Application for Employment

Please print all entries legibly and in ink on this application.

POSITION(S) APPLIED FOR DATE OF APPLICATION
FOR OFFICE USE ONLY

Hire Date
NAME OF APPLICANT

Payroll Number
LAST FIRST MIDDLE INITIAL

ADDRESS

STREET

CITY

STATE

ZIP CODE

SOCIAL SECURITY NUMBER

TELEPHONE NUMBER (INCLUDE AREA CODE)

CELL NUMBER (INCLUDE AREA CODE)

EMAIL ADDRESS

Do you have a current and valid Drivers License?

YES

NO

Drivers License #:

State:

LIST ALL MOTOR VEHICLE ACCIDENTS AND/OR VIOLATIONS IN THE PAST TEN (10) YEARS:

If employed and you are under 16 can you furnish a work permit? ........................................ Have you filed an application with GoJet Airlines before? .................................................. If Yes, provide date Have you previously been employed with GoJet Airlines? ................................................... If Yes, provide location and date Are you currently employed? ..................................................................................... If so, may we contact your present employer? ........................................................... Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? ........................................................................................... (PROOF OF CITIZENSHIP OR IMMIGRATION STATUS WILL BE REQUIRED PRIOR TO EMPLOYMENT.) On what date would you be available for work? Are you available to work: Full Time Part Time Week-Ends Temporary Are you currently laid-off and subject to recall with another company? ................................. Can you travel if your job requires it? .......................................................................... Do you have the ability to perform the job function you are applying for? ............................... Please describe:
IN CASE OF EMERGENCY NOTIFY:

YES YES

NO NO

YES

NO

YES YES YES

NO NO NO

YES YES YES

NO NO NO

NAME

ADDRESS

AREA CODE & PHONE NUMBER

Page 1

APPLICANT 0003 APR 2005

* The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 45.

Grammar School
NAME OF SCHOOL ADDRESS, CITY, STATE, AND ZIP CODE

* DATES ATTENDED: FROM: TO:

* DID YOU GRADUATE:

SUBJECTS STUDIED:

YES

NO

SCHOOL PHONE NUMBER INCLUDING AREA CODE

Middle School or Junior High School

NAME OF SCHOOL ADDRESS, CITY, STATE, AND ZIP CODE

* DATES ATTENDED: FROM: TO:

* DID YOU GRADUATE:

SUBJECTS STUDIED:

YES

NO

SCHOOL PHONE NUMBER INCLUDING AREA CODE

High School
NAME OF SCHOOL ADDRESS, CITY, STATE, AND ZIP CODE

* DATES ATTENDED: FROM: TO:

* DID YOU GRADUATE:

SUBJECTS STUDIED:

YES

NO

SCHOOL PHONE NUMBER INCLUDING AREA CODE

College
NAME OF SCHOOL ADDRESS, CITY, STATE, AND ZIP CODE

* DATES ATTENDED: FROM: TO:

* DID YOU GRADUATE:

SUBJECTS STUDIED:

YES

NO

SCHOOL PHONE NUMBER INCLUDING AREA CODE

Trade, Business or Correspondence School

NAME OF SCHOOL ADDRESS, CITY, STATE, AND ZIP CODE

* DATES ATTENDED: FROM: TO:

* DID YOU GRADUATE:

SUBJECTS STUDIED:

YES

NO

SCHOOL PHONE NUMBER INCLUDING AREA CODE

General
(Subjects of Special Study or Research Work)
BRANCH

From: To:

DATES:

US Military or Naval Service

From: Present Membership in National Guard or Reserves To:

DATES:

RANK

Summarize special skills and qualifications acquired from employment or other experience:

References: Provide the names of at least three adult persons NOT RELATED TO YOU, whom you have known at least one year, who can be readily contacted by telephone to verify the information and dates listed on this document. References may include school administrators, principals, teachers, clergy, civic leaders, family doctors, bankers and law enforcement officials, etc. (No Relatives). Please list a daytime telephone number for any reference provided. PLEASE PRINT CLEARLY!
NAME AND TITLE ADDRESS, CITY, STATE, ZIP PHONE (Including Area Code) YEARS KNOWN

