JOB APPLICATION FORM: Maintenance Technician

*Padgett, Inc. is An Equal Opportunity Employer and does not discriminate against applicants or employees in any phase of employment on the basis of age, race, color, gender, religion, national origin, ancestry, physical or mental disability, veteran status, genetic information or any other classification protected by local, state, or federal law. Equal access to employment, services, and programs is available to al qualified persons. Applicants requiring reasonable accommodation for the application and/or interview process should notify a Company representative.

FORMER EMPLOYERS Please give an accurate, complete full-time and part-time employment record. Include any job-related military service assignments and volunteer activities. Start with your current employer (or most recent employer if not employed) and account for all periods of unemployment. You must complete all requested categories. Use a separate sheet if necessary.

(Give the names of three persons not related to you, whom you have known at least one year. Do not include any prior employer.)

I expressly authorize, without reservation, the Company, its representatives, employees or agents to contact and obtain information, and I agree to cooperate in obtaining such information, from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume and interview. I hereby waive any and all rights and claims I may have against the Company, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. In addition, I authorize any party having information bearing upon my qualifications for employment to release such information to the Company. I release from any and all liability all individuals and organizations who provide information to the Company concerning my employment, competence, ethics, character and other qualifications, including privileged or confidential information. I agree to submit to any lawful drug, alcohol, or other testing that may be required as a condition of employment or continued employment and understand that refusal to promptly submit and cooperate with such testing prior to or during the course of my employment will result in disqualification from consideration for employment or, if hired, termination. I fully understand that if employed, any misrepresentation or omission on this Application or any other Company record will result in dismissal, regardless of the date of discovery. I acknowledge that employment is also subject to a satisfactory review of my references. Neither this Application nor any statement made to me during the hiring process or thereafter shall be considered a contract of employment of any kind. Where such a contract is intended, I understand that it will be separately entered into and signed by the President of the Company. Absent such a contract, I understand that, if hired, my employment will be terminable-at-will, with or without reason, cause or notice, that I am not being employed for any specified or definite period of time, and that this application is not and is not intended to be a contract, offer, statement or confirmation of or for continued employment. I understand that any employee handbook or manual does not represent an employment contract if I am hired. The Company may alter, modify, amend, or terminate any of its policies and benefits, both as to active and retired employees.

Invitation to Self-Identify as a Protected Veteran (Pre-Employment)Padgett, Inc. is a federal contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. § 4212 (VEVRAA), which requires federal contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined at the end of this document. Padgett, Inc. maintains an affirmative action plan covering the recruitment and employment of protected veterans. In addition to other provisions, the plan outlines our commitment to make efforts to recruit protected veterans, to make employment decisions without regard to an individual’s veteran status, to review our practices to ensure that they do not create barriers for protected veterans and to audit and monitor our efforts. If you believe you belong to any of the categories of protected veterans defined below, please indicate by checking the appropriate box below. As a federal contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed. The classifications of protected veterans are defined as follows: A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability. A "recently separated veteran" means any veteran during the three year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service. An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness Autism Bipolar disorder Post-traumatic stress disorder (PTSD) Deafness Cerebral palsy Major depression Obsessive compulsive disorder Cancer HIV/AIDS Multiple sclerosis (MS) Impairments requiring the use of a Wheelchair Diabetes Schizophrenia Missing limbs or partially missing limbs Intellectual disability (previously called mental retardation) Epilepsy Muscular Dystrophy

It is this Company’s policy to provide equal employment opportunities to all employees in accordance with all applicable laws, directives and regulations of federal, state and local governing bodies. It is our policy to recruit, hire, train and promote individuals in all employment positions without regard to race, color, religion, sex, national origin, age, veteran status or disability. The following information is being requested so that we may comply with the law and our Equal Employment Opportunity Policy. COMPLETION OF THESE QUESTIONS IS VOLUNTARY. No adverse treatment will result from your refusal to provide this information. This information will only be used for statistical analyses and compliance reporting. It will not be placed in your personnel file.