with Human Resource before signing.

THE EMPLOYMENT RELATIONSHIP AT EMERY TELCOM IS AT WILL, AND EMPLOYMENT CAN BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE OR NOTICE AT THE OPTION OF EITHER EMERY TELCOM, OR THE EMPLOYEE.

It is the policy of EMERY TELCOM to provide a harassment-free and equal employment opportunity work environment for all applicants and employees.

"I certify that the information contained in this application, and accompanying resume, if any, is true and complete to the best of my knowledge and understand that falsification, misrepresentation and/or omission of information is grounds for refusal to hire, or if hired, dismissal. I authorize any of the persons or organizations referenced in the application to give EMERY TELCOM or its agents any and all information concerning my previous employment, education, or any other information that they may have, with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. This authorization does not include release or other prohibited use of disability and medical related information prohibited in pre-employment inquiries by the Americans with Disabilities Act (ADA). I understand that an investigative consumer report may be made by EMERY TELCOM or through a credit bureau investigative agency. I authorize you to request and receive such information unless otherwise indicated in the employment section of this application."

"In the event of my employment, I agree to conform to the policies, rules, and regulations of EMERY TELCOM and acknowledge that these rules and regulations may be changed, interpreted, withdrawn, or added to by EMERY TELCOM at any time, at EMERY TELCOM'S sole option and without prior notice to me. I understand that EMERY TELCOM reserves the right to investigate any suspected unethical or illegal activities and any violation of the policies including, but not limited to, misappropriation of funds, falsification of records, the use, sale or possession of alcohol or drugs while working or working under the influence of drugs or alcohol, unexcused absences, and the like. Violation of EMERY TELCOM'S policies will result in disciplinary actions by EMERY TELCOM, which could include termination and prosecution. I understand that this application will be given every consideration but its receipt does not imply that I will be employed. I understand that this employment application and any other EMERY TELCOM documents are not contracts for employment, and that my employment will be employment at will and can be terminated at any time, with or without cause or notice, at the option of either EMERY TELCOM or myself. If hired, I understand that no modification or alternation of my employment at will status shall be valid or binding, unless it is expressly set forth in a written document by the General Manager of EMERY TELCOM."

"I understand that EMERY TELCOM may require me to undergo a drug test by medical staff and/or agent selected by EMERY TELCOM as a condition of my employment and/or continued employment. I consent to the release of my drug test results to EMERY TELCOM. I further understand that I must successfully pass the drug test to be considered for employment with EMERY TELCOM. I understand that medical examinations, which are job-related and consistent with the EMERY TELCOM's business necessity, may be required of me once I am employed. I further release EMERY TELCOM, including all of its officers, agents, representatives and employees from any and all claims, suits, causes of action, liabilities and damages associated with or arising from my submission to a drug test and/or medical examination. I also understand that EMERY TELCOM may maintain a restricted smoking environment."

"I understand that this application will remain open, for the Job for which I have applied for a six month period. At the conclusion of that time, if I have not heard from EMERY TELCOM and still wish to be considered for employment, it will be necessary to reapply and fill out a new application."

"I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard."

"I certify that the information in this application is correct and complete. I certify that my signature or typed name sent electronically justifies my acknowledgement of this certification. I understand that if offered employment, my employment is contingent on completing all aspects of the pre-employment and reference checking process."

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE CERTIFICATION IN ITS ENTIRETY.