1 2 3

Page 2

APPLICANT 0003 APR 2005

Drug and Alcohol Testing

GoJet Airlines is committed to a drug and alcohol free working environment. This pledge is coupled with providing the traveling public with the highest possible degree of safety. The Department of Transportation, and the Federal Aviation Administration has mandated rigid guidelines. The company fully supports these rules and has developed, as required by law, an Anti-Drug and Alcohol Program. The company has a paramount interest in assuring that our personnel performing safety and security related duties do so free of illegal drugs and alcohol. Employment is contingent upon an applicant passing a Department of Transportation Drug and Alcohol screening test. Under federal guidelines any employee performing a safety or security job function must be tested for the following five (5) substances prior to performing his/her job duties: Amphetamines & Methamphetamine Cocaine Marijuana Opiates (Morphine & Codeine) Phencyclidine (PCP) The FAA requires the following types of drug testing: pre-employment, periodic, random, post-accident, reasonable cause, return to duty and follow-up. Also included under federal regulations is alcohol testing under the following circumstances: random, reasonable cause, post-accident, return to duty, and follow-up testing. Failure to comply with Federal guidelines and/or company policies and procedures is grounds for disciplinary action up to and including immediate termination. The Anti-Drug and Alcohol Program Manager will be responsible for administering all aspects of the drug and alcohol program. Under federal guidelines, as a condition of employment, each applicant, or current employee will be preemployment drug tested and a negative test result must be received prior to the individual performing a covered position. The employee is then randomly selected for both, drug and alcohol testing. Reasonable cause, or post-accident drug and alcohol testing will be conducted as required under FAA regulations. Under FAA guidelines, applicants are required to sign a release of information form from previous employers who are affected by the Department of Transportation rules and regulations. The company is permitted to obtain drug testing results and alcohol test results.

Conditions of Employment
Employment may be, at the discretion of GoJet Airlines contingent upon passing a physical examination administered by a company physician. Health conditions must be fully and accurately reported and failure to do so shall be just cause for terminating your employment with GoJet Airlines, at anytime.

Background Verification
I hereby authorize GoJet Airlines without liability, to investigate all statements contained in this application. I affirm that all the information contained in this application is true and complete and that any misrepresentation, falsification or omission herein, shall be sufficient reason for dismissal from, or refusal of employment. I hereby authorize GoJet Airlines without liability, and also authorize and request each former employer and person, firm or corporation and schools, given above as reference to answer, without liability, any questions that may be asked and to give any information or opinion that may be sought in connection with this application, or concerning my work, habits, character or skills. I further agree, if accepted for employment, to comply with all rules and regulations of GoJet Airlines, to perform all duties assigned to me to the best of my ability, and to be responsible for GoJet Airlines, property entrusted to my care. Furthermore, I agree to acquaint myself with company rules, regulations and policies and abide thereby.

Applicants Signature

Date

Page 3

APPLICANT 0003 APR 2005

TEN (10) YEAR CRIMINAL HISTORY/VERIFICATION FORM

Any person knowingly providing false certification to the completion of the required ten year criminal history check or false certifications regarding prior conviction of any of the disqualifying crimes, may be subject to prosecution under applicable Federal, State or Local Laws.
Within the past ten (10) years have you been convicted or found not guilty by reason of insanity of a felony in the following crimes? Answer each of the questions below by placing a in the appropriate column.
Yes No Yes No

1 Forgery of certificates, false marking of aircraft, and other aircraft registration violation; 49 U.S.C. 46306 ........................... 2 Interference with air navigation; 49 U.S.C. 46308...................... 3 Improper transportation of a hazardous material; 49 U.S.C.
46312.............................................................................................

19 Rape or aggravated sexual abuse ............................................. 20 Unlawful possession, use, sale, distribution, or manufacture of an explosive or weapon.............................................................. 21 Extortion ..................................................................................... 22 Armed or felony unarmed robbery.............................................. 23 Distribution of, or intent to distribute a controlled substance...... 24 Felony arson............................................................................... 25 Felony involving a threat ............................................................ 26 Felony involving any of the following:......................................... Willful destruction of property............................................... Importation or manufacture of a controlled substance......... Burglary................................................................................ Theft ..................................................................................... Dishonesty, fraud or misrepresentation ............................... Possession or distribution of stolen property ....................... Aggravated assault .............................................................. Bribery or ............................................................................. Illegal possession of a controlled substance punishable by a maximum term of imprisonment of more than 1 year ....... Any other crime classified as a felony that indicates a propensity for placing contraband aboard an aircraft in return for money................................................................... 27 Violence at international airports; 18 U.S.C. 37............................ 28 Conspiracy or attempt to commit any of the aforementioned criminal acts ....................................................................................

4 Aircraft piracy; 49 U.S.C. 46502 .................................................. 5 Interference with flight crewmembers or flight attendants; 6 Commission of certain crimes aboard aircraft in flight; 49
49 U.S.C. 46504 ............................................................................

U.S.C. 46506 ................................................................................. 46505.............................................................................................

