Micro Precision Calibration, Inc.

Application for Employment

PLEASE READ THIS APPLICATION THOROUGHLY AND COMPLETE IT HONESTLY. THIs EMPLOYER PERFORMS A
DETAILED BACKGROUND INVESTIGATION ON ALL FINAL CANDIDATES.

Important Notice: Applicants should be extremely careful as they complete this application. This company
utilizes a sophisticated and detailed background and pre-employment investigation process. This process
frequently discloses inaccurate, false, and/or incomplete or omitted information. Should this process determine
any inaccurate or incomplete information, it will cause you to be either disqualified for employment with this
company as an applicant, or be grounds for termination if the inaccuracies are discovered subsequent to your
employment with our firm. Accordingly, our company strongly suggests that you NOT complete this
application until you have the requisite time and accurate information to do so.

This company is an equal opportunity employer and will not discriminate against any employee or applicant
for employment in an unlawful manner. Employment is conditioned on the successful completion of the
screening program. The information sought on this form is given voluntarily and may be used in filing reports
required by state or federal governments. This company requires all individuals who are offered employment
to submit to a drug and alcohol screening program, which may include hair, blood and/or urine samples. The
results of such screening will be initially disclosed to decision-makers for Micro Precision Calibration, Inc. and
may be the basis for disqualifying any candidate for employment. Our company reserves the right to utilize
this information in any way it deems necessary, such as but not limited to, unemployment hearings, civil cases,
criminal cases, and other such similar administrative hearings. By completing this application for employment,
the applicant authorizes this employer to conduct such screening for drug and/or alcohol use, and agrees to
hold this employer harmless for any claims resulting from such screening.

Employment Desired:

Position applied for: _Lab Technician. Wage Desired: $_27.00 PfHr+_

Date application submitted: _01/07/2011__ Referred by:_ Richard Lima~ _
Have you ever been employed by Micro Precision Calibration, Inc. before? DYes [2] No
If yes, state the dates of employment and positions: ~ ~~.~.
How did you hear about MICRO PRECISIONCALIBRATION,INC.? D Newspaper Ad D
Walk-in [2] Employee D Relative D Employment Agency D Other _

Personal Information:
Last Name First Name Middle Name Social Security Number
_Goulet 5tephen John. 532-80-8669 _
Street City State Zip Code
_5511 Wrigley Drive]asco_ WA 99301

Telephone Number: (509 ) 420-3452 __ Private Email:_ stephenjgoulet@gmail.coID_

Revised 1/26/2010
Are you over the age of 18? [:gJYes DNo If not, state your age: _
(If under 18, hire is subject to verification that you are at minimum legal age and have a work permit, if
applicable)

Check box desired: I2$JRegular Full Time Work (30 + hours/wk): 0 Regular Part Time Work (>30
hours/wk) 0 Temporary

If part time or temporary, specify days and hours available to work:

Are you willing and able to work overtime? [:gJYes D No

On what date would you be available to begin work? _Within 30 Days of Accepted Offer _

Are you able to perform in a reasonable and safe manner, with or without reasonable
accommodations, the activities involved in the job for which you have applied? (Please ask
about the specific requirements of the job for which you are applying before answering this
question) [:gJYes DNo
If no, please describe the functions that cannot be performed:

Note: We comply with applicable laws regarding disabilities and consider reasonable acromrnodation measures that may be
necessary for the known disabilities of qualified applicants/employees in order to perform the essential functions of the job.
Hiring may be subject to passing a medical examination and skill and agility tests.

If hired, would you have a reliable means of transportation to and from work?
[:gJYes DNo

Have you ever been convicted of a felony or serious misdemeanor? DYes [:gJ No
Note: Convictions for marijuana-related offenses that are more than two years old need not be listed.
If yes, please state the nature of the crime(s), when and where convicted and disposition of the
case: _

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the
offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position applied for may,
however, be considered.

Do you have the legal right to work and remain in the United States? [:gJ Yes DNo
Federal laws require that employers hire only individuals who are authorized to be lawfuJJyemployed
in the United States. In compliance with such laws, the company will verify the status of every
individual offered employment with the company. In this connection, all offers of employment are
subject to verification of the applicant's identity and employment authorization, and it will be
necessary for you to submit such documents as are required by law to verify your identification and
employment authorization upon employment.

