This employment application is for employment with Oran Safety Glass, Inc. (the company). The company is an equal opportunity employer. All qualified applicants will be considered without regard to race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability, veteran status or other protected status. Each question should be fully and accurately answered. Use blank paper if you do not have enough space on this application. Please print except for signature.

DISCLAIMER AND SIGNATURE

I authorize investigation of all statements contained in this application. I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that misrepresentation or omission of facts is cause for dismissal. Further I understand that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, terminated at any time without any previous notice.

I authorize the above named references and employers to release information regarding my previous work history and character and agree that they are in no way liable for any of the information provided for the reference check.

This form has been designed to strictly comply with the State and Federal fair employment practice laws prohibiting discrimination on the basis of the applicant’s sex or minority status. Questions directly or indirectly reflecting such status have been included only where needed to determine a bona fide occupational qualification or for other permissible purposes such questions are appropriately noted on the application. Notwithstanding these efforts, the employer does not assume responsibility and hereby disclaims any liability for inclusion in this form, of any questions upon which a violation of State and Federal fair employment practice laws may be based.

APPLICATIONS WILL BE KEPT ON FILE FOR 90 DAYS. IF YOU ARE CHOSEN FOR AN INTERVIEW, YOU WILL BE CALLED BY OUR HUMAN RESOURCES DEPARTMENT TO SCHEDULE A DATE/TIME FOR THE INTERVIEW.