Alkeida and Anarchy - JamesGelvin

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Micro Precision Calibration, Inc.

Application for Employment

PLEASE READ THIS APPLICATION THOROUGHLY AND COMPLETE IT HONESTLY. THIs EMPLOYER PERFORMS A

DETAILED BACKGROUND INVESTIGATION ON ALL FINAL CANDIDATES.

Important Notice: Applicants should be extremely careful as they complete this application. This companyutilizes a sophisticated and detailed background and pre-employment investigation process. This process

frequently discloses inaccurate, false, and/or incomplete or omitted information. Should this process determine

any inaccurate or incomplete information, it will cause you to be either disqualified for employment with this

company as an applicant, or be grounds for termination if the inaccuracies are discovered subsequent to your

employment with our firm. Accordingly, our company strongly suggests that you NOT complete this

application until you have the requisite time and accurate information to do so.

This company is an equal opportunity employer and will not discriminate against any employee or applicant

for employment in an unlawful manner. Employment is conditioned on the successful completion of the

screening program. The information sought on this form is given voluntarily and may be used in filing reports

required by state or federal governments. This company requires all individuals who are offered employment

to submit to a drug and alcohol screening program, which may include hair, blood and/or urine samples. The

results of such screening will be initially disclosed to decision-makers for Micro Precision Calibration, Inc. and

may be the basis for disqualifying any candidate for employment. Our company reserves the right to utilizethis information in any way it deems necessary, such as but not limited to, unemployment hearings, civil cases,

criminal cases, and other such similar administrative hearings. By completing this application for employment,

the applicant authorizes this employer to conduct such screening for drug and/or alcohol use, and agrees to

hold this employer harmless for any claims resulting from such screening.

Employment Desired:

Position applied for: _Lab Technician. Wage Desired: $_27.00PfHr+_

Date application submitted: _01/07/2011__ Referred by:_ Richard Lima~ _

Have you ever been employed by MicroPrecisionCalibration, Inc. before? DYes [2] No

Ifyes, state the dates of employment and positions: ~ ~~.~.How did you hear about MICROPRECISIONCALIBRATION,INC.? D Newspaper Ad D

Walk-in [2] Employee D Relative D Employment Agency D Other _

Personal Information:

First NameLast Name Middle Name SocialSecurity Number

_Goulet 5tephen John. 532-80-8669 _

Street City State Zip Code

_5511 Wrigley Drive]asco_ WA 99301

Telephone Number: (509 ) 420-3452 __ Private Email:_ [email protected]_

Revised 1/26/2010

mailto:[email protected]_

mailto:[email protected]_



Are you over the age of 18? [:gJYes DNo If not, state your age: _

(Ifunder 18, hire is subject to verification that you are at minimum legal age and have a work permit, if

applicable)

Check box desired: I 2 $ J Regular Full Time Work (30+ hours/wk): 0 Regular Part Time Work (>30hours/wk) 0Temporary

If part time or temporary, specify days and hours available to work:

Are you willing and able to work overtime? [:gJYes D No

On what date would you be available to begin work? _Within 30 Days of Accepted Offer _

Are you able to perform in a reasonable and safe manner, with or without reasonable

accommodations, the activities involved in the job for which you have applied? (Please ask

about the specific requirements of the job for which you are applying before answering this

question) [:gJYes DNo

If no, please describe the functions that cannot be performed:

Note: We comply with applicable laws regarding disabilities and consider reasonable acromrnodation measures that may be

necessary for the known disabilities of qualified applicants/employees in order to perform the essential functions of the job.

Hiring may be subject to passing a medical examination and skill and agility tests.

If hired, would you have a reliable means of transportation to and from work?

[:gJYes DNo

Have you ever been convicted of a felony or serious misdemeanor? DYes [:gJ No

Note: Convictions for marijuana-related offenses that are more than two years old need not be listed.

If yes, please state the nature of the crime(s), when and where convicted and disposition of thecase: _

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the

offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position applied for may,

however, be considered.

