Personal Information:

Work Status:

Employment History (begin with most recent):

Please exclude misdemeanor conviction from marijuana-related offenses more than two years old; convictions that have been seled, expunged, or legally eradicated; and misdemeanor convictions for which probation was successfully completed or otherwise discharged and the case was judicially dismissed

If yes, please explain and state the charge, the court, the date of the conviction and the disposition of the case.

(This company will not deny employment to any applicant solely because the person has been convicted of a crime. Each case will be evaluated based on its own facts and merits.)

List any special skills or training:

Application Affirmatitive Action Information

For Federal Record Keeping

We seek your assistance in helping AEM, Inc. to comply with it's Affirmitive Action Program in accordance with Federal Law. As an applicant for a position with AEM, Inc., we would like you to complete this form.

We wish to advise you that the information requested will not be used for discriminary purpose; will not be available to administrators when applications are being considered; and will be kept seperately from your application and used for required Affirmative Action record keeping purposes only.

Completion of this form is voluntary. You may choose not to respond.

Thank You for your assistance!

Ethnicity: (Please check one or more than one if applicable)

Handicapped:

It is the policy of AEM, Inc. not to discriminate on the basis of sex, race, color, religion, creed, age, handicap, polotical affiliation, marital status or national original in it's educational programs, activities, or employment policies as required by Federal Law

Application's Statement and Agreement

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby release the Company and any former employer with any third party from any liability whatsoever that may be imposed as a result of the release of such information. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer of employment or, if I am hired, my dismissal from employment.

I hereby acknowledge that, if hired, my employment relationship with the Company will be "at will," which means that I may resign at any time, for any reason, with or without notice and that the Company may discharge me any time, for any reason and with or without notice. It is further understood that this "at will" employment relationship may not be changed unless such change is specifically made in writing by the Chief Executive Officer or the Company. I further understand that I may be required to take a drug test as part of the application process and that any offer of employment will be contingent on my passing the pre-employment drug test. I also understand that, if hired, I may be required to take drug and/or alcohol tests during my employment to the extent permitted by federal, state and local law.