GE Employment Application

GE Employment Application INSTRUCTIONS: Failure to complete the application completely and accurately will delay the process and may disqualify the application. Please print legibly. In the Personal Data section, please list a phone number where you can be reached directly or where you will receive a message. In the Job Interest section, specify which position you are applying for: Production Assembler/Tester or Warehouse Utility. Submit a separate application for each position. Completely fill out the Education and Training section including Full School Name, City, and State and if you graduated from that institution. Please indicate in the Employment section whether or not you have previously been on the payroll at GE or a GE affiliated business. Please check the box whether or not you have a n-compete agreement with your current employer. Fully complete the Current/Previous Employer section. Fully complete the Convictions/Suspensions/Debarments section. Make sure you sign BOTH the Application (page 8) and the Background Waiver (page 10). PROCESS: Applications are considered in the order they are received. Any applications received before March 12 th or after March 16 th,2007 will not be accepted for consideration during this current hiring initiative. GE Healthcare WILL NOT accept applications at GE Healthcare sites for these production positions. Applications for these production positions will ONLY be accepted at the Wisconsin Job Center locations listed. A 2007 application must be completed to be considered, but a resume may also be attached. Completed applications will be considered for immediate and additional openings through January 31 st, 2008. Meeting minimum requirements does not guarantee an interview. Please DO NOT call to check on the status of your application. All applicants will be contacted regarding their application status. Thank you for your interest in employment with GE Healthcare and for following these guidelines! An Equal Opportunity Employer Please keep this page for your records. Page 1

GE Employment Application For Use by GE and GE Affiliates* An Equal Opportunity Employer It is the policy of GE and GE s affiliate businesses (GE and GE Affiliates are separate and distinct legal entities) to employ, train, compensate, promote and provide other terms and conditions of employment, without regard to a person s race, color, religion, national origin, sex (including pregnancy), sexual orientation, age, disability, veteran status, or other characteristics protected by law. This application must be completed in full. Please print or type. Answer every question. EMPLOYMENT ELIGIBILITY The Immigration Reform and Control Act of 1986 prohibits the employment of unauthorized aliens, and requires employers to verify the employment eligibility of all new employees. An offer of employment made by the Company will be conditioned upon your providing the documentation required by law as evidence of your personal identity and your authorization to work in the United States. Any offer of employment is also conditioned upon the successful completion of a background investigation, a post-offer physical evaluation (if applicable) and a drug screen. PERSONAL DATA Name: Last First Middle Date of Application: Previous/Different last name(s) used in past 7 years, including maternal last name, if applicable (do not answer question if applying for a position at GE Asset Management.) Please indicate N/A if you have no other names: Street Address: City: State/Province: Country: ZIP/Postal Code: Email Address: Is Your Age Under 18? Telephone (day): (evening): Social Security.: Are you a U.S. citizen or national, permanent resident, temporary resident, refugee or asylee? Temporary residence does not include those with non-immigrant work authorization (F, J, H or L visas). Exceptions to these requirements will be determined based on shortage of qualified candidates with a particular skill.) JOB INTEREST What position are you applying for?: Date Available For Employment: How or by whom were you referred to us? Please provide your drivers license number. Your motor vehicle record will be checked if you are applying for a position that requires you to operate a GE owned/leased, privately owned/leased or rental vehicle for company business. Name On License: State: License #: EDUCATION AND TRAINING (please do not abbreviate school names) Please list only those educational institutions where you attended classes (physically or online) and do not include those educational institutions where your degree was acquired by only fulfilling life experience requirements and/or paying a one-time flat fee. Full School Name City State Country Major Course or Subject Did You Graduate If, Est. Grad Date Degree High School or GED (Testing Site): Trade School/Technical School: Page 2

College: Graduate School: Other Education: Please indicate name(s) used during highest level of education: Page 3