Do you have the legal right to work and remain in the United States? [:gJ Yes DNo

Federal laws require that employers hire only individuals who are authorized to be lawfuJJyemployedin the United States. In compliance with such laws, the company will verify the status of everyindividual offered employment with the company. In this connection, all offers of employment aresubject to verification of the applicant's identity and employment authorization, and it will be

necessary for you to submit such documents as are required by law to verify your identification and

employment authorization upon employment.

Revised 1/26/2010



Are you currently employed? 0Yes [ g J No

May we contact your present employer? [ g J Yes 0No

Supervisor's Name/ Phone Number: __ Eddie Willers__ 800-795-8013 _

Have you ever initiated an act of workplace violence or been disciplined for violence in the

workplace? 0Yes [ g J No

If yes, explain the circumstances of the workplace violence?

Do you have a record of engaging in harassment at work? 0Yes [ g J No If yes, describe

circumstances and outcome, but do not divulge names of individuals involved.

d-- ----- --- ---, - --------- ------ --or ---------

School Name & Number of years Did you DegreeAddress Completed Graduate? Earned

High Calvary Academy 4 YSchool

Broken Arrow, OK1981

College Sierra College 2 Y Assoc2004

Rocklin, CA Degree

University California State 1 N2005

University Hayward

Military Keesler AFB 9 months Y Cert1984Biloxi, MS

Military FT Leonard Wood 4 Months Y Cert2002

St. Joseph, MO

Describe any specialized training, apprenticeship, skills, and extra curricular activities related

to the position for which you are applying:

An extensive background in RF systems maintenance, measurement, testing and calibration_

If you are applying for a professional position, are you licensed or certified for the job applied

for? 0Yes [ g J No

Name of license/ certification: _

Issuing state: _

License/certification number: _

Has your license/ certification ever been revoked or suspended? 0Yes 0No

Revised 1(26(2010



If yes, state the reasons, date of revocation or suspension and the date of reinstatement:

Employment History:

List below all present and past employment starting with your most recent employer (last

four positions are sufficient).

Name of Employer:_ Crane Nuclear _ _

Address: _2825 Cobb International Blvd, Kennesaw, GA 30152. _

Telephone #: (800)795-8013

Supervisor's Name/ Title:_Eddie Meadows - AOV Supervisor _

Date of employment: From:_03/19/2007 _ To:_10/07/2009 __

Hourly / Monthly Wages: Starting: _$24.00 P/Hr_ Ending: __ $29.00P/Hr __

Reason for leaving: _Let go do to ilIness__

May we contact this employer for a reference? . . , j Yes 0 No Ifno, why not?

Name of Employer:_ Energy Northwest. _

Address:_PO Box968,Richland, WA 99352 _

Telephone #: ( 509)372-5000

Supervisor's Name/ TitIe:_Harold Adams . _ ..

Date of employment: From:_04/30/2007 _ To:_06/06/09_Hourly / Monthly Wages: Starting: _$37.00 __ Ending:_$37.00 _

Reason for leaving:_Completed most recent assignment _


Name of Employer:_The Atlantic Group _

Address:_5426 Robin Hood Road, Norfolk, VA 23513. . .

Telephone #: (800)332-0058

Supervisor's Name/ Title: _Melvin Richardson. _

Date of employment: From: _09/17/2006_ To:_09/12/2007 _

Hourly / Monthly Wages: Starting: _$23.00 P/Hr_ Ending:__ $24.00P/Hr _

Reason for leaving: _Accepted assignment with Crane Nuclear.


Revised 1/26/2010



Name of Employer:_ Labor Works _

Address: _12001 NE 12th, Bellevue, WA 98058 _

Telephone #: (509)377-4437

Supervisor's Name/ Title: _Tony Warner, Manager _

Date of employment: From:_01/17 /2007 _ To:__ 03/12/2007 __

Hourly / Monthly Wages: Starting: _$8.50 P/Hr_ Ending: __ $8.50P/Hr __Reason for leaving: _Took next assignment from Crane Nuclear__

May we contact this employer for a reference? ..;Yes 0 No If no, why not?

Employment &Professional History:

State any additional information you feel may be helpful to us in considering your application

(e.g., Why do you feel you are particularly suited for this position?

