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									                                                 Gila Corporation
                                               Application Instructions

Gila Corporation accepts employment applications for current and future position openings. Your
application will be retained for ninety (90 days). Your credentials will be reviewed against open positions
for which you have expressed interest on the application form. There is no need to re-apply for the same
type of vacancy within the 90 day time period.

Information provided on the application is subject to verification. Individuals being actively considered for
employment will be subject to background investigation, verification of past employment and education,
professional work references, etc.

In order to be considered for a position within the organization, the following must be completed on the

         All previous employment history must be filled out, even if a resume is provided.
         Answer all questions on the first page.
         Three professional names and contact numbers must be listed. Acceptable contacts are supervisors in
          paid or volunteer positions, co-workers, and/or mentors.
         If a number is not provided at the time of interview, it is the candidate’s responsibility to provide the
          information as soon as possible in order to continue in the employment process.

                               Thank you, and we wish you luck in your professional endeavors

Gila Corporation Application                      Page 1                   Revision Date: March 15, 2008
                                                    Application for Employment
     Equal access to programs, services and employment is available to all persons. Those applicants requiring
     reasonable accommodation to the application and/or interview process should notify Human Resources.

Position(s) applied for ____________________________________________Date of application                           ________________

Name                                                                                          Social Security #__________________
           LAST                     FIRST                    MIDDLE

           STREET                                                         CITY                          STATE                  ZIP

Telephone                                                         Mobile/Beeper/Other Phone

Email Address _________________________________________________

Date available for work ______________________________Desired salary range __________________________

Type of employment desired          □ Full-time □ Part-time □ Temporary □ Educational Co-Op

Availability      Monday             Tuesday               Wednesday              Thursday            Friday             Saturday    Sunday

If you are under 18, and it is required, can you furnish a work permit?                       □ Yes            □ No

Have you ever been employed here before?                                                      □ Yes            □ No

Are you legally eligible for employment in this country?                                      □ Yes            □ No

Are you able to meet the attendance requirements of the job?                                  □ Yes            □ No

Do you currently have any family members working at Gila Corporation?                         □ Yes            □ No

Can you with or without reasonable accommodations, perform the essential

functions of this/these job(s)?                                                               □ Yes            □ No

Have you ever been convicted, or pled guilty or no contest to, a felony offense

In the past 10 years?                                                                         □ Yes            □ No

If so, please explain

     Gila Corporation Application                              Page 2                          Revision Date: March 15, 2008
Important: For purposes of employment with Gila Group, “convictions” include sentenced to confinement, paid fine, time served,
placed on probation (including deferred adjudication) and court-ordered restitution.
I ___________________________ agree to immediately notify Gila Group if I am convicted of, receive deferred adjudication in,
or otherwise plead guilty or no contest to a felony, or any crime involving dishonesty or a breach of trust, while my application is
pending or during my period of employment, if hired.

Driver’s license number ____________________________________________________ State ________________
Employment History: Please provide the following information of your last 4 employers, assignments or volunteer activities,
    starting with the most Recent.

 From               To               Employer

 Telephone #                         Address

 Starting/Final Job Title                       Pay Rate
                                                Start $ ________ per _______       Final $ ________ per _________

 Name & Title of Immediate Supervisor           May we contact this employer for a reference?
                                                   □ Yes □ No □ Later

 Summarize the nature of work performed and job responsibilities

 Reason for Leaving

 From               To               Employer

 Telephone #                         Address

 Starting/Final Job Title                       Pay Rate
                                                Start $ ________ per _______ Final $ _________ per __________

 Name & Title of Immediate Supervisor           May we contact this employer for a reference?
                                                   □ Yes □ No □ Later

 Summarize the nature of work performed and job responsibilities

    Gila Corporation Application                    Page 3                        Revision Date: March 15, 2008

 Reason for Leaving
 From               To             Employer

 Telephone #                       Address

 Starting/Final Job Title                      Pay Rate
                                               Start $ ________ per _______ Final $ _________ per __________

 Name & Title of Immediate Supervisor          May we contact this employer for a reference?
                                                  □ Yes □ No □ Later

 Summarize the nature of work performed and job responsibilities

 Reason for Leaving

 From               To             Employer

 Telephone #                       Address

 Starting/Final Job Title                      Pay Rate
                                               Start $ ________ per _______ Final $ _________ per __________

 Name & Title of Immediate Supervisor          May we contact this employer for a reference?
                                                  □ Yes □ No □ Later

 Summarize the nature of work performed and job responsibilities

 Reason for Leaving

    Skills and Qualifications
Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job-related
functions in the position for which you are applying.

    Gila Corporation Application                   Page 4                       Revision Date: March 15, 2008
    Educational Background
(If job related)

                                                     # of Years
                Name and Location                    Completed          Did you graduate               Course of Study

 High School



    Please List 2 Professional References and 2 Personal References Below
 Professional: Name                                               Telephone                              # of Years Known

 Personal: Name                                                   Telephone                              # of Years Known

    How did you hear about Gila Corporation?
    How did you hear about Gila Corporation?

          □ Austin American Statesman □ Austin Chronicle             □ Radio Ad       □       □

          □ Friend (who?)___________________________

          □ Employee Referral (who?)___________________________

          □ Relative (who?)_______________________________________

          □ Flyer (where did you see it? I.e., on a car, bulletin board, handed to you, etc.)