7 Carrying a weapon or explosive aboard aircraft; 49 U.S.C.

8 Conveying false information and threats; 49 U.S.C. 46507....... 9 Aircraft piracy outside the special aircraft jurisdiction of the United States; 49 U.S.C. 46502(b)............................................... 10 Lighting violations involving transporting controlled substances; 49 U.S.C. 46315....................................................... 11 Unlawful entry into an aircraft or airport area that serves air carriers or foreign air carriers contrary to established security requirements; 49 U.S.C. 46314.................................................... 12 Destruction of an aircraft or aircraft facility; 18 U.S.C. 32 ......... 13 Murder...................................................................................... 14 Assault with intent to murder.................................................... 15 Espionage ................................................................................ 16 Sedition .................................................................................... 17 Kidnapping or hostage taking .................................................. 18 Treason....................................................................................
Anyone found not guilty by reason of insanity

I understand that Federal Regulations under 49 CFR 1542.209 requires me to disclose to the Airport Authority within 24-hours if I have been convicted of a disqualifying criminal offense. I understand I am entitled to a copy of the criminal record received from the FBI if requested in writing. I have not been convicted of any of the above listed enumerated crimes. I do not have charges pending for any enumerated crime as defined and stipulated within any of the above listed enumerated crimes. You are ineligible for an Airport ID, if you have received a Suspended Imposition of Sentence (SIS) for any of the Enumerated Crimes or any misdemeanor conviction of Weapons in the past 10 (ten) years. The information I have provided on this application is true, complete and correct to the best of my knowledge and belief, and is provided in good faith. I understand that a knowing and willful false statement on this application can be punished by fine or imprisonment or both. (See Section 1001 of Title 18 United States Code).
NAME OF APPLICANT (PRINTED)

LAST

FIRST

MIDDLE NAME

Applicants Signature

Date

Page 4

APPLICANT 0003 APR 2005

Application for Employment - Insert

Please print all entries legibly and in ink.

NAME OF APPLICANT

LAST

FIRST

MIDDLE INITIAL

SOCIAL SECURITY NUMBER

Have you ever been arrested?

YES

NO

If you answered YES, list ALL arrests (even if they did not result in conviction).

Have you ever been convicted of a crime?

If you answered YES, list ALL criminal convictions.

YES

NO

YOU MUST SIGN AND DATE BELOW:

Signature of Applicant

Date

Page 1

APPLICANT TSH 0003-INSERT

APR2008

Employment, Self Employment & Unemployment Record

Please print all entries legibly and in ink on this form.
Applicants Name SSN Page of
Federal Air Regulations require that all persons employed by the airport, tenants, contractors, including air carriers, who have unescorted access to any area of the airport controlled for security reasons must have background checks to the extent allowable by law including at a minimum, references and prior employment histories to the extent necessary to verify representation made by the employee/applicant relating to employment in the preceding ten years.
FAA requires that a minimum of ten (10) year employment history be done on all new employees. You must be able to thoroughly furnish below the names of businesses, persons, references and their telephone numbers who may be contacted to confirm your employment, self-employment, school history and/or unemployment over the past 10 years. This information must be over a continuous 10-year period, leaving NO GAPS IN TIME including time spent caring for children, attending school, traveling, etc. Applicants will be fingerprinted and are subject to an FBI Records Check prior to employment.
EMPLOYER POSITION

STREET ADDRESS

CITY, STATE, ZIP CODE

AREA CODE/TELEPHONE NUMBER

SUPERVISOR

REASON FOR LEAVING

DATES EMPLOYED, SELF EMPLOYED, UNEMPLOYED, MATERNITY, IN SCHOOL, ETC. FROM: TO: STARTING:

HOURLY RATE/SALARY FINAL:

FOR OFFICE USE ONLY

EMPLOYER

PERSON CONTACTED

VERIFIED BY

DATE

REMARKS

POSITION

STREET ADDRESS

CITY, STATE, ZIP CODE

AREA CODE/TELEPHONE NUMBER

SUPERVISOR

REASON FOR LEAVING

DATES EMPLOYED, SELF EMPLOYED, UNEMPLOYED, MATERNITY, IN SCHOOL, ETC. FROM: TO: STARTING:

HOURLY RATE/SALARY FINAL:

FOR OFFICE USE ONLY

EMPLOYER

PERSON CONTACTED

VERIFIED BY

DATE

REMARKS

POSITION

STREET ADDRESS

CITY, STATE, ZIP CODE

AREA CODE/TELEPHONE NUMBER

SUPERVISOR

REASON FOR LEAVING

DATES EMPLOYED, SELF EMPLOYED, UNEMPLOYED, MATERNITY, IN SCHOOL, ETC. FROM: TO: STARTING:

