Employment Application

Please fill out this Employment Application thoroughly and accurately. All questions need to be answered in full for your Application to be processed. All personal information provided will be made available only to ULTRA personnel with a "need to know", or as required by law.

ULTRA AVIATION SERVICES considers all applicants for employment equally. ULTRA does not prejudice in hiring or terms or conditions of employment based on race, color, creed, religion, gender, sexual orientation, ethnicity, age, disability, marital or military status, or any other criteria upon which discimination is prohibited by applicable city, state or federal law.

REFERRAL
How did you find ULTRA? REFERRER NAME RELATIONSHP
Have you ever worked
for ULTRA before?		   No   Yes If so, when? In which position?
Do you have an
FAA Dispatcher's License?		   No   Yes FAA LICENSE #
DESIRED
POSITION		 DESIRED
SALARY		 DESIRED
JOB TYPE		 AVAILABLE
DAYS		 AVAILABLE
HOURS
PERSONAL INFORMATION
FIRST NAME LAST NAME DATE OF BIRTH
ADDRESS GENDER  F   M
CITY STATE ZIP CODE COUNTRY RACE
PHONE CELL EMAIL ETHNICITY
VALID U.S.
DRIVER'S LIC.#		 ISSUER STATE Has your Driver's License been revoked,
denied or suspended in the last 10 years?		   No   Yes If yes, bring to the job interview a written
statement of facts and circumstances.
PREVIOUS ADDRESSES — LAST 5 YEARS
ADDRESS
CITY STATE ZIP CODE COUNTRY
ADDRESS
CITY STATE ZIP CODE COUNTRY
BACKGROUND INFORMATION
Are you a United States citizen?   Yes   No If not,
which country?		 IMMIGRATION STATUS Are you legally entitled
to work in the United States?		   Yes   No
Do you have any
medical / health problem?		   No   Yes If so, explain
Have you ever filed a claim
for workman's compensation?		   No   Yes If so, explain
Have you ever
been convicted of a crime?		   No   Yes  If yes, provide a written statement of facts and circumstances. Conviction of a crime will not necessarily bar you from employment with ULTRA.
Have you ever had a confirmed
positive drug/alcohol test?		   No   Yes Have you ever refused to take
a required drug/alcohol test?		   No   Yes
EMPLOYMENT HISTORY
TEN (10) YEARS — NO GAPS — EVERY MONTH MUST BE ACCOUNTED FOR — This section must be completed. Resumes will not be accepted in lieu of completion.
Please begin with most recent employer and list complete address, phone and fax numbers of all employers for the last ten (10) years. If period of unemployment is over six (6) months, please explain.
FROM TO EMPLOYER
ADDRESS
CITY STATE POSTAL CODE COUNTRY
PHONE FAX SUPERVISOR
POSITION DESCRIPTION
REASON
FOR LEAVING
FROM TO EMPLOYER
ADDRESS
CITY STATE POSTAL CODE COUNTRY
PHONE FAX SUPERVISOR
POSITION DESCRIPTION
REASON
FOR LEAVING
FROM TO EMPLOYER
ADDRESS
CITY STATE POSTAL CODE COUNTRY
PHONE FAX SUPERVISOR
POSITION DESCRIPTION
REASON
FOR LEAVING
FROM TO EMPLOYER
ADDRESS
CITY STATE POSTAL CODE COUNTRY
PHONE FAX SUPERVISOR
POSITION DESCRIPTION
REASON
FOR LEAVING
U.S. MILITARY HISTORY
Have you had served in the U.S. Armed Forces?    No   Yes  If so, please complete this section.
ENTRY DATE BRANCH RANK
DISCHARGED TYPE OF DISCHARGE If not honorable, explain
EDUCATION & SKILLS
HIGH SCHOOL LOCATION
YEARS ATTENDED    1   2   3   4   5 GRADUATED?    No   Yes GRADUATION DATE
COLLEGE LOCATION
YEARS ATTENDED    1   2   3   4   5 GRADUATED?    No   Yes GRADUATION DATE
TRADE SCHOOL LOCATION
YEARS ATTENDED    1   2   3   4   5 GRADUATED?    No   Yes GRADUATION DATE
AVIATION RELATED TRAINING
LANGUAGE FLUENCY
ENGLISH SPANISH CREOLE OTHER... OTHER...
COMPUTER SKILLS
 Office  Database  Finance  Graphics  Publishing  Aviation  Drawing  Editing  Coding  Hardware
 Acrobat  Excel  Outlook  Word  Powerpoint  Publisher  Access  QuickBooks  Others
Can you type?    No   Yes If so, how many words per minute?
PERSONAL REFERENCES
NAME RELATION CITY STATE
DAY PHONE EVE PHONE May we contact this reference?    No   Yes Best time?
NAME RELATION CITY STATE
DAY PHONE EVE PHONE May we contact this reference?    No   Yes Best time?
NAME RELATION CITY STATE
DAY PHONE EVE PHONE May we contact this reference?    No   Yes Best time?
Please include any additional information that you believe may be helpful in evaluating your background...
IMPORTANT! PLEASE ACKNOWLEDGE BEFORE SUBMITTING — Unchecked applications will be automatically dismissed.

Check here		 I certify that all the statements made in this Application are true, complete and correct to the best of my knowledge and belief, and are made in good faith, understanding that any misrepresentations could be grounds for immediate dismissal.

I also acknowledge that the submittal of this Application is a preliminary step to employment with ULTRA and it does not implies in any way an offer of employment.