Application for Employment

APPLICATION FOR EMPLOYMENT

Equal access to programs, services and employment is available to all persons. Those applicants requiring accommodation to the application and/or interview process should contact the Human Resources department. Wireless Telecom Group, Inc., its subsidiaries and holdings considers all applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, marital status, age, disability or status as a Vietnam-Era Veteran or specially disabled Veteran in accordance with federal law. Additionally, Wireless Telecom Group, Inc. complies with applicable state and local laws prohibiting discrimination in employment. Wireless Telecom Group, Inc. provides reasonable accommodation to individuals with a disability in accordance with applicable laws.

Position(s) Applying For:

Last Name:

First Name:

Middle Name or Initial:

Present Street Address:

City:

State:

Zip:

Telephone Number:

Business Telephone Number:

Email Address:

How do you hear about our available opportunity or how were you referred to Wireless Telecom Group, Inc.?

Have you ever been employed before by Wireless Telecom Group, Inc.?

Yes

No

If you are under 18, can you furnish a work permit?

Yes

No

Are you authorized for employment in the United States?

Yes

No

Federal laws require employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with such laws, Wireless Telecom Group, Inc. will verify the status of every individual offered a position 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 documentation as required by law to verify your identification and employment authorization.

Are you able to perform the essential requirements of this position which you are applying for?

Yes

No

Do you have a valid driver’s license? (For driving positions only)

Yes

No

What hours and days can you work?

Are there specific times/days that you cannot work?

Are you willing and able to work overtime as necessary?

Yes

No

Consistent attendance and punctuality are essential requirements of every job with this Company. Is there anything which would interfere with your regular attendance and punctuality if you are offered a position with the Company?

Yes

No

May we contact your present employer?

Yes

No

Date available for work?

Wages/Salary Desired (you may specify a range)?

EMPLOYMENT HISTORY

Begin with present or most recent employer (please fill out completely).

Employer1

Employer2

Employer3

EDUCATION

High School

Name and Location of School:

Course of Study:

Dates Attended
From:

MM

DD

YYYY

To:

MM

DD

YYYY

Graduation Date:

MM

DD

YYYY

Degree Received:

Business/ Technical/ Other

Name and Location of School:

Course of Study:

Dates Attended
From:

MM

DD

YYYY

To:

MM

DD

YYYY

Graduation Date:

MM

DD

YYYY

Degree Received:

College

Name and Location of School:

Course of Study:

Dates Attended
From:

MM

DD

YYYY

To:

MM

DD

YYYY

Graduation Date:

MM

DD

YYYY

Degree Received:

Graduate School

Name and Location of School:

Course of Study:

Dates Attended
From:

MM

DD

YYYY

To:

MM

DD

YYYY

Graduation Date:

MM

DD

YYYY

Degree Received:

REFERENCES

Professional/Business/Academic

(Please do not include personal references)

REFERENCE 1
Name:

Relationship:

Telephone:

Business Phone:

Present Address:

REFERENCE 2
Name:

Relationship:

Telephone:

Business Phone:

Present Address:

REFERENCE 3
Name:

Relationship:

Telephone:

Business Phone:

Present Address:

SECRECY / NON-COMPETITION

Have you signed a secrecy and /or invention or confidentiality agreement in favor of any previous employer(s)

Yes

No

Have you signed a non-competition agreement or any other agreement that would restrict you from accepting employment with a competitive firm?

Yes

No

RESPECTING CONFIDENTIAL INFORMATION/MATERIAL OF OTHERS AND CONFIDENTIALITY

I agree to not bring any trade secrets, confidential and /or proprietary information of my former employer(s) to Wireless Telecom Group, Inc. and its subsidiaries and holdings. I agree to not reveal any such information during the application process.

I acknowledge and accept that Wireless Telecom Group, Inc. and its subsidiaries and holdings have a need for confidentiality too and that if an offer of employment is extended, it is contingent upon the execution of an Employee Non-Competition and Confidentiality Agreement.

Signature - Agree

Signature

Signature - Date

Date

APPLICATION SIGNATURE

The information provided in the Application for Employment is true, correct and complete. I understand that any misstatement, omission or misrepresentation of fact on this application may be sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by Wireless Telecom Group, Inc. its subsidiaries or holdings. I understand that my employment is conditioned on a background check. I understand that references and/or past employers may be contacted in connection with this employment application without my prior knowledge and affirmatively authorize you to do so. I release the Company, any former employers and all references listed above, from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future and that my employment will be “at will”, without fixed term, and may be terminated by the Company or by me at any time, with or without cause and without prior notice. I understand and agree that nothing in this application, or conveyed during my interview, is intended to create an employment contract.

If the Company decides to engage an investigative consumer reporting agency to report my credit and personal history, I authorize it to do so. If a report is obtained the Company must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report.

I understand that filling out this form does not indicate that there is a position open and does not obligate the Company to hire me. If hired, I agree to abide by all Company work rules, policies and procedures including, without limitation, those contained in the Employee Handbook. The Company reserves the right to modify, revoke, suspend, terminate or change its polices or procedures, in whole or in part, at any time, with or without notice.

Signature - Applicant

Signature

Signature Date - Applicant

Date