PREVIOUS EMPLOMENT

CoRngRny

Adress Supervitsr
atb Ttle Startng Saiary Ending Satiary
Responsibites

Fro 10 Reason for Leaving

May we comtact your previaUs supervisor for a reference

Phne
Acidress Supervisor
ob Te Sarting Selary Endineg Saler

Responsiblties
From Reason for Leaving

May we comtac your previous superisor for a erenoe YE

Compaimy Phone

Address Sappervisor
Jot Tibe Startimg Saiar Endirg Salar
Responsiblities

From 10 Reason for Leeving

May we contact your previous supervisor for a referesce?

DISCLAIMER AND SIGNATURE

I certhy that my answers are true and complete to the best of ny ktowiedge.
T tis aplcabo leads to emptoyment, 1 umdersand mat fase or misieadng intormatn amy espikcarcn ca merven may sesut im my rese
I authorize Align Technoiogies de Costa Riz SRL to
itivestigate my background and qualiiaons for puarposes af esaluatng wheter I am quaifet
tarthepasboe for wtich I am appiviang. 1undensiand that ign Techokogies Costa Rca wil alize an cutsie tes ar tems D a t n cecsn
suchinfoaton and i speciicaby autorae suth an veation by intmation serices d outide enctes af he conmganys choe. 1i
understand that I may withhoic my permission and mat in sudh a case, no investigation nill be done, and my application for empicyment wid not be
prxcessed further

Signature SRA Date1--

PREVIOUS EMPLOYMENT
Phone
Company
Supervisor
Address
Ending Salary
Starting Salary
Job Titie
Responsibifities
Reason for Leaving
From To
YES NO
for a reference?
May we contact your previous supervisor
Phone
Company
Supervisor
Address $
Ending Salary
Starting Salary
Job Title
Responsibilitbes
Reason for Leaving
From TO
YES NO
for a reference?
May we contact your previous supervisor
Phone
Company
Supervisor
Address
Ending Salary
Starting Salary
Job Title
Responsibiliies
Reason for Leaving
From TO
YES NO
we contact your previous supervisor
for a reference
May
PREVIOUS EMPLOYNENT
Compeny
Pthone
Address
Supervisor
Job Ttke
Starting Salary
Endng Salary $
Responsibities
From To Raason for Leaving
May we contact your previours supervisor for a reference? YES NO
Compeny
Phone
Address
Supervior
ob Titie Starting Sialary Ending Sakary
Responsibiities
From To Reason for Leaving
May we contact your previous supervisor for a reference?
YES NO
Company Pthone
Acddress
Supervisor
Job Title
Starting Saiary Ending Salary
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference?
YES NO
DISCLAIMER
I
AND SIGNATURE
certily that my answers are true and complete to the best of my
knowkdge.
If this application leads to
employment, I understand that faise or misleadin information in my applicatton or interview may result in my release.
I authorize Align
Technoogies de Costa Rica SRL to investigate my background and qualifications for purposes of evaluating whether I am qualified
for the position for which I am
applying. I understand that Align Technologies Costa Rica will utilize an outside firm or firms to assist it in
checking
Such information, and I specificaltly authorize such an investigation by information services and outside entities of the
understand that I may withhold my company's choice. I also
permission and that in such a case, no investigation will be done, and my application for empkoyment will not be
processed further.
Signature
SRL Date
PREVIOUS EMPLOYMENT
Phone
Company

Address Supervisor

Job Ttie Starting Salary Ending Salary

Responsibtities

From Reason for Leaving

May we contact your prevous supervisor for a reference? YES NO

Company Phone

Address Supervisor

ob Titte Starting Salary Ending Salary

Responsibilittes

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone

Address Supervisor

Job Titte Starting Salary Ending Saary

Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

DISCLAIMER AND SIGNATURE

I certify that my answers are true and comptete to the best of my knowiledge.
thts application leads to employment, I understand that
faltse or misleading information in my application or interview may result in my release
Iauthorue Algn Technologies de Costa Rica SRL to Investigate my background and qualifications for purposes of evaluating whether I am quailied
forthe position tor which I am applying. I understand that Align Technologies Costa Rica will utilize an outside firm or frms to assist t in checking
suchinfomaton, and I specitkally authortze such an investigation by information services and outside entities of the company's chokce. I also
understand that I may withhod my permisson and that n such a case, no investigation will be done, and my application for empoyment will not be
processed further.

Signeture
SR Date
17-1-20
PREVIOUS EMPLOYMENT
Company Phone

Address Supervisor

Job Tite Starting Salary Ending Salary

Responsibilities

From TO Reason for Leaving

May wwe contact your previous supervisor for a reference? YES NO

Company Phone

Address Superviso

Job Tiie Starting Salary $ Ending Salary

Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference?? YES NO

Company Phone

Address Supervisor

Job Title Starting Salary Ending Salary

Responsibilities

From Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.
f this application leads to employment, I understand that false or misleading information in my application or interview may resuit in my release.

I authorze Aign Technoiogies de Costa Rica SRL to investigate my background and qualifications for purposes of evaluating whether I am qualifed
for the posation for whicth I am applying. I understand that Align Technokoges Costa Rica will utlze an outside firm or firms to assist it in checking
SUch infornation, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I aso
understand that I may withhvoid my permission and that in such a case, no investigation will be done, and my application for employment will not be
processedfurther

Signature SRA Date

PREVIOUS EMPLOYMENT
Company Phone

Address
Supervisor
Job Title
Starting Salary Ending Salary
Responsibilities
From TO Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

Company Phone
Address
Supervisor
Job Title
Starting Salary Ending Salary
Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

Company Phone

Address
Supervisor
Job Title
Starting Salary Ending Salary
Responsibilities
From Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

DISCLAIMER AND SIGNATURE

I certify that my answers are true and
complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
I authorize Align Technologies de Costa Rica SRL to
investigate my background and qualifications for purposes of evaluating whether I am qualified
for the position for which I am applying. I understand that
Align Technologies Costa Rica will utilize an outside firm or firms to assist it in checking
such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also
understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be
processed further.

Signature SR Date 17-||- 2 0