Revised 1/26/2010
Are you currently employed? 0 Yes [gJ No
May we contact your present employer? [gJ Yes 0 No
Supervisor's Name/ Phone Number: __ Eddie Willers __ 800-795-8013 _
Have you ever initiated an act of workplace violence or been disciplined for violence in the
workplace? 0 Yes [gJ No
If yes, explain the circumstances of the workplace violence?

Do you have a record of engaging in harassment at work? 0 Yes [gJ No If yes, describe
circumstances and outcome, but do not divulge names of individuals involved.

d
-- -- -- - - -- - --, - - -------- ------ --or ---------

School Name & Number of years Did you Degree

Address Completed Graduate? Earned
High Calvary Academy 4 Y
School
Broken Arrow, OK
1981
College Sierra College 2 Y Assoc
2004
Rocklin, CA Degree
University California State 1 N
2005
University Hayward
Military Keesler AFB 9 months Y Cert
1984
Biloxi, MS
Military FT Leonard Wood 4 Months Y Cert
2002
St. Joseph, MO

Describe any specialized training, apprenticeship, skills, and extra curricular activities related
to the position for which you are applying:
An extensive background in RF systems maintenance, measurement, testing and calibration_

If you are applying for a professional position, are you licensed or certified for the job applied
for? 0 Yes [gJ No

Name of license/ certification: _

Issuing state: _
License/certification number: _

Has your license/ certification ever been revoked or suspended? 0 Yes 0 No

Revised 1(26(2010
If yes, state the reasons, date of revocation or suspension and the date of reinstatement:

Employment History:
List below all present and past employment starting with your most recent employer (last
four positions are sufficient).

Name of Employer:_ Crane Nuclear _ _

Address: _2825 Cobb International Blvd, Kennesaw, GA 30152. _
Telephone #: (800)795-8013
Supervisor's Name/ Title: _Eddie Meadows - AOV Supervisor _
Date of employment: From:_03/19/2007 _ To:_10/07/2009 __
Hourly / Monthly Wages: Starting: _$24.00 P/Hr_ Ending: __ $29.00 P/Hr __
Reason for leaving: _Let go do to ilIness__
May we contact this employer for a reference? ..,j Yes 0 No If no, why not?

Name of Employer:_ Energy Northwest. _

Address:_PO Box 968, Richland, WA 99352 _
Telephone #: ( 509) 372-5000
Supervisor's Name/ TitIe:_Harold Adams . _ ..
Date of employment: From:_04/30/2007 _ To:_06/06/09_
Hourly / Monthly Wages: Starting: _$37.00 __ Ending:_$37.00 _
Reason for leaving:_Completed most recent assignment _
May we contact this employer for a reference? ..,j Yes 0 No If no, why not?

Name of Employer:_The Atlantic Group _

Address:_5426 Robin Hood Road, Norfolk, VA 23513. . .
Telephone #: (800)332-0058
Supervisor's Name/ Title: _Melvin Richardson. _
Date of employment: From: _09/17/2006_ To:_09/12/2007 _
Hourly / Monthly Wages: Starting: _$23.00 P/Hr_ Ending: __ $24.00 P/Hr _
Reason for leaving: _Accepted assignment with Crane Nuclear.
May we contact this employer for a reference? ..,j Yes 0 No If no, why not?

Revised 1/26/2010
Name of Employer:_ Labor Works _
Address: _12001 NE 12th, Bellevue, WA 98058 _
Telephone #: (509)377-4437
Supervisor's Name/ Title: _Tony Warner, Manager _
Date of employment: From:_01/17 /2007 _ To:__ 03/12/2007 __
Hourly / Monthly Wages: Starting: _$8.50 P/Hr_ Ending: __ $8.50 P/Hr __
Reason for leaving: _Took next assignment from Crane Nuclear __
May we contact this employer for a reference? ..;Yes 0 No If no, why not?