PRIVACY POLICY At GE and GE s affiliate businesses* we are committed to protecting your privacy. Your personal information will be maintained in an electronic database in the U.S. and will be processed by a third party provider for purposes of conducting background investigations. Your personal information will be used by GE and GE s affiliate businesses* for recruitment, GE and GE s affiliate businesses* human resource processes and background check purposes. It will be protected internationally according to GE s and GE s affiliate businesses* Candidate Data Protection Standards. The electronic database has security measures in place to protect the loss, misuse, unauthorized access or disclosure, alteration or destruction of the information under our control. By submitting your personal information and signing this application, you agree that GE and GE s affiliate businesses* may process it for recruitment, human resources processes and background check purposes and transfer it worldwide consistent with GE s and GE s affiliate businesses* Candidate Data Protection Standards. For the full text of GE's and GE s affiliate businesses* Candidate Data Protection Standards, please refer to: http://www.gecareers.com/gecareers/html/us/searchjobs/candidate_privacy.html. PRIOR ADDRESS INFORMATION Please indicate all addresses other than the current address indicated on Page 1 that you have used in the last seven years. Street Address City: State/Province: ZIP/Postal Code: Country: Dates At This Address: FROM: TO: City: State/Province: ZIP/Postal Code: Country: Dates At This Address: FROM: TO: City: State/Province: ZIP/Postal Code: Country: Dates At This Address: FROM: TO: City: State/Province: ZIP/Postal Code: Country: Dates At This Address: FROM: TO: City: State/Province: ZIP/Postal Code: Country: Dates At This Address: FROM: TO: Page 4

EMPLOYMENT Have you ever been on the payroll at GE or a GE affiliated business*?. If yes, which business? Location? Dates Employed From: Dates Employed To: Are you currently subject to a non-compete or employment agreement with another employer? Starting with your current or most recent employment, list all previous employers. Include self-employment, military service, summer and part-time jobs for at least the last seven years. Include at least your three most recent employers, if applicable. Must be completed in full for each employer. Writing See resume is not acceptable. If a contract worker assignment, list the name of the company that PAID you, not the company where you were assigned to work. CURRENT/PREVIOUS EMPLOYER (Please use complete names no abbreviations. If self-employed, indicate name of business entity. Company Name: Start Date: End Date: Job Title and Duties: Department: City: State: Country: Telephone Number: ( ) - When may we contact this employer? w After acceptance of conditional offer Reason For Leaving: Name & Title of Mgr (or Commanding Officer): Company Name: Start Date: End Date: Job Title and Duties: Department: City: State: Country: Telephone Number: ( ) - Reason For Leaving: Name & Title of Mgr (or Commanding Officer): Company Name: Start Date: End Date: Job Title and Duties: Department: City: State: Country: Telephone Number: ( ) - Reason For Leaving: Name & Title of Mgr (or Commanding Officer): Company Name: Start Date: End Date: Job Title and Duties: Department: City: State: Country: Telephone Number: ( ) - Reason For Leaving: Name & Title of Mgr (or Commanding Officer): Page 5