_I posses an extensive history of work in related fields including RFand Electro-Mechanical

systems maintenance, RFMeasurement, Testing, Calibration and Customer Service. All of my

previous positions require a high degree of poise under pressure to resolve complex technical

issues and deal successfully with managers, engineers, clients andcoworkers. _

Have you ever been terminated from any job for any reason?0Yes ~ No

Have you ever quit a job after being notified that you would be terminated? 0Yes ~ No

Have you signed a confidentiality, trade secret or employment agreement with any prior

employer? ~Yes 0No

*Ifyour answer to any of these questions is yes, please explain: (list name and address of

employer and approximate date in each case) _CKC Labs, Freemont, CA1999-2000,__

Extreme Networks, Santa Clara CA 2000, P-COMInc, Campbell, CA 1997.

References: List below three persons who have first hand knowledge of your work

performance within the last three years:

Name:__ Michael Barnes__ Occupation / Title:~I&C Technician.

Company:_Energy Northwest__ Telephone Number:_509-372-5000_

Address:_PO Box 968 Richland, WA 99352_

Dates Known:_1992 to Present_ Relationship: _Friend and Coworker __

Name:_Dewey Exon_ Occupation / TitIe:_I&C Technican__

Company:_Energy Northwest Telephone Number:_208-862-7871_

Address:_1516 South 600 West, Oakley, ID 83346. _ _ _ .

Dates Known:__ 2007to Present__ Relationship: __ Friend and Coworker __

Revised 1/26/2010



Name:------Jim Tucker__ Occupation / Title:_AOV Data Analyst

Company:_Crane Nuclear__ Telephone Number:_770-355-3877 __

Address:_61 Cross Creek Parkway, Dallas,GA30157

Dates Known:_2009 to Present_ Relationship:_Friend and Coworker__

Revised 1/26/2010



PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH AND SIGN BELOW:

./~reby certify that I have not knowingly withheld any information and that the

~:~';iven by me are true and correct to the best of my knowledge. I further certify that I,

the undersigned applicant, have personally completed this application. I understand that any

omission or misstatement of material fact on this application or on any documents or oral

representations used to secure employment shall be grounds for rejection of this application

or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

~I Hereby give MICROPRECISIONCALIBRATION,INC Company, Inc. (MICRO

CISIONCALIBRATION,INC) or its agents the right to thoroughly check my references,

work record, driving record (if applicable), education and other matters related to my

suitability for employment and, further, authorize the references I have listed to disclose to

MICRO PRECISIONCALIBRATION,INC any and all letters, reports and other information

related to my work records, without giving me prior notice of such disclosure. In addition, I

hereby release MICRO PRECISIONCALIBRATION,INC, its agents, my former employers

and all persons, corporations, partnerships and associations from any and all claims, demands

or liabilities arising out of or in any way related to such investigation or disclosure.

~erstand that nothing contained in this application, or conveyed during any- ~iew which may be granted or during my employment, if hired, is intended to create an

employment contract between me and MICRO PRECISIONCALIBRATION,INC. In

addition, I understand and agree that if I am employed, my employment is for no definite or

determinable period and may be terminated at any time, with or without prior notice or

cause, at the option of myself or MICROPRECISIONCALIBRATION,INC, and that no

promises or representations contrary to the foregoing are binding on MICROPRECISION

CALIBRATION,INC unless made in writing and signed by me and the President of MICRO

PRECISIONCALIBRATION,INC.

A~rstand that any offer of employment I may receive from MICRO PRECISION

'~BRATION, INC is contingent upon my successful completion of MICROPRECISION

CALIBRATION, INC's pre-employment screening process. This process includes receiving

satisfactory references and verification and suitability of information provided on this

Employment Application form and may also include a background check of criminal

convictions, driving record and/ or credit information. If such information is requested, I

agree to sign a consent authorizing such release of information to the company or a consumer

reporting agency hired by the company.

~application is current for only 6 months. At the conclusion of this time, if I have

.n~eard from MICRO PRECISIONCALIBRATION,INC and still wish to be considered for

employment, it will be necessary to fill out a new application.

Applicant's Signature:

Date:__ 01/07/2011__ Print Name:

Revised 1(26(2010

0\;.1&

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Alkeida and Anarchy - JamesGelvin