Employment Application

WE WELCOME YOU TO JOIN OUR MOTIVATED TEAM AT KAMPI COMPONENTS

As an integral member of our workforce, you’ll be able to contribute to projects that directly support the greater cause of safeguarding and strengthening our homeland as well as the nation’s security and capabilities. We welcome individuals who are dedicated, willing to learn and driven by a strong work ethic. Our company values communication, integrity, and teamwork to keep our supply chain running seamlessly. Every employee plays an essential role and we are committed to providing a supportive environment where you can thrive and grow in a career that is professionally rewarding. If you enjoy a fast-paced environment, possess a keen attention to detail, and thrive on excellence, we want to hear from you.

We invite you to apply below and become an integral part of our mission to serve the needs of our nation.

Step 1 of 9

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AN EQUAL OPPORTUNITY EMPLOYER

Kampi Components provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, or status as a Vietnam-era, special disabled veteran, or other covered veteran, in accordance with applicable federal laws and state laws.

Your Personal Information

Upload Your Resume

Upload your resume in .pdf, .doc or .docx format

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Your Name(Required)

First Middle Last

Present Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands

How long have you lived there?

Present Address (Years)(Required)

Years

Present Address (Months)(Required)

Months

Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands

How long have you lived there?

How long have you lived there? (previous)

Years

How long have you lived there? (previous)

Months

Contact Information (Check which preferred)

Home Phone

Business Phone

Cell Phone

Email

Home Phone

Business Phone

Cell Phone

Email

Position Desired(Required)

Position Status(Required)

Full-Time

Part-Time

Date Available to Work(Required)

MM slash DD slash YYYY

Salary/Compensation Desired(Required)

Specific days and hours you are available to work(Required)

Have you ever applied for a position with us?(Required)

Yes

No

If "yes", when?(Required)

Have you ever been employed by us?(Required)

Yes

No

If "yes", when and what position?(Required)

Do you have any relative or friends working here?(Required)

Yes

No

If "yes", state identity and relationship:(Required)

How did you hear about us?(Required)

Employment Agency

Newspaper Ad

Walk-in Applicant

School/College

Employee Referral

Other

How did you hear about us? (other)(Required)

Are you currently employed?(Required)

Yes

No

Are you currently on "lay off" status and subject to recall?(Required)

Yes

No

Are you able to perform in a reasonable and safe manner each essential job function and requirement of the job for which you are applying?(Required)

Yes

No

Are you at least 18 years of age?(Required)

Yes

No

If "no", state your age.(Required)

If employment is offered, can you submit two of the following: birth certificate, social security card, certificate of U.S. citizenship, a U.S. passport, a state issued driver's license, or other verification of your identity and authorization to work in the U.S.?(Required)

Yes

No

EMPLOYMENT HISTORY

In the following spaces give a complete record of your last five (5) years of employment and explain any periods of unemployment. Begin with your most recent employment and work back. If additional space is needed, please use the supplementary information box located at the bottom of the page.

1. Present or last employer(Required)

1. Employed From (Mo. / Yr.)(Required)

1. Employed To (Mo. / Yr.)(Required)

1. Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands

1. Telephone(Required)

1. Starting Position(Required)

1. Last Position(Required)

1. Other positions held(Required)

1. Starting Salary(Required)

1. Final Salary(Required)

1. Immediate Supervisor(Required)

1. Duties(Required)

1. What did you like best about your job?(Required)

1. What did you like least about your job?(Required)

1. Reason for Leaving(Required)

---

2. Previous employer

2. Employed From (Mo. / Yr.)

2. Employed To (Mo. / Yr.)

2. Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands

2. Telephone

2. Starting Position

2. Last Position

2. Other positions held

2. Starting Salary

2. Final Salary

2. Immediate Supervisor

2. Duties

2. What did you like best about your job?

2. Reason for Leaving

---

3. Previous employer

3. Employed From (Mo. / Yr.)

3. Employed To (Mo. / Yr.)

3. Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands

3. Telephone

3. Starting Position

3. Last Position

3. Other positions held

3. Starting Salary

3. Final Salary

3. Immediate Supervisor

3. Duties

3. What did you like best about your job?

3. Reason for Leaving

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Supplementary Information

EDUCATIONAL DATA

High School

Name, City, State

High School (No. of Yrs. Completed)

High School (Diploma/ Degree)

High School (Major Course of Study)

College

Name, City, State

College (No. of Yrs. Completed)

College (Diploma/ Degree)

College (Major Course of Study)

Graduate School

Name, City, State

Graduate School (No. of Yrs. Completed)

Graduate School (Diploma / Degree)

Graduate School (Major Course of Study)

Trade, Bus., Night, or Corres.

Name, City, State

Trade, Bus., Night, or Corres. (No. of Yrs. Completed)

Trade, Bus., Night, or Corres. (Diploma / Degree)

Trade, Bus., Night, or Corres. (Major Course of Study)

Other

Name, City, State

Other (No. of Yrs. Completed)

Other (Diploma / Degree)

Other (Major Course of Study)

REFERENCES (NOT EMPLOYERS OR RELATIVES)

1. Reference Name / Address

1. Reference Relationship

1. Reference Occupation

1. Reference Telephone

2. Reference Name / Address

2. Reference Relationship

2. Reference Occupation

2. Reference Telephone

3. Reference Name / Address

3. Reference Relationship

3. Reference Occupation

3. Reference Telephone

SPECIAL SKILLS AND QUALIFICATIONS

Please include any other information you think would be helpful to us in considering you for employment, such as military experience, additional work experience, skills, abilities, articles/books published, activities, foreign languages, accomplishments, professional/ trade/business/or civic activities and offices held, etc. (You may exclude all information indicative of age, sex, race, religion, color, national origin, genetic, handicap, or disability or any relationship with any labor organization.)

