EMPLOYMENT APPLICATION

Please Answer All Questions. Resumes Are Not A Substitute For A Completed Application.

THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS

MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY
OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH
OR WITHOUT CAUSE OR NOTICE.

Date _________________________

Name___________________________________________________________________________________________________________
Last Name First Name Middle Name

Position desired _______________________________________________________ Expected Salary ______________________________

Type of work desired: Full-time Part-time Temporary

Present Address__________________________________________________________ City___________________ State______________

How long residing here? _________________________________Telephone Number(s)__________________________________________

PERSONAL:
Age: Disability? Yes No If yes, pleases sate:

Have you ever been convicted of a misdemeanor (other than minor traffic) or a felony? Yes No

If yes, explain: _____________________________________________________________________________________________________

Do you know anyone employed by Hans Hanne Group? Yes No If yes Identify______________________________________

Have you ever worked for Hans Hanne Group before? Yes No If yes, when? ______________________________________

Do you use tobacco products or any other drugs? Yes No

REFERRED TO HANS HANNE GROUP BY:

School HHG Employee State Employment Agency On my own Advertisement

Referral Name___________________________________________________________

EMPLOYMENT HISTORY - Start with your present or last job. List all jobs you have held. Account for all periods of time including
military service. Additional information may be placed on a separate sheet and attached.

EMPLOYER________________________________________________________________________________________________________

ADDRESS________________________________________________________________ PHONE (IF KNOWN_________________________

DATE STARTED______________INITIAL POSITION_______________________________ INITIAL SALARY_____________________________

DATE LEFT__________________ FINAL POSITION _______________________________FINAL SALARY______________________________

NAME AND TITLE OF SUPERVISOR_____________________________________________________________________________________

REASON FOR LEAVING________________________________________RESPONSIBILITIES________________________________________

EMPLOYER________________________________________________________________________________________________________

ADDRESS________________________________________________________________ PHONE (IF KNOWN)________________________

DATE STARTED______________INITIAL POSITION_______________________________ INITIAL SALARY_____________________________

DATE LEFT__________________ FINAL POSITION _______________________________FINAL SALARY______________________________

NAME AND TITLE OF SUPERVISOR_____________________________________________________________________________________

REASON FOR LEAVING________________________________________RESPONSIBILITIES________________________________________

May we communicate with your present employer? _____________________________________________________________________

Did you have problems complying with previous employer’s attendance policy? ________________________________________________

Explain: __________________________________________________________________________________________________________

For jobs requiring office machine skills: Typing speed_______________________________________________________

Data entry by touch: Yes No Other: ____________________________________________________________________

EDUCATION
Degree or
Name and location Date Did you Credits Major Minor Grade
From To graduate Earned Subject Subject Average

High School(s)

College(s)

Graduate
School

Technical
Business
or Other

Do you have any other special interests, skills, or training which you feel would be an asset to Hans Hanne Group? Explain: ___________

_________________________________________________________________________________________________________________

JOB REQUIREMENTS:

The title of the position for which I am applying is_______________________________________________________________________

I understand the position description for the above position. I understand the physical and emotional demands of the essentia l functions
of the position. I also understand the environments in which these essential functions might be performed and the various hazards which
might be present.

____________________________________________I am able to perform the essential functions of the position, as defined in the
position description, without presenting a danger to either myself or my co-workers, with or without reasonable accommodations.

_____________________________________________I am unable to meet the physical or emotional demands of the essential functions
of the position. However, I would like to be considered should a less demanding position become available. I understand that I may define
my limitations to facilitate such consideration, but that I have no obligation to do so.

PLEASE READ CAREFULLY BEFORE SIGNING:

I authorize Hans Hanne Group to investigate all statements contained in this application. It is understood and agreed that any
misrepresentations by me in this application will be sufficient cause for cancellation of the application and/or for separation from Hans
Hanne Group service if I have been employed.

I agree, if employed, to abide by all of Hans Hanne Group’s rules and regulations. I understand that an offer of employment by Hans Hanne
Group may be conditioned on the results of a physical examination designed to determine my ability to meet the physical demands of the
position for which I am under consideration.

I authorize Hans Hanne Group to investigate information regarding my previous employment, my working ability, my character and
reputation, and all statements contained in this application. I hereby release Hans Hanne Group, its officers, employees, representatives,
or agents, and the person(s) Hans Hanne Group contacts in its investigation from any and all liability and/or damage incurred in obtaining
or providing such information.

Date _____________________________________Signature of Applicant____________________________________________________