Phone: (252) 438-8778

P.O. Box 3301 — 115 Young Street, Suite C

Henderson NC 27536

Job Application

Kilian Engineering, Inc. is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on the basis prohibited by local, state, or federal law.

Please fill in the following sections below:

Applicant Information

Applicant Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

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Telephone Number

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Date of Application

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Employment Position

Position applying for:

How did you hear about this position?

Are you looking for full time or part time work?

Do you have reliable transportation?

When can you start work?

YYYY

Desired Pay Rate/Salary:

Personal Information

Do you have friends or relatives that work for Kilian Engineering, Inc.?

Yes

If yes, state name and relationship:

Do you have a work permit or are over the age of 18 years?

Yes

Are you approved to work in the United States?

Yes

Job Qualifications

Please list the skills and qualifications you possess for the position you are applying to:

Education and Training:

High School

Name

Location (City, State)

Degree Earned

College / University

Name

Location (City, State)

Degree Earned

Vocational School / Specialized Training

Name

Location (City, State)

Degree Earned

Previous Employment

Job Title

Supervisor Name

First Name

Last Name

Employer Address

Address 1

Address 2

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Country

Employer's Phone

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Employer's Email

Dates Employed

YYYY

Reason for leaving

Job Title

Supervisor Name

First Name

Last Name

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer's Phone

(###)

###

####

Employer's Email

Dates Employed

YYYY

Reason for leaving

Job Title

Supervisor Name

First Name

Last Name

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer's Phone

(###)

###

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Employer's Email

Dates Employed

YYYY

Reason for leaving

References

Contact Name

First Name

Last Name

Contact Information

Contact Name

First Name

Last Name

Contact Information

Contact Name

First Name

Last Name

Contact Information

Contact Name

First Name

Last Name

Contact Information

Any additional information you wish to provide:

At-Will Employment:

The relationship between you and Kilian Engineering, Inc, is referred to as “employment at will,” per North Carolina Labor Law. This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or Kilian Engineering, Inc. No representative of Kilian Engineering, Inc. has authority to enter into any agreement contrary to the forgoing “employment at will” relationship. You understand that your employment is “at will” and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and your office leader, and the president or COO of the company.

Assertion of Truth:

By signing below, the applicant (you) attests that all information provided is truthful and accurate. You further attest that information provided via cover letter or resumé is correct, truthful, and accurate.

Name

First Name

Last Name

Date

YYYY

Please attach your resume and any other supporting documents below: