If yes, please complete

In case of emergency

Employment History

All applicants must provide the following information on all employers during the preceding 3 years. List complete address, street number, city, state and zip code.

Education

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.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

DO NOT WRITE BELOW THIS LINE

WE ARE A "SAFETY SENSITIVE" EMPLOYER

We are an employer concerned with the safety of its employees, the general public, and the users of the nation's highways, streets, and roads.

ASTECH Corp. has a program/policy in force that prohibits the use of controlled substances, including marijuana, by its employees. If a job offer is made, that offer is contingent upon our receipt of a NEGATIVE pre-employment drug test result.

You will also be subject to "random" testing throughout your employment with us, this includes during winter "layoff".

By your signature at the bottom, you acknowledge that you understand a negative pre-employment test result is required to be eligible for employment with this company. Should you request a "retesting" of the split specimen, any and all costs would be your responsibility. You understand that the job offer will be withdrawn if the pre-employment test result is positive, and you would not be eligible to apply for a

position within this company for a period of one year after the date of the positive test result.

Your signature also authorizes this company's processing lab and medical review officer to release the test result information to the designated third party company representative (Midwest Compliance, Inc.), as required by the Federal Motor Carrier Safety Regulations.

To All Applicants

Applicant Tracking Survey Form

As an affirmative action employer, we must monitor our equal employment opportunity and affirmative action program, and report the results to the Minnesota Dept. of Human Rights. Please help us gather this information by identifying your sex, race or ethnicity, and disability on this form.

Providing this information is completely voluntary. If you choose not to provide some or all of this information, you will not be subject to any negative or adverse treatment.

The information you provide will be used only to monitor our compliance with equal opportunity laws and regulations, and for no other purpose. *When we receive this form, we will immediately place it in a confidential file separate from your application. If you wish, you may mail this form to us in envelope separate from the one that contains your application.

Race/Ethnicity (Please check an appropriate response)

*This form is not used for employment decisions. If you have a disability and need an accomodation so that you can perform the duties of the job for which you are applying, please notify us in some manner.

Equal Opportunity Employer