THE STEBBINS ENGINEERING AND MANUFACTURING COMPANY

363 Eastern Boulevard · Watertown, New York 13601 · 315-782-3000

The Stebbins Engineering and Manufacturing Company is an Equal Opportunity Employer. All applications are considered for employment without regard to race, color, sex, age, handicap, religion, creed, national origin, disability, genetic information, military or veteran status.

APPLICATION FOR EMPLOYMENT

Applicants with disabilities who desire accommodation in completing the pre-employment questionnaire are invited to discuss their needs with the Director of Human Resources, Office Manager, or the person from whom they received this application form. Please be as specific as possible and fill in all spaces. If an item does not apply, write "not applicable" or "N/A". This application will be considered current for one year from this date. After that time the application must be renewed to be considered.

Name:

Address:

(If hired, proof of status will be required)
(If hired, proof of status will be required)

EMPLOYMENT HISTORY: Please list all positions for the past 10 years, giving present or last positions first. Use additional pages if necessary.

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Dates Worked:

Employer's Address

SKILLS & TRAINING ACQUIRED

EDUCATION:

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PLEASE LIST ANY RELATIVES OR FRIENDS EMPLOYED CURRENTLY OR IN THE PAST BY STEBBINS:

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PERSONAL REFERENCES: Please list three (3) business professionals, or other persons who are not relatives, former employers, or employees of The Stebbins Engineering and Manufacturing Company who can act as a reference for you.

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IMPORTANT: READ CAREFULLY & SIGN BELOW

In signing below, I certify that my answers to the foregoing questions on the employment application submitted to The Stebbins Engineering and Manufacturing Company (“Stebbins” or ”the Company”) are true and correct and understand that any false or misleading information on the application shall be sufficient cause for rejection of my employment application or, if hired, termination of my employment. I understand that if considered for employment, I may be subject to background screenings and/or investigations including without limitation review of consumer credit reports pertaining to me. I hereby authorize the release of information stemming from such screenings or investigations including the release of information from my former employers educational institution(s) I attended and from other individuals and/or entities that may have responsive information provided that the release of such information is not otherwise prohibited by law.

In making this application for employment, it is understood and accepted that as part of the application and employment process, and/or during employment with the Company, I may be asked to submit to physical examinations which may include testing for alcohol and drugs, and/or be fingerprinted, all in accordance with applicable law. By signing this application, I hereby agree to submit to such examinations, tests, and fingerprinting.

I understand that the use of this form does not indicate that there are positions open at Stebbins and does not in any way obligate Stebbins to extend an offer of employment to me. If chosen for employment, I agree to abide by and observe all Company rules and regulations. I further understand that any such future employment is terminable by either party at will with or without notice or cause in accordance with applicable law. No person other than the Director of Human Resources of Stebbins is authorized on behalf of Stebbins to modify or amend the provisions stated herein.