Application for Employment

(Please list below your last four employers, starting with your present or last place of employment.) You may include any verifiable work performed on a volunteer basis, internship or military service.

Please give the names of three additional work-related references whom we may call. Please do not list relatives. Individuals with no prior work experience may list school or volunteer-related references.

I understand that this application is not a contract, offer or promise of employment. I acknowledge that employment with RTC is on an employment-at-will basis. This means that my employment with RTC can be terminated at any time, with or without cause or advance notice and acceptance of employment is not a contract of employment for any specified time. Similarly I am free to terminate my employment with RTC at any time for any reason. I further understand that I am responsible for being familiar with RTC’s policies, rules and regulations, and I understand that RTC has complete discretion to modify its policies, rules, regulations and practices at any time, to the extent permitted by federal, state and local law, except that it will not modify its policy of employment at will. By my continued employment with RTC, I consent to any such changes. I certify that the above information is complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation or omission of information on this form or relating to my application of employment may result in my denial of employment, or if employed my immediate dismissal. I hereby authorize RTC or its agents to confirm all statements contained in this application and/or resume to the extent permitted by federal, state or local law and I agree to complete any requisite authorization forms. I release all parties from any liability arising out of this provision and the use of such information. I hereby authorize Refractron Technologies Corporation to obtain information from my previous employers and such other sources Refractron Technologies Corporation determines to be reasonably necessary in connection with my employment. I understand that according to Federal law all individuals who are hired must, as a condition of employment, produce certain documentation to verify their identity and U.S. citizen status or, if aliens, their legal authorization to work in the U.S.. As a consequence, I understand that any offer of employment would be contingent on my ability to produce the required documentation within the time period by law. By submitting this form, I acknowledge that the information provided above is correct to the best of my knowledge.