ApplicationFor Employment

Bos Tnvron EuclnrrRtNc, INC.22688 Three Notch Rd . Lexington Park, MD 20653

301 -862-4300 . 301 -932-5575Fax 301 -862-5764

We consider applicants for all positions without regard to race, color, religion, creed, gender, nationalorigin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

(PLEASE PRINT)

Position(s) Applied For Salary Desired Date of Application

How Did You Learn About Us?

E Advertisement E Friend tr Walk-In E Employment Agency fl Relative tr Other

Last Name First Name Middle Name

Address Number Street City State Zip

Telephone Number(s)

lf you are under 18 years of age, can you provide required proof of your eligibility to work? E Yes tr No

Have you ever fiied an application with us before? D Yes E No

If Yes, give date

Have you ever been employed with us before? EYes [NoIf Yes, give date

Are you currentiy employed?

May we contact your present employer?

Are you prevented from lawfuily becoming employedin this country because of Visa or Immigration Status?

Proo{ of citizenship or immigrafion status will be reqttircd upon employment.

On what date would you be available for work?

Are you available to work: E Full Time fl Part Time tr Shift Work E Temporary

Are you currently on "lay-off" status and subject to recall?

Have you been convicted of a felony within the last 7 years?Conviction will not necessarily disqualify an applicant from employntent

If Yes, please expiain

EYes trNo

EYes trNo

EYes trNo

EYes trNo

EYes trNo

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

FOR PERSONNEL DEPARTMENT USE ONLY

Hourly Rate/Salary DateBy

FORM99544 REV2/06

Education

Nasre and Addre*s of $chool Course of Study Yeare Completed Diploma Degree

Elementarv School

High School

Other {Specify}

FTUENT cooD FAIR

SPEAK

READ

WRITE

Employment Experience

1.

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You mayexclude organizations which indicate race, color, religion,.gender, national origin, disabilities or other protected status.

Employer Dates f,mploved Work PerformedFrom To

Address

Telephone Number(s) Hourly Rate/Salary$tartinE Finatr

|ob Title Supervisor

Reason for Leaving

2.

J.

4.

Employer Dates Emploved Wotk PerformedFrom To

Address

Telephone Number(s) Hourly Rate/SalaryStartine FinaI

]ob Title Supervisor

Reason for Leaving

Employer Bates Emnloved Work PerformedFrom To

Address

Telephone Number(s) Hourly RatelSa-Iary

Slarting FinaI

Job Title Supervisor

Reason for Leaving

Employer Dates Esploved I{ork PerfcrmedFrcm To

Address

Telephone Number(s) Hourly RatelSalary$tartine Find

Job Title Supervisor

Reason for Leaving

If you need additional space, please continue on a separate sheet of paper.

List professional. trad€, business or civic activities and offices held.Yau maSt exclude membe$hip which reveal gendet; race, religian, natianal origiq age, ance€tr)t disability ar other protected status:

Additional Information

Other QualificationsSummarize special jab-related skills and qualifications acquired fuom employment or other experience

Specialized Skills

D CRT

trPC

E Calculator

E Typewriter

Check SkillslEquipment Operated

E Fax

tr Lotus 1-2-3

tr PBX System

E Wordperfect

Construction Machinery (list): Other (list):

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

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THEREQUIREMENTS OF THE JOB FOR WHICH vbU enE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activitiesinvoived in the job or occupation for which you have applied? A description of the activities involved in such a job oroccuPation is attached'

E Yes tr No

References

1.

(Name)

(Address)

(Name)

(Address)

(Name)

(Address)

Applicant/s Staternent

I certify that 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. This application foremployment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered foremploy*ent beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby

understand and acknowledge that, unless otherwise defined by applicable 1aw, any employment relationship with this organization

is of an "at will"nature, which means that the Employee may resign at any time and the Employer may discharge Employee at

anytimewithorwithoutcause. Itisfurtherunderstoodthatthis "atwill"etnploymentrelationshipmaynotbechangedbyany*.itt"rl document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this

organization. In the er.ent of employment, I undersiand that false or misleading information given in my application or interview(s)

may result in discharge. I understand, a1so, that I am required to abide by all rules and regulations of the employer.

Signature of Applicant Date