Skills & Qualifications

ADDITIONAL INQUIRIES CONCERNING EMPLOYMENT HISTORY

May we contact your present employer?(Required)

Yes

No

Your previous employers?

Yes

No

Please identify any exceptions and reasons for not contacting.

In order to permit a check of your work and education records, are there any name changes or assumed names that you previously used?(Required)

Yes

No

If "yes", identify name(s) and relevant dates.

Have you ever been terminated or asked to resign from any employment?(Required)

Yes

No

If "yes", please explain

DRIVER INFORMATION

(To be completed only by applicants who are applying for a position where they will be required to operate a Kampi Components vehicle.)

Do you have a current driver’s license?

Yes

No

Driver’s License (State)

Driver’s License (License No.)

Driver’s License (Expiration Date)

Has your driver’s license ever been suspended or revoked?

Yes

No

If "yes", please explain circumstances

Has your personal automobile insurance ever been canceled for reasons other than financial?

Yes

No

If "yes", please explain circumstances

Have you ever been cited for driving under the influence (DUI) or driving while intoxicated (DWI)?

Yes

No

If "yes", please explain circumstances and outcome

Please list all moving traffic violations in the last five (5) years

1. Traffic Violation (Offense)

1. Traffic Violation (Date)

MM slash DD slash YYYY

1. Traffic Violation (Location)

2. Traffic Violation (Offense)

2. Traffic Violation (Date)

MM slash DD slash YYYY

2. Traffic Violation (Location)

3. Traffic Violation (Offense)

3. Traffic Violation (Date)

MM slash DD slash YYYY

3. Traffic Violation (Location)

4. Traffic Violation (Offense)

4. Traffic Violation (Date)

MM slash DD slash YYYY

4. Traffic Violation (Location)

PLEASE READ CAREFULLY BEFORE SIGNING THIS APPLICATION

Please read the enclosed statements and Initial in the boxes below

1. I authorize Kampi Components to investigate all statements in this application and to secure any necessary information from all my employers, references, and academic institutions. I hereby release all of those employers, references, academic institutions, and Kampi Components from any and all liability arising from their giving or receiving information about my employment history, my academic credentials or qualifications, and my suitability for employment with Kampi Components.

Yes

No

2. I also authorize Kampi Components to secure criminal, motor vehicle, and financial and credit information through an appropriate agency, and I understand that, upon my written request made within a reasonable period of time, the agency providing a consumer credit report to Kampi Components will provide me with a complete description of the nature and scope of the credit report investigation.

Yes

No

3. I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my academic credentials, motor vehicle driving record (if applicable), and employment references.

Yes

No

4. I authorize Kampi Components to supply information about my employment record, in whole or in part, in confidence to any prospective employer, government agency, or other party having a legal and proper interest, and I hereby release Kampi Components from any and all liability for providing this information.

Yes

No

5. In the event of employment or an offer of employment, I authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the essential functions of the job for which I am hired or being considered for any future job.

Yes

No

6. I hereby agree to submit to any drug, alcohol or other testing that may be required as a condition of employment or continued employment and understand that refusal to submit to such testing during the course of my employment may result in disciplinary action up to and including discharge.

Yes

No

7. 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. citizenship 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 required by law.

Yes

No

8. I agree and understand that any offer of employment I may receive is contingent upon my successful completion of Kampi Components pre-employment, post offer, screening process including any pre- employment, post offer, physical examination that may be required.

Yes

No

9. In the event of my employment with Kampi Components, I will comply with all rules, regulations, and policies of Kampi Components.

Yes

No

10. I understand that nothing in this employment application, Kampi Components policy statements, personnel guidelines, or in my communications with any Kampi Components official is intended to create an employment contract between Kampi Components and me. I also understand that Kampi Components has the right to modify its policies, procedures, benefits, etc. without giving me any notice of the changes. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Kampi Components. I understand that if an employment relationship is established, I have the right to terminate my employment at any time for any reason I think is appropriate. I also understand that Kampi Components retains the right to terminate my employment at any time for any reason Kampi Components believes is appropriate.

Yes

No

11. I certify that all of the information I have provided on this application for employment is true and complete. I further understand that any false or misleading statements will be sufficient cause for rejection of my application if Kampi Components has not employed me and for immediate dismissal if Kampi Components has employed me.

Yes

No

VOLUNTARY SELF-IDENTIFICATION

The Equal Employment Opportunity Commission (EEOC) requires organizations with 100 or more employees to invite applicants to self-identify gender and race and complete an EEO-1 report each year. Completion of this data is voluntary and will not affect your opportunity for employment, or terms or conditions of employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by the Human Resources department.

Legal Name

First Last

Job Title

Gender

(Please check one of the options below)

Male

Female

(Please check one of the descriptions below corresponding to the ethnic group with which you identify.)

Hispanic or Latino

A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

Yes

White (Not Hispanic or Latino)

A person having origins in any of the original peoples of Europe, the Middle East or North Africa.

Yes

Black or African American (Not Hispanic or Latino)

A person having origins in any of the black racial groups of Africa.

Yes

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)

A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.

Yes

Asian (Not Hispanic or Latino)

A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

Yes

American Indian or Alaska Native (Not Hispanic or Latino)

A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.

Yes

Two or more races (Not Hispanic or Latino)

All persons who identify with more than one of the above five races.

Yes