APPLICATION FOR EMPLOYMENT <% if request.form("JobCode")="" then %> Date Position applying to (This field is required) We are an equal opportunity employer and we will not unlawfully discriminate against any applicant or employee. Should you be in need of special accommodations for the application process please email hireVision Group, Inc. at applyonline@hirevisiongroup.com or phone us at (610) 443-0119. PERSONAL INFORMATION First Name     M.I.   Last Name Previous names used First name known by Home Address City     State   Zip Phone Cell Phone Email Best way to reach you Are you eligible for employment in the US?     Yes     No How did you hear of us? What position are you applying for? What are the ideal working hours for you? If accepted for employment, when could you start? Convictions of any of the below will not necessarily bar employment. Have you ever been convicted of a felony, misdemeanor or any other offense other than a minor traffic violation?    Yes     No If so, please explain EDUCATION School Name Years Completed Course of Study Graduate? Degree/Diploma High School Yes   No College Yes   No College Yes   No Other Yes   No MILITARY EXPERIENCE Branch of Service Dates Begin/End Rank at Discharge Duties/Accomplishments PRESENT AND PREVIOUS EMPLOYMENT HISTORY Please begin with your most recent position and list all previous positions including any temporary/part time positions, self- employment and volunteer work. Company Name Position Address Please give us a brief description of your major job duties and responsibilities.   Start Date End Date Reason for leaving Starting Salary Ending Salary May we contact this employer for a reference?   Yes   No Company Name Position Address Please give us a brief description of your major job duties and responsibilities.   Start Date End Date Reason for leaving Starting Salary Ending Salary May we contact this employer for a reference?   Yes   No Company Name Position Address Please give us a brief description of your major job duties and responsibilities.   Start Date End Date Reason for leaving Starting Salary Ending Salary May we contact this employer for a reference?   Yes   No ADDITIONAL INFORMATION Please use this space for any additional information you think would help us evaluate your application, including training seminars, workshops, special achievements, specialized skills and any gaps in your work experience or education that you care to explain. Dates Explanation • The information set forth on my application is true and complete. I understand that if employed, any false statement, misrepresentation or material omission of information on this application may result in dismissal or may result in my failure to receive an offer of employment. I further understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides not to hire me. • The company is an AT-WILL employer, meaning that either the employer or the employee can end the employment relationship at any time and for any or no reason. • I authorize you to confirm any of the information provided, obtain employment references and personal history, and obtain a consumer report, which may include a criminal history background check. Other Federal, State or local governmental agencies, former employers and former schools may also be contacted. I also authorize you to disclose any pertinent information concerning me to others. Further, I release all parties and persons from any liability that my result from furnishing such information to you as well as from the use or disclosure of such information by you. SignatureDate <% else TodaysDate = Request.Form("TodaysDate") JobCode = Request.Form("JobCode") FirstName = Request.Form("FirstName") MIName = Request.Form("MIName") LastName = Request.Form("LastName") PreviousNames = Request.Form("PreviousNames") PreferedName = Request.Form("PreferedName") PersonalAddress = Request.Form("PersonalAddress") PersonalCity = Request.Form("PersonalCity") PersonalState = Request.Form("PersonalState") PersonalZip = Request.Form("PersonalZip") PersonalPhone = Request.Form("PersonalPhone") PersonalCell = Request.Form("PersonalCell") Email = Request.Form("Email") PersonalReach = Request.Form("PersonalReach") PersonalEligible = Request.Form("PersonalEligible") PersonalHear = Request.Form("PersonalHear") PersonalApplying = Request.Form("PersonalApplying") PersonalHours = Request.Form("PersonalHours") PersonalStart = Request.Form("PersonalStart") PersonalConvicted = Request.Form("PersonalConvicted") PersonalConvictedExplain = Request.Form("PersonalConvictedExplain") EducationHS = Request.Form("EducationHS") EducationHSYC = Request.Form("EducationHSYC") EducationHSCS = Request.Form("EducationHSCS") EducationHSG = Request.Form("EducationHSG") EducationHSD = Request.Form("EducationHSD") EducationC = Request.Form("EducationC") EducationCYC = Request.Form("EducationCYC") EducationCCS = Request.Form("EducationCCS") EducationCG = Request.Form("EducationCG") EducationCD = Request.Form("EducationCD") EducationC2 = Request.Form("EducationC2") EducationC2YC = Request.Form("EducationC2YC") EducationC2CS = Request.Form("EducationC2CS") EducationC2G = Request.Form("EducationC2G") EducationC2D = Request.Form("EducationC2D") EducationO = Request.Form("EducationO") EducationOYC = Request.Form("EducationOYC") EducationOCS = Request.Form("EducationOCS") EducationOG = Request.Form("EducationOG") EducationOD = Request.Form("EducationOD") MilitaryBranch = Request.Form("MilitaryBranch") MilitaryDates = Request.Form("MilitaryDates") MilitaryRank = Request.Form("MilitaryRank") MilitaryDuties = Request.Form("MilitaryDuties") PECompanyName = Request.Form("PECompanyName") PECompanyPosition = Request.Form("PECompanyPosition") PECompanyAddress = Request.Form("PECompanyAddress") PECompanySupervisor = Request.Form("PECompanySupervisor") PECompanyPhone = Request.Form("PECompanyPhone") PECompanyEmail = Request.Form("PECompanyEmail") PECompanyFax = Request.Form("PECompanyFax") PECompanyDuties = Request.Form("PECompanyDuties") PECompanySD = Request.Form("PECompanySD") PECompanyED = Request.Form("PECompanyED") PECompanyRFL = Request.Form("PECompanyRFL") PECompanySS = Request.Form("PECompanySS") PECompanyES = Request.Form("PECompanyES") PECompanyContact = Request.Form("PECompanyContact") PECompanyName2 = Request.Form("PECompanyName2") PECompanyPosition2 = Request.Form("PECompanyPosition2") PECompanyAddress2 = Request.Form("PECompanyAddress2") PECompanySupervisor2 = Request.Form("PECompanySupervisor2") PECompanyPhone2 = Request.Form("PECompanyPhone2") PECompanyEmail2 = Request.Form("PECompanyEmail2") PECompanyFax2 = Request.Form("PECompanyFax2") PECompanyDuties2 = Request.Form("PECompanyDuties2") PECompanySD2 = Request.Form("PECompanySD2") PECompanyED2 = Request.Form("PECompanyED2") PECompanyRFL2 = Request.Form("PECompanyRFL2") PECompanySS2 = Request.Form("PECompanySS2") PECompanyES2 = Request.Form("PECompanyES2") PECompanyContact2 = Request.Form("PECompanyContact2") PECompanyName3 = Request.Form("PECompanyName3") PECompanyPosition3 = Request.Form("PECompanyPosition3") PECompanyAddress3 = Request.Form("PECompanyAddress3") PECompanySupervisor3 = Request.Form("PECompanySupervisor3") PECompanyPhone3 = Request.Form("PECompanyPhone3") PECompanyEmail3 = Request.Form("PECompanyEmail3") PECompanyFax3 = Request.Form("PECompanyFax3") PECompanyDuties3 = Request.Form("PECompanyDuties3") PECompanySD3 = Request.Form("PECompanySD3") PECompanyED3 = Request.Form("PECompanyED3") PECompanyRFL3 = Request.Form("PECompanyRFL3") PECompanySS3 = Request.Form("PECompanySS3") PECompanyES3 = Request.Form("PECompanyES3") PECompanyContact3 = Request.Form("PECompanyContact3") AdditionalDates = Request.Form("AdditionalDates") AdditionalExplanation = Request.Form("AdditionalExplanation") AdditionalDates2 = Request.Form("AdditionalDates2") AdditionalExplanation2 = Request.Form("AdditionalExplanation2") Signature = Request.Form("Signature") SignatureDate = Request.Form("SignatureDate") fullname = FirstName & " " & LastName myText = " Application for Employment " myText = myText + "" myText = myText + "" myText = myText + " Date: " + TodaysDate + vbCrLf myText = myText + " Job Code: " + JobCode + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Personal Information " myText = myText + "" myText = myText + " First name: " + FirstName + vbCrLf myText = myText + " M.I.: " + MIName + vbCrLf myText = myText + " Last name: " + LastName + vbCrLf myText = myText + " Previous names: " + PreviousNames + vbCrLf myText = myText + " Prefered name: " + PreferedName + vbCrLf myText = myText + " Address: " + PersonalAddress + vbCrLf myText = myText + " City: " + PersonalCity + vbCrLf myText = myText + " State: " + PersonalState + vbCrLf myText = myText + " Zip: " + PersonalZip + vbCrLf myText = myText + " Phone: " + PersonalPhone + vbCrLf myText = myText + " Email: " + Email + vbCrLf myText = myText + " Cell phone: " + PersonalCell + vbCrLf myText = myText + " Best time to be reached: " + PersonalReach + vbCrLf myText = myText + " " + vbCrLf myText = myText + " How did you hear about us? " myText = myText + " " + PersonalHear myText = myText + " " myText = myText + " What position are you applying for? " myText = myText + " " + PersonalApplying myText = myText + " " myText = myText + " What are the ideal working hours for you? " myText = myText + " " + PersonalHours myText = myText + " " myText = myText + " If accepted for employment, when could you start? " myText = myText + " " + PersonalStart myText = myText + " " myText = myText + " Have you ever been convicted of a felony, misdemeanor or any other offense other than a minor traffic violation? " myText = myText + " " + PersonalConvicted myText = myText + " " myText = myText + " If so, please explain: " myText = myText + " " + PersonalConvictedExplain myText = myText + " " myText = myText + " Education " myText = myText + " High School " myText = myText + "" myText = myText + " School name: " + EducationHS + vbCrLf myText = myText + " Years completed " + EducationHSYC + vbCrLf myText = myText + " Course of study " + EducationHSCS + vbCrLf myText = myText + " Graduate?: " + EducationHSG + vbCrLf myText = myText + " Degree/Diploma: " + EducationHSD + vbCrLf myText = myText + " " + vbCrLf myText = myText + " College " myText = myText + "" myText = myText + " School name: " + EducationC + vbCrLf myText = myText + " Years completed " + EducationCYC + vbCrLf myText = myText + " Course of study " + EducationCCS + vbCrLf myText = myText + " Graduate?: " + EducationCG + vbCrLf myText = myText + " Degree/Diploma: " + EducationCD + vbCrLf myText = myText + " " + vbCrLf myText = myText + " College (secondary) " myText = myText + "" myText = myText + " School name: " + EducationC2 + vbCrLf myText = myText + " Years completed " + EducationC2YC + vbCrLf myText = myText + " Course of study " + EducationC2CS + vbCrLf myText = myText + " Graduate?: " + EducationC2G + vbCrLf myText = myText + " Degree/Diploma: " + EducationC2D + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Other " myText = myText + "" myText = myText + " School name: " + EducationO + vbCrLf myText = myText + " Years completed " + EducationOYC + vbCrLf myText = myText + " Course of study " + EducationOCS + vbCrLf myText = myText + " Graduate?: " + EducationOG + vbCrLf myText = myText + " Degree/Diploma: " + EducationOD + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Military Experience " myText = myText + " " myText = myText + "" myText = myText + " Branch of Service: " + MilitaryBranch + vbCrLf myText = myText + " Dates: Begin/End " + MilitaryDates + vbCrLf myText = myText + " Rank at Discharge " + MilitaryRank + vbCrLf myText = myText + " Duties/Accomplishments: " + MilitaryDuties + vbCrLf myText = myText + " " + vbCrLf myText = myText + " " myText = myText + "" myText = myText + " Branch of Service: " + MilitaryBranch2 + vbCrLf myText = myText + " Dates: Begin/End " + MilitaryDates2 + vbCrLf myText = myText + " Rank at Discharge " + MilitaryRank2 + vbCrLf myText = myText + " Duties/Accomplishments: " + MilitaryDuties2 + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Present and Previous Employment History " myText = myText + " " myText = myText + "" myText = myText + " Company Name: " + PECompanyName + vbCrLf myText = myText + " Position: " + PECompanyPosition + vbCrLf myText = myText + " Address: " + PECompanyAddress + vbCrLf ' NURD: Commented out by NURD on 01/23/2006 as requested by hireVision ' NURD: Only commented out in the case that hireVision finds a use for this at a later time, yo. ' myText = myText + " Supervisor: " + PECompanySupervisor + vbCrLf ' myText = myText + " Phone: " + PECompanyPhone + vbCrLf ' myText = myText + " Email: " + PECompanyEmail + vbCrLf ' myText = myText + " Fax: " + PECompanyFax + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Please give us a brief description of your major job duties and responsibilities. " myText = myText + " " + PECompanyDuties myText = myText + " " myText = myText + " " myText = myText + "" myText = myText + " Start date: " + PECompanySD + vbCrLf myText = myText + " End date: " + PECompanyED + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Reason for leaving " myText = myText + " " + PECompanyRFL myText = myText + " " myText = myText + " " myText = myText + "" myText = myText + " Starting salary: : " + PECompanySS + vbCrLf myText = myText + " Ending salary: " + PECompanyES + vbCrLf myText = myText + " May we contact this employer for a reference? " + PECompanyContact + vbCrLf myText = myText + " " + vbCrLf myText = myText + " " myText = myText + " " myText = myText + "" myText = myText + " Company Name: " + PECompanyName2 + vbCrLf myText = myText + " Position: " + PECompanyPosition2 + vbCrLf myText = myText + " Address: " + PECompanyAddress2 + vbCrLf ' NURD: Commented out by NURD on 01/23/2006 as requested by hireVision ' NURD: Only commented out in the case that hireVision finds a use for this at a later time, yo. ' myText = myText + " Supervisor: " + PECompanySupervisor2 + vbCrLf ' myText = myText + " Phone: " + PECompanyPhone2 + vbCrLf ' myText = myText + " Email: " + PECompanyEmail2 + vbCrLf ' myText = myText + " Fax: " + PECompanyFax2 + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Please give us a brief description of your major job duties and responsibilities. " myText = myText + " " + PECompanyDuties2 myText = myText + " " myText = myText + " " myText = myText + "" myText = myText + " Start date: " + PECompanySD2 + vbCrLf myText = myText + " End date: " + PECompanyED2 + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Reason for leaving " myText = myText + " " + PECompanyRFL2 myText = myText + " " myText = myText + " " myText = myText + "" myText = myText + " Starting salary: : " + PECompanySS2 + vbCrLf myText = myText + " Ending salary: " + PECompanyES2 + vbCrLf myText = myText + " May we contact this employer for a reference? " + PECompanyContact2 + vbCrLf myText = myText + " " + vbCrLf myText = myText + " " myText = myText + " " myText = myText + "" myText = myText + " Company Name: " + PECompanyName3 + vbCrLf myText = myText + " Position: " + PECompanyPosition3 + vbCrLf myText = myText + " Address: " + PECompanyAddress3 + vbCrLf ' NURD: Commented out by NURD on 01/23/2006 as requested by hireVision ' NURD: Only commented out in the case that hireVision finds a use for this at a later time, yo. ' myText = myText + " Supervisor: " + PECompanySupervisor3 + vbCrLf ' myText = myText + " Phone: " + PECompanyPhone3 + vbCrLf ' myText = myText + " Email: " + PECompanyEmail3 + vbCrLf ' myText = myText + " Fax: " + PECompanyFax3 + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Please give us a brief description of your major job duties and responsibilities. " myText = myText + " " + PECompanyDuties3 myText = myText + " " myText = myText + " " myText = myText + "" myText = myText + " Start date: " + PECompanySD3 + vbCrLf myText = myText + " End date: " + PECompanyED3 + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Reason for leaving " myText = myText + " " + PECompanyRFL3 myText = myText + " " myText = myText + " " myText = myText + "" myText = myText + " Starting salary: : " + PECompanySS3 + vbCrLf myText = myText + " Ending salary: " + PECompanyES3 + vbCrLf myText = myText + " May we contact this employer for a reference? " + PECompanyContact3 + vbCrLf myText = myText + " " + vbCrLf myText = myText + " Additional Information " myText = myText + " Dates: " myText = myText + " " + AdditionalDates myText = myText + " " myText = myText + " Explanation: " myText = myText + " " + AdditionalExplanation myText = myText + " " myText = myText + " Dates: " myText = myText + " " + AdditionalDates2 myText = myText + " " myText = myText + " Explanation: " myText = myText + " " + AdditionalExplanation2 myText = myText + " " myText = myText + " " myText = myText + "" myText = myText + " Signature: " + Signature + vbCrLf myText = myText + " Signature date: " + SignatureDate + vbCrLf myText = myText + " " + vbCrLf myText = myText + "" Set JMail = Server.CreateObject("JMail.SMTPMail") JMail.ServerAddress = "127.0.0.1:25" JMail.ISOEncodeHeaders = False JMail.Sender = "webmaster@hirevisiongroup.com" JMail.AddRecipient "applyonline@hirevisiongroup.com" JMail.Subject = "Online InterApp Submission from " & fullname JMail.HTMLBody = myText JMail.Priority = 1 JMail.Execute 'Set JMail = Server.CreateObject("JMail.SMTPMail") 'JMail.ServerAddress = "127.0.0.1:25" 'JMail.ISOEncodeHeaders = False 'JMail.Sender = "webmaster@hirevisiongroup.com" 'JMail.AddRecipient "applyonline@hirevisiongroup.com" 'JMail.Subject = "Online InterApp Submission from " & fullname 'JMail.HTMLBody = myText 'JMail.Priority = 1 'JMail.Execute %> Your application has been received. A representative will contact you shortly. <% end if %>

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