APPLICATION FOR EMPLOYMENT

(Divisions: Epcor Foundries / HiTech Shapes & Designs / A-G Tool & Die Co. / Hamilton Precision LLC)

Seilkop Industries, inc. is an equal Employment Opportunity Employer. Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, disability or handicap, or any other legally protected status. All qualified applicants will be given equal opportunity and selection decisions are based solely on job-related factors.

Division:

PERSONAL INFORMATION

Full Name: Date Available to Start? / /

Street Address: City: State: Zip: Home Phone*: Business or Cell Phone*:

Position applied for: Desired Wages/Salary:

EDUCATION

Elementary School

City: State:

City: State: Grade Completed: 1 2 3 4 Did you graduate? Yes No GED? Yes No Not Applicable

College

City: State: Degree Received Or Expected: Average Grade: Course major/Field:

College

City: State: Degree Received Or Expected: Average Grade: Course major/Field:

Other

City: State: Degree Received Or Expected: Average Grade: Course major/Field:

Other job-related, educational institutions, licenses, certifications, any specialized training, apprenticeship, skills or any additional information you feel may be helpful to us in considering your application. Do you have a reliable means of transportation to and from work?

EMPLOYMENT HISTORY (List below last employers, starting with the most recent one first)

Present or last Position: Name of Company: From (Mo/Yr): / To (Mo/Yr): / Street Address: City: State: Zip: Duties: Reason for Leaving: Starting Annual Salary: Final Annual Salary: Bonus: Commission: Name of Supervisor: Title and Department of Supervisor: Phone Number of Supervisor*: If currently employed, may we contact your supervisor? Yes No

Next Previous Position: Name of Company: From (Mo/Yr): / To (Mo/Yr): / Street Address: City: State: Zip: Duties: Reason for Leaving: Starting Annual Salary: Final Annual Salary: Bonus: Commission: Name of Supervisor: Title and Department of Supervisor: Phone Number of Supervisor*:

If currently employed, may we contact your present employer? Yes No

REFERENCES

List at least three responsible adults who have knowledge of your work ethic, experience, and ability.
(Do not include relatives)

Name: Address: Telephone No*: Occupation:

Driver's license # State: Class: CDL: Yes No

Please describe any experience or special training received in the military or in government service related to the position for which you are applying:

If applying for a clerical position, what business equipment can you operate? (For example, computers, copiers, etc.)

If applying for a clerical/administrative/professional position that requires speed and accuracy on the keyboard,

indicate your speed: Words/Minute:

List the specific skills, qualifications you possess related to the position for which you are applying:

In what computer software programs are you proficient? [Name the package(s).]

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING

JOB APPLICANT'S AGREEMENT AND CERTIFICATION

In consideration of my employment, I agree to conform to the policies and procedures of Seilkop Industries, Inc., including without limitation any of its affiliated companies and divisions (the “Company”). I understand that in accepting this application, the Company is in no way obligated to provide me with employment and that I am not obligated to accept employment if offered. Furthermore, if employed, I understand that I am employed at will and that my employment and compensation can be terminated with or without reason, and with or without notice at any time.
I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any misrepresentation or falsification of information or significant omissions on either this application or during the pre-employment process will result in my application being rejected, or, may be cause for subsequent dismissal if I am hired.
I also understand that any offer of employment may be conditioned on pre-employment procedures, which includes a background check, tests and documentation. I will, upon request, sign all necessary consent and authorization and release forms. I voluntarily and knowingly authorize the Company and/or its agents, to verify any aspect of the information contained in my employment application or through public and private sources. I authorize any third party organization to perform a consumer report and background investigation. I also authorize and consent any companies, schools or persons listed on this application (or accompanying resume) to give any information regarding my employment, qualifications and character to Seilkop Industries. I understand that the employment information may include, but is not necessarily limited to, performance evaluation and reports, job descriptions, disciplinary reports, letters of reprimand, and opinions regarding my suitability for employment possessed by it.
• I voluntarily and knowingly, fully release and discharge, absolve, indemnify and hold harmless you, your agents and any former employer, person, firm, corporation, school or government agency, its officers, employees and agents from any and all claims, liability, demands, causes of action, damages, or costs, including attorney's fees, present or future, whether known or unknown, anticipated or unanticipated, arising from or incident to the disclosure or release of any such information to you, your agents, or consumer reporting agency
I understand that I may be required to take a drug test as a condition of employment or during employment. I may also be required to take and pass a physical exam if I am selected for employment and before beginning employment.
I agree that in exchange for the Company considering my application for employment, and in exchange for any offer of employment that the Company may extend to me, to the maximum extent permitted by applicable law, I shall file any lawsuit (and all claims that could be included in that lawsuit) against the Company or any of its current or former owners, directors, managers, agents or other employees, relating to my application for employment, employment, or separation of employment, within 180 days after the date of the action or event that is the subject of my lawsuit. I hereby waive any statute of limitations to the contrary. I understand and agree that despite this 180 day statute of limitations, I can still file a charge with or participate, testify, or assist in any investigation or proceeding before any federal, state, or local government agency. To the extent I file a charge(s) with any federal, state, or local government agency, I agree that I am required to file the charge(s) within the statutory statute of limitations applicable to such charge(s).
I have read and understand the contents of this employment application and am fully able and competent to complete it.

Date: / / Signature:

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

NOTICE

All offers of employment are conditional upon our assessment of the individual's ability to perform the essential elements of the job safely and efficiently. Following an offer of employment, our Company may provide a post-offer physical examination to assist in this assessment.

The examination is conducted by a licensed physician specializing in such examinations. The cost of the physical is borne solely by our Company.

Included in the examination is a hearing test, vision test, a comprehensive medical and occupational history questionnaire, vital signs, height, weight, a general physical examination, and a urine drug screen. Additionally, if you are offered a position that requires the ability to lift, you may be administered relevant tests.

Results of the physical will be submitted under confidential cover to the Company's Human Resources Department. Where test results indicate the presence of illicit drugs and/or undeclared pharmaceutical and/or alcoholic substances, the offer of employment will be rescinded. Where test results make questionable your ability to perform the essential elements of the position in a safe and efficient manner, a meeting will be held with you to determine if reasonable accommodations can be made.

By affixing your signature below, you certify that you have been advised via this notice of the tests which may be conducted, that you voluntarily agree to submit to such testing following an offer of employment, that you will authorize release of test results to the responsible agent of our Company, and that you understand and agree to all conditions stated above.

Applicant's Signature: Print name as signed above: Date: / /