CONVICTIONS/SUSPENSIONS/DEBARMENTS Any uncertainty in answering the questions below should be resolved in favor of disclosure. This information will not necessarily bar an applicant from employment. The nature and seriousness of the crime, the date of conviction, and the relation to the position sought will be considered. Applicants need not disclose information pertaining to sealed, expunged, pardoned, or statutorily eradicated arrest or conviction records. Have you ever been convicted of a felony? Include all pleas of guilty or no contest * Have you been convicted of a misdemeanor within the last seven years OR imprisoned for any type of misdemeanor within the last seven years? If to any of the above questions, please indicate the county, state, year and explain fully below: County: State: Year: Description: CA applicants: Exclude information regarding (1) convictions of marijuana offenses in violation of CA Health and Safety Code Sections 11357(b) or (c) or a statutory predecessor thereof, 11360(c) [now (b)], 11364, 11365, or 11550, as they related to marijuana prior to January 1, 1976 or a statutory predecessor thereof, which are more than 2 years old; and (2) any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed pursuant to CA. Penal Code Section 1203.4. CT applicants: Do not disclose arrests, criminal charges, or convictions for which records have been erased pursuant to Conn. Gen. Stat. 46b-146m 54-176o, or 54-142a. These records pertain to findings of delinquency; findings that a child was a member of a family with service needs; adjudications as a youthful offender; dismissed or nolled criminal charges; criminal charges for which you have been found not guilty; or convictions for which you received absolute pardons. Applicants whose criminal records have been so erased are deemed never to have been arrested and may so swear. HI applicants: Do not answer either of the above 2 questions. MA applicants: Include all misdemeanor convictions and completed periods of incarceration within the last 7 years if any of the convictions or completed periods of incarceration occurred within the last 5 years. Include all convictions for felonies. Exclude first convictions for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violation, affray or disturbing the peace. An applicant for employment with a sealed record on file with the Commissioner of Probation may answer no record with respect to any inquiry herein relative to prior convictions. In addition, any applicant for employment may answer no record with respect to any inquiry relative to prior arrests, court appearances, and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the Superior Court for criminal prosecution. NV applicants: Include all felony convictions. Only include misdemeanor convictions within the last 7 years which resulted in imprisonment. WA applicants: Only include convictions or releases from imprisonment, whichever are more recent, within the last 7 years. Are you currently debarred, suspended or otherwise ineligible to work on any federally funded program? FOR APPLICANTS IN MARYLAND AND MASSACHUSETTS UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Applicant s Acknowledgement: This page to be detached by Human Resources Page 6

SELF IDENTIFICATION We request that you provide the following information on a voluntary basis. The Federal Government requires us to report on the sex and race of every applicant. This information is requested for statistical purposes only, and will not be kept with your application or used in connection with any employment decisions. There will be no negative consequences to you if you choose not to provide this information. (Mark only one sex and one race/ethnic group.) SEX: Male Female RACE/ETHNICITY: American Indian or Alaskan Native (A person with origins in any of the original peoples of rth America who maintains cultural identification through tribal affiliation or community recognition.) Asian or Pacific Islander (A person with origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Republic and Samoa; and on the Indian Subcontinent, includes India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim and Bhutan.) Black (An individual, not of Hispanic origin, with origins in any of the Black racial groups of Africa.) Hispanic (A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race. This does not include persons of Portuguese descent or persons from Central or South America who are not of Spanish origin or culture.) White (An individual, not of Hispanic origin, with origins in any of the original peoples of Europe, rth Africa, or the Middle East.) This page is not needed for background checking purposes and should not be transmitted outside GE. This page to be detached by Human Resources Page 7

ADDITIONAL INFORMATION State any additional information you feel may be helpful to us in considering your application. This could include any specialized training or courses you have completed that will aid in evaluating your qualifications for the position you are seeking. (Example: If applying for a clerical position, note training such as word processing, typing, calculator, computer, hardware, software, etc.) Please include grade or other indicator of achievement, such as words per minute typed. You should feel free to attach a resume. REFERENCES Please list at least three business or school related references that GE and GE s affiliate businesses* may contact regarding your application. Do not include relatives. Reference Name Address Daytime Phone Number 1. 2. 3. COMMITMENT TO INTEGRITY GE and GE s affiliate businesses* commitment to integrity is an integral part of our success. As such, all employees must acknowledge in writing their commitment to adhering to GE s and GE s affiliate businesses* policies and reporting concerns about possible violations. APPLICANT RELEASE AND ACKNOWLEDGEMENT I understand that GE and GE s affiliate businesses* (hereinafter referred to as the Company) requires certain information about me to evaluate my qualifications for employment and to conduct its business if I become an employee. Therefore, I authorize the Company to investigate my past employment, educational credentials, and other employment-related activities. I agree to cooperate in such investigations and release those parties supplying such information to the Company from all liability or responsibility with respect to information supplied. I agree that the Company may use the information it obtains concerning me in the conduct of its business. I understand that such use may include disclosure outside the Company in those cases where its agents and contractors need such information to perform their functions, where their company s legal interests and/or obligations are involved, or where there is a medical emergency involving me. I understand, however that the Company intends to protect the confidentiality of personal information it obtains concerning me to the extent required by law. I agree that I will not disclose or use while interviewing with or employed with GE and GE s affiliate businesses* any confidential or proprietary information of others, including any former employer. I understand that any employment with the Company would not be for any fixed period of time and that, if employed, I may resign at any time, for any reason, or the Company may terminate my employment at any time for any reason in the absence of a specific written agreement to the contrary. I understand that my employment-at-will status may not be modified or changed except in writing and signed by a duly authorized officer of the Company. I understand that any false answers or statements made by me on this application, any supplement thereto or in connection with the abovementioned investigations may be grounds for refusal of employment, invalidate my employment or, if employed, will be sufficient grounds for immediate discharge and render me ineligible for any Company benefits. My signature below acknowledges that I have read, understand, and agree to the terms of the entire application. Applicant s Signature: Date: Applicant Name: This page is not needed for background checking purposes and should not be transmitted outside GE. Page 8