          □ Agency (please specify which one)

          □ Other (please specify)

    Gila Corporation Application                     Page 5                        Revision Date: March 15, 2008
Please list all residences you’ve lived at in the past 7 years

  Address                                                  City                              State

  Address                                                  City                              State

  Address                                                  City                              State

  Address                                                  City                              State

  Address                                                  City                              State

  Address                                                  City                              State

Gila Corporation Application         Page 6                  Revision Date: March 15, 2008
  Applicant Statement

  I certify that all information I have provided in order to apply for and secure work with Gila Corporation is true, complete and correct.

  I understand that if any information provided by me is found to be false, incomplete or misrepresented in any respect, this will be considered
  sufficient cause to be dropped from further consideration of this application, or immediately discharged from employment.

  I authorize the employer, or its representatives or designees, to contact and obtain information from all references (personal and
  professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all
  information provided by me in this application, resume or job interview. This process includes checking for delinquencies and/or surcharges in
  Gila Corporation client systems. I hereby waive any and all rights and claims I may have regarding the employer, or its representatives or
  designees, for obtaining and using such information in the employment process and all other persons, corporations or organizations for
  furnishing such information about me.

  If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the
  same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This
  application does not constitute an agreement or contract for employment. I understand that no supervisor or representative of the employer is
  authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express
  language are valid unless they are in writing and signed by a Gila Corporation officer.

  I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that
  federal immigration laws require me to complete an I-9 Form in this regard.

  Do not sign until you have read the Applicant Statements.

  By signing below, I, the applicant, agree that “Any employment offered to me is subject to both a criminal background and
  personal/business reference check. By signing this application below, I give Gila Corporation and/or it’s representatives
  permission to run these background checks and I agree, by my signature below, that I may be immediately terminated, without the
  right of any recourse against the Gila Corporation, its employees and agents, whatsoever, should either or both of these
  background checks not meet our minimum non-discriminatory hiring standards.”

All positions at Gila Corporation

          Applicants and employees must release all information on the criminal background checks conducted by vendors or agencies to Gila
          Corporation. Furthermore, applicants and employees must release Gila to give any information related to determination of eligibility
          for specific client assignments to the client. Employment and criminal history record information obtained by the organization may be
          used only for the purpose of evaluating applicants for employment and shall in no way be used to discriminate on the basis of race,
          color, national origin, religion, sex, disability, or age.

          I also certify that I have read, fully understand, and accept all terms of the above Applicant Statement.

  Applicant’s Signature                                                                                        Date

Gila Corporation Application                               Page 7                               Revision Date: March 15, 2008
                                      EQUAL EMPLOYMENT OPPORTUNITY
                                         STATISTICAL INFORMATION

                                                     EEO Statement

It is the policy of Gila Corporation to prohibit discrimination against any person in the job structuring,
recruitment, application, examination, selection, appointment, placement, training, upward mobility,
discipline or any other aspect of personnel administration based on race, age, religion, color, handicap,
national origin, sex, political affiliation or belief, or any other non-merit factor. Personnel decisions will be
made only on the basis of occupational qualifications and job-related factors such as skill, knowledge,
education, experiences and ability to perform a specific job. Retaliation or discrimination against an
employee for alleging discrimination on any basis covered in these policies is prohibited.

For EEOC Statistical reporting purposes, please provide the following information for our records by
placing a checkmark in the boxes that most nearly describe your demographics. Completion of this form
is voluntary.

Print Your Name

                                     Male                       Female

 White (not            Black (not      Hispanic or       Asian or         Native         Two or more
 Hispanic or           Hispanic or       Latino           Pacific       American            races
   Latino)               Latino)                         Islander     (not Hispanic     (not Hispanic
                                                      (not Hispanic     or Latino)        or Latino)
                                                        or Latino)

Gila Corporation Application                     Page 8                      Revision Date: March 15, 2008

                                  File Number (online users only):________________
To Whom It May Concern:

I,___________________________, hereby authorize A-Check America, Inc. and/or its agents to make an independent investigation of my background,
which may include my character, general reputation, personal characteristics, and mode of living in connection with an application of employment
with Gila Corporation.

The Scope of the report may include information concerning my driving record, civil and criminal court records, credit, workers compensation
record, education, credentials, identity, past addresses, social security number, previous employment and personal references.

I authorize and request any present or former employer, state/federal government office, state department of motor vehicles, credit bureaus, school,
police department, court records, including those maintained by both public and private organizations, financial institution or other persons having
personal knowledge about me to furnish A -Check America, Inc. with any and all information in their possession regarding me for the purpose of
confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications for
employment. I am willing that a photocopy of this authorization be accepted with the same authority as the original, and I specifically waive any
written notice from any present or former employer who may provide information based upon this authorization request.

The following is my true and complete legal name and all information is true and correct to the best of my knowledge:

Print Full Name:_______________________________________________________________________

Print Maiden Name or Other Names Used:_________________________________________________

Present Address:_______________________________________________________________________

City:___________________________State:______________Zip Code:___________________________

Date of Birth (for I.D. purposes only):_____/____/_____

Social Security Number:________________________________

Drivers License Number:________________________State of Issue:______________

A-Check America will need to contact you if additional information is needed to process your Background Investigation. Please provide a
telephone/cell phone number where we may contact you.

                 Phone: (_________) _______-__________ Cell: (_____) _______-_________

          If you would like to receive a free copy of your background information obtained by A-Check America, please indicate by checking the
          following box:□ (Please send me a copy of my Background Report)


Gila Corporation Application                              Page 9                              Revision Date: March 15, 2008

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