HOURLY RATE/SALARY FINAL:

FOR OFFICE USE ONLY

EMPLOYER

PERSON CONTACTED

VERIFIED BY

DATE

REMARKS

POSITION

STREET ADDRESS

CITY, STATE, ZIP CODE

AREA CODE/TELEPHONE NUMBER

SUPERVISOR

REASON FOR LEAVING

DATES EMPLOYED, SELF EMPLOYED, UNEMPLOYED, MATERNITY, IN SCHOOL, ETC. FROM: TO: STARTING:

HOURLY RATE/SALARY FINAL:

FOR OFFICE USE ONLY

PERSON CONTACTED

VERIFIED BY

DATE

REMARKS

Page 1

APPLICANT TSH 0004 OCT06

EMPLOYER

POSITION

STREET ADDRESS

CITY, STATE, ZIP CODE

AREA CODE/TELEPHONE NUMBER

SUPERVISOR

REASON FOR LEAVING

DATES EMPLOYED, SELF EMPLOYED, UNEMPLOYED, MATERNITY, IN SCHOOL, ETC. FROM: TO: STARTING:

HOURLY RATE/SALARY FINAL:

FOR OFFICE USE ONLY

EMPLOYER

PERSON CONTACTED

VERIFIED BY

DATE

REMARKS

POSITION

STREET ADDRESS

CITY, STATE, ZIP CODE

AREA CODE/TELEPHONE NUMBER

SUPERVISOR

REASON FOR LEAVING

DATES EMPLOYED, SELF EMPLOYED, UNEMPLOYED, MATERNITY, IN SCHOOL, ETC. FROM: TO: STARTING:

HOURLY RATE/SALARY FINAL:

FOR OFFICE USE ONLY

EMPLOYER

PERSON CONTACTED

VERIFIED BY

DATE

REMARKS

POSITION

STREET ADDRESS

CITY, STATE, ZIP CODE

AREA CODE/TELEPHONE NUMBER

SUPERVISOR

REASON FOR LEAVING

DATES EMPLOYED, SELF EMPLOYED, UNEMPLOYED, MATERNITY, IN SCHOOL, ETC. FROM: TO: STARTING:

HOURLY RATE/SALARY FINAL:

FOR OFFICE USE ONLY

EMPLOYER

PERSON CONTACTED

VERIFIED BY

DATE

REMARKS

POSITION

STREET ADDRESS

CITY, STATE, ZIP CODE

AREA CODE/TELEPHONE NUMBER

SUPERVISOR

REASON FOR LEAVING

DATES EMPLOYED, SELF EMPLOYED, UNEMPLOYED, MATERNITY, IN SCHOOL, ETC. FROM: TO: STARTING:

HOURLY RATE/SALARY FINAL:

FOR OFFICE USE ONLY

EMPLOYER

PERSON CONTACTED

VERIFIED BY

DATE

REMARKS

POSITION

STREET ADDRESS

CITY, STATE, ZIP CODE

AREA CODE/TELEPHONE NUMBER

SUPERVISOR

REASON FOR LEAVING

DATES EMPLOYED, SELF EMPLOYED, UNEMPLOYED, MATERNITY, IN SCHOOL, ETC. FROM: TO: STARTING:

HOURLY RATE/SALARY FINAL:

FOR OFFICE USE ONLY

PERSON CONTACTED

VERIFIED BY

DATE

REMARKS

Page 2

APPLICANT TSH 0004 OCT06

VOLUNTARY EEO Applicant Data Information

(For Statistical Purposes Only)

As an employer committed to equal employment and to help comply with governmental record keeping requirements, we would appreciate your completing the information below. Periodic reports are made to the government on the following information. The completion of the data record is optional. If you choose to volunteer the requested information please note that all data records are kept in a confidential file and are not a part of your application for employment or personnel file. Please Note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISIONS.

Gender:
Male Female

Age:
I am 40 years old or older I am under 40 years old

Ethnicity:
Caucasian / White African American / Black Hispanic Asian / Pacific Islander Native American Other (please specify)

Veteran Status:
Veteran Vietnam Era Veteran Disabled Veteran Disabled Vietnam Era Veteran Not a Veteran

Are You An Individual With a Disability?

Yes No

Military Status:
Active Reserve

Branch of Service:
Army Navy Air Force Marines National Guard Coast Guard Employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or disability, or any other legally protected status. Our company is committed to being an Equal Opportunity Employer.

SUBMISSION OF THIS INFORMATION IS VOLUNTARY.

APPLICANT (GJ) 0005 AUG07