Employment & Professional History:

State any additional information you feel may be helpful to us in considering your application
(e.g., Why do you feel you are particularly suited for this position?
_I posses an extensive history of work in related fields including RF and Electro-Mechanical
systems maintenance, RF Measurement, Testing, Calibration and Customer Service. All of my
previous positions require a high degree of poise under pressure to resolve complex technical
issues and deal successfully with managers, engineers, clients and
coworkers. _
Have you ever been terminated from any job for any reason? 0 Yes ~ No
Have you ever quit a job after being notified that you would be terminated? 0 Yes ~ No
Have you signed a confidentiality, trade secret or employment agreement with any prior
employer? ~Yes 0 No
*Ifyour answer to any of these questions is yes, please explain: (list name and address of
employer and approximate date in each case) _CKC Labs, Freemont, CA 1999-2000,__
Extreme Networks, Santa Clara CA 2000, P-COM Inc, Campbell, CA 1997.

References: List below three persons who have first hand knowledge of your work
performance within the last three years:
Name: __ Michael Barnes__ Occupation / Title:~I&C Technician.
Company:_Energy Northwest__ Telephone Number:_509-372-5000_
Address:_PO Box 968 Richland, WA 99352_
Dates Known:_1992 to Present_ Relationship: _Friend and Coworker __

Name:_Dewey Exon_ Occupation / TitIe:_I&C Technican __

Company:_Energy Northwest Telephone Number:_208-862-7871_
Address:_1516 South 600 West, Oakley, ID 83346. __ _ .
Dates Known:__ 2007 to Present__ Relationship: __ Friend and Coworker __

Revised 1/26/2010
Name:------Jim Tucker__ Occupation / Title:_AOV Data Analyst
Company:_Crane Nuclear__ Telephone Number:_770-355-3877 __
Address:_61 Cross Creek Parkway, Dallas, GA 30157
Dates Known:_2009 to Present_ Relationship:_Friend and Coworker__

Revised 1/26/2010
 PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH AND SIGN BELOW:

./~reby certify that I have not knowingly withheld any information and that the
~:~';iven by me are true and correct to the best of my knowledge. I further certify that I,
the undersigned applicant, have personally completed this application. I understand that any
omission or misstatement of material fact on this application or on any documents or oral
representations used to secure employment shall be grounds for rejection of this application
or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

~I Hereby give MICRO PRECISION CALIBRATION, INC Company, Inc. (MICRO

CISION CALIBRATION,INC) or its agents the right to thoroughly check my references,
work record, driving record (if applicable), education and other matters related to my
suitability for employment and, further, authorize the references I have listed to disclose to
MICRO PRECISION CALIBRATION, INC any and all letters, reports and other information
related to my work records, without giving me prior notice of such disclosure. In addition, I
hereby release MICRO PRECISION CALIBRATION, INC, its agents, my former employers
and all persons, corporations, partnerships and associations from any and all claims, demands
or liabilities arising out of or in any way related to such investigation or disclosure.
~erstand that nothing contained in this application, or conveyed during any
- ~iew which may be granted or during my employment, if hired, is intended to create an
employment contract between me and MICRO PRECISION CALIBRATION, INC. In
addition, I understand and agree that if I am employed, my employment is for no definite or
determinable period and may be terminated at any time, with or without prior notice or
cause, at the option of myself or MICRO PRECISION CALIBRATION, INC, and that no
promises or representations contrary to the foregoing are binding on MICRO PRECISION
CALIBRATION, INC unless made in writing and signed by me and the President of MICRO
PRECISION CALIBRATION,INC.

A~rstand that any offer of employment I may receive from MICRO PRECISION
'~BRATION, INC is contingent upon my successful completion of MICRO PRECISION
CALIBRATION, INC's pre-employment screening process. This process includes receiving
satisfactory references and verification and suitability of information provided on this
Employment Application form and may also include a background check of criminal
convictions, driving record and/ or credit information. If such information is requested, I
agree to sign a consent authorizing such release of information to the company or a consumer
reporting agency hired by the company.

~application is current for only 6 months. At the conclusion of this time, if I have
. n~eard from MICRO PRECISION CALIBRATION, INC and still wish to be considered for
employment, it will be necessary to fill out a new application.

Applicant's Signature:

Date:__ 01/07/2011__ Print Name: 0\;.1&

Revised 1(26(2010