This page to be detached by Human Resources NOTICE REGARDING BACKGROUND INVESTIGATION You are being considered for employment by GE or GE s affiliate businesses (the Company ). We would like to investigate the information that you have provided to us, and other relevant background information, in connection with your application for employment to determine whether you are a suitable candidate. Accordingly, you may be the subject of a consumer report 1 requested by the Company from an outside agency. If you are hired, additional consumer reports may be obtained during the tenure of your employment for employment purposes. For purposes of your employment with the Company, we typically verify: 1) your criminal history; 2) your educational background; 3) your past employment; and 4) in connection with certain positions with the Company, your driving record and/or your credit history. Should you decline to authorize a background investigation, your employment application will be deemed withdrawn. In the event that information from a consumer report is utilized in whole or in part in making an adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the Fair Credit Reporting Act before making the adverse decision. For California Applicants: You may view the file maintained on you during normal business hours and on reasonable notice by contacting the supplier who completed your report, noted by the checkmark: Adrem Proudfoot Reports, Inc 5461 West Waters Avenue, Suite 900 1300 Walt Whitman Road, Suit 103 Tampa, FL 33634 Melville, NY 11747-5102 (800) 463-9929 (631) 421-8000 Hours: 8:30 a.m. to 6 p.m. (EST), Mondays-Fridays Hours: 8 a.m. to 8 p.m. (EST), Mondays-Fridays You may also obtain a copy of this file upon submitting proper identification and paying the cost of duplication services, by appearing at the background check supplier in person, or by mail. You may also receive a summary of your file by telephone. The background check supplier is required to have personnel available to explain your file to you, including any coded information that may appear in your file. If you appear in person, you may be accompanied by one other person of your choice, provided that this person furnishes proper identification. This form is for GE and GE s affiliate businesses. GE affiliates and GE are separate and distinct legal entities. 1 The law defines a consumer report as a report which may contain information obtained from an outside agency on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and mode of living which will be used to establish your eligibility for employment. Page 9

APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION I acknowledge that I have received a copy of the NOTICE REGARDING BACKGROUND INVESTIGATION, and that I have read and understand that notice. I hereby give the Company permission to obtain consumer reports and other background information to be used for employment purposes at any time during the application process and, if I am hired, throughout the tenure of my employment. For California Applicants: I understand that I have the right to make a request to the background check supplier who completed my report as noted by the checkmark on the previous page, upon proper identification, to review the information contained in its files on me which the background check supplier has previously furnished within the two year period preceding my request. Applicants in California only: I request to receive a free copy of a consumer report ordered on me by checking this box. Applicants in Minnesota and Oklahoma: I request to receive a free copy of a consumer report ordered on me by checking this box. Signature: Date: Name (please print): Social Security Number: Page 10