Preliminary Application for Employment

Employment History

Please provide all employment information for your past three employers starting with the most recent.

Employment 1

Employer: *

Position held: *

Address: *

Phone Number: *

Immediate supervisor and title: *

Date employed from: *

Date employed to: *

Salary: * $

Job Summary: *

Reason for leaving: *

Employment 2

Employer: *

Position held: *

Address: *

Phone Number: *

Immediate supervisor and title: *

Date employed from: *

Date employed to: *

Salary: * $

Job Summary: *

Reason for leaving: *

Employment 3

Employer: *

Position held: *

Address: *

Phone Number: *

Immediate supervisor and title: *

Date employed from: *

Date employed to: *

Salary: * $

Job Summary: *

Reason for leaving: *

Other Skills and Qualifications

Summarize any job-related training, skills, licenses, certificates, and/or other qualifications:

Qualifications: *

Educational History

List school name and location, years completed, course of study, and any degrees earned:

Do you hold an associates degree or higher: *

Yes

High School:

College:

Technical Training:

Other:

References

Reference 1:

Reference 2:

Reference 3:

Attach Resume:

I hereby authorize Noble Technologies Corp (dba NobleTek) to contact, obtain, and verify the accuracy of information contained in this

application from all previous employers, educational institutions, and references. I also hereby release NobleTek and its representatives from

liability for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing

such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this

application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or

contract for employment. Accordingly, either NobleTek or I can terminate the relationship at will, with or without cause, at any time, so long as

there is no violation of applicable federal, state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability

because of that persons need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization upon hire.

Failure to submit such proof, may result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.

Acceptance: *

Yes