APPLICATION FOR EMPLOYMENT

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Answer each question fully and accurately. No action can be taken on this application until you have answered all of the questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon job-related information.

This is an application for Polisher - 1st Shift.

Personal Information
When can you start? First Name Last Name Middle Name Email Telephone Number Street Address City State Zip Code Are you 18 years of age or older? (If hired, you may be required to submit proof of your age) Y N Have you ever applied here before? Y N

If yes, when?

Were you ever employed here? Y N

If yes, when?

If employed, do you expect to be engaged in any additional business or employment outside of your job? Y N

If yes, please explain

PROFESSIONAL ASSOCIATIONS

List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships that reveal race, color, religion, national origin, sex, age, disability or other protected status.)

Education
High School or GED NAME AND ADDRESS Number of years completed Diploma, Degree, Certificate Subjects Studied College or University NAME AND ADDRESS Number of years completed Diploma, Degree, Certificate Subjects Studied Vocational or Technical NAME AND ADDRESS Number of years completed Diploma, Degree, Certificate Subjects Studied

What additional training do you have that relates to the job for which you are applying?

What machines or equipment can you operate that relate to the job for which you are applying?

Employment History

List the names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job offer may be contigent upon acceptable references from current and former employers.

Name of Employer Address City, State, Zip Supervisor(s) Telephone Job Title & Duties Date of Employment: Month/Year, From/To Starting Pay $ Final Pay $ Reason for Leaving Name of Employer Address City, State, Zip Supervisor(s) Telephone Job Title & Duties Date of Employment: Month/Year, From/To Starting Pay $ Final Pay $ Reason for Leaving Name of Employer Address City, State, Zip Supervisor(s) Telephone Job Title & Duties Date of Employment: Month/Year, From/To Starting Pay $ Final Pay $ Reason for Leaving Name of Employer Address City, State, Zip Supervisor(s) Telephone Job Title & Duties Date of Employment: Month/Year, From/To Starting Pay $ Final Pay $ Reason for Leaving Name of Employer Address City, State, Zip Supervisor(s) Telephone Job Title & Duties Date of Employment: Month/Year, From/To Starting Pay $ Final Pay $ Reason for Leaving Have you worked or attended school under any other name? Y N

If yes, give names

Are you presently employed? Y N Have you ever been fired from a job or asked to resign? Y N

If yes, please explain

Additional Information or Comments
AGREEMENT

I certify that all of the information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in dismissal if discovered at a later date.

I authorize the investigation of any and all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

BSI is working to ensure the health of all our team members. After January 1, 2016 smoking will not be allowed on BSI property. By clicking "I agree", this confirms that upon employment you agree to abide by this policy.

I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GURANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.

I agree