JOB APPLICATION

Advance Screw Products, Inc is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all of the sections below

Applicant Information

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Employment Position

Position(s) Applying for

How did you hear about this position?

On what date can you start working if you are hired?

Personal Information

Are you a U.S. citizen or approved to work in the United States?

Yes

What document can you provide as proof of citizenship or legal status?

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying

(Note: Advance Screw Products, Inc complies with the ADA and considers reasonable accommodation measures that may be

necessary for eligible applicants/employees to perform essential functions. )

Education and Training

High School

Name / Location (City, State) / Year Graduated / Degree Earned

College/University

Name / Location (City, State) / Year Graduated / Degree Earned

Vocational School/Specialized Training

Name / Location (City, State) / Year Graduated / Degree Earned

Military

Are you a member of the Armed Services?

Yes

What branch of the military did you enlist?

Yes

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Previous Employment

Previous Position 1

Employer Name

Job Title

Supervisor Name

Employer Address

Address, City, State and Zip Code:

Employer Telephone

Dates Employed

Reason for leaving

Previous Position 2

Employer Name

Job Title

Supervisor Name

Employer Address

Address, City, State and Zip Code:

Employer Telephone

Dates Employed

Reason for leaving

Previous Position 3

Employer Name

Job Title

Supervisor Name

Employer Address

Address, City, State and Zip Code:

Employer Telephone

Dates Employed

Reason for leaving

References

Please provide 3 personal and professional reference(s) below

Reference Name and Contact Information

AT-WILL EMPLOYMENT

The relationship between you and the Advance Screw Products, Inc is referred to as "employment at will." This means that youremployment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Advance ScrewProducts, Inc. No representative of Advance Screw Products, Inc has authority to enter into any agreement contrary to the foregoing"employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or writtenstatements or representations regarding your employment can alter your at-will employment status, except for a written statementsigned by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

Signature

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Date

Month

Day

Year