Employment Application Bryant Group Incorporated 7891-B Beechcraft Avenue Gaithersburg, MD 20879 (30...

Name (Last, First, Middle)*
E-mail*
Other or former Names used in past employment records
Are you authorized to work in the United States?

YesNo
Permanent address (street, city, state, zip)
Home phone w' area code
Current address (if different than Permanent address
Mobile Telephone Number w' area code
Position applying for

Full TimePart TimeTemporarySummer
State specific position for which you are applying
Date available for work

MonthDayYear
Date
Salary requirement

Education
High School: Name of school, location (city & state), Highest level attained, Degree or Diploma received, Year degree attained, Major subject(s)
College: Name of school, location (city & state), Highest level attained, Degree or Diploma received, Year degree attained, Major subject(s)
Other, tech school etc: Name of school, location (city & state), Highest level attained, Degree or Diploma received, Year degree attained, Major subject(s)

Employment History (list postions starting with present or most recent)
1. Name of firm and address
From

MonthDayYear
Date
To

MonthDayYear
Date
Position
2. Name of firm and address
From

MonthDayYear
Date
To

MonthDayYear
Date
Position
3. Name of firm and address
From

MonthDayYear
Date
To

MonthDayYear
Date
Position
4. Name of firm and address
From

MonthDayYear
Date
To

MonthDayYear
Date
Position

US Military Service
Branch of Service
Active service from

MonthDayYear
Date
to

MonthDayYear
Date
Describe positions and duties in service
Dishonorable Discharge?

YesNo
Describe offense
Information supplied with respect to any dischargeable offense will not necessarily bar applicant from consideration for employment. Nature, reason, and time elapsed since offense will be reviewed in light of duties of job being sought.
Describe any special training you received in the service or are receiving as a member of the active reserve.

Background Authorization Form
Name

First NameLast Name
SSN:
**Previous Names Used (Within the past 7 years)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Driver's License Number
State License was issued
Have you ever been convicted of a crime other than minor traffic offenses? (If yes, answer next 3 questions.)

YesNo
Year of Offense:
County offense was committed:
Offense Description:
**THIS INFORMATION IS REQUIRED IN ORDER TO CONDUCT AN ACCURATE CRIMINAL BACKGROUND SEARCH AND WILL NOT BE USED AS CRITERJA IN THE HIRING PROCESS. AS DESCRIBED BY THE AGE DISCRIMINATION ACT OF 1967.
In connection with my.application and/or continued employment, (Including contract for services) with you, I understand that investigative background inquiries are to be made on myself including consumer investigative crimninal convictions. Further, I understand that you will be requesting information from various Federal, State, and other agencies, which maintain records concerning my past activities relating to any criminal experiences.

I acknowledge that I have been counseled that a person or entity may not procure or cause to be prepared an investigative consumer report on any consumer unless it is clearly and accurately disclosed to the consumer, that an investigative consumer report on any consumer unless it is clearly and accurately disclosed to the consumer, that an investigative consumer report - including all applicable inforrnation as to his or her character, general reputation, personal characteristics, mode of living, education history, driving history (including but not limited to accident history, alcohol/drug and any other DOT requirements as permitted by the ADA) employment history and credit history - may be made. If you are denied employment because of the consumer investigation, it is your right under the Fair Credit Reporting Act (Law 91- 508) SS 606. to have the name of the agency or agencies from whom information concerning you was obtained. You are also entitled to receive free copies of the information supplied by those agencies within sixty days upon written request.

You have the right to directly dispute with the consumer reporting agency the accuracy and completeness of any information furnished by that agency.

I authorize without reservation, any party or agency contacted by this employer to furnish the above mentioned information.

I release BACKGROUND NETWORK, INC. d.b.a. CRIMCHECK.COM and any other person and/or agencies from any suits, liens, judgments damage and/or liability resulting from this process.

The above information is used solely for inquriies and criminal history checks.

Falsifying any information on this release form will constitute grounds for immediate dismissal or declining any pending job offers.
Signature*

Clear
Date*

MonthDayYear
Date
For residents of CA, MN and OK:

You will be provided with a free copy of any consumer reports or investigative consumer reports if you check the box below.By checking this box,.
Fair Credit Reporting Act Notification

You have the right to receive a copy of your consumer credit report should one be requested for employment reasons. By checkingthis box, I request a free copy of the report.

Any ideas, inventions, or improvements made or conceived by me during any employment resulting from this application to Bryant Group, Inc, (all hereafter called the "Company"), relating to the Company's activities or work I perform fro the Company, shall be the sole property of the Company and I will execute all papers necessary to vest title thereto in the Company or its nominee(s) in the United States and foreign countries. The Company reserves the right to refuse to employ an applicant or terminate employment upon proof of misrepresentation in this application, or upon receipt of unsatisfactory references. I hereby authorize former and present employers to give or verify any information they have regarding my employment with them, and I release them and their companies from any liability for damages resulting from. UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT ANY INDIVIDUAL SUBMIT OR TAKE A LIE DETECTOR OR SIMILAR TEST. ANY EMPLOYER THAT VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. The President of Bryant Group, Inc. is the sole individual that has the authority to alter the at-will-relationship. This contract must be in writing and signed by the President to be considered valid. Noncompliance or violation of any company policy or practice may lead to corrective action up to and including termination of employment.
Name of Applicant
Today's Date

MonthDayYear
Date
Should be Empty:

Background Authorization Form