PO Box 1527 • 5121 Martin Luther King Jr.

Hwy
Greenville, NC 27835-1527
GRADY WHITE Tel (252) 752-2111 Fax; (252) 752-4217

AN EQUAL OPPORTUNITY EMPLOYER Date___/___/

NOTIFICATION/ RELEASE OF INFORMATION
Please read before filling out this application

This form serves to notify you, the applicant, that a Consumer Report will be conducted during the course
of consideration for employment with Grady-White Boats. Please complete ALL information requested

Grady-White Boats, Inc. does not discriminate in hiring or employment on the basis of race, color, sex, religion,
genetic information, disability, national origin, citizenship, military status, or on the basis of age with respect to
persons 18 years or older. No question on the application is intended to secure information to be used for such
discrimination. Proof of identity and work authorization will be required upon employment in accordance with
federal regulations. Grady-White Boats, Inc. intends to check and hold you responsible for the accuracy of the
statements you make on this application. In connection with this request, I authorize all corporations, credit
agencies, educational institutions, law enforcement agencies, city/state/county and federal courts, and military
services to release information to Grady-White Inc., about employment, education, consumer credit history, driving
record, criminal record, worker's compensation and general public history. This form releases the aforesaid
companies from any liability and responsibility for collecting the above information.

Signature of Applicant

Date of Signature

Personal Data- PLEASEPRINTINFORMATION

Are you currently covered by a non-compete agreement with any former employer?  Yes  No
If yes, identify employer

Applicant Name _______________________________________________________________________________

Last First Middle
Date of Birth ____________________I ______________________ I __________________ (example 06 / 05 / 61)
Telephone # _______________________________________

Driver's License # _________________________________________________ State Issued ___________________

Current Address _______________________________________________________________________________

City ____________________________________ State _________________________________ Zip ___________

Alias / Maiden Names Used ______________________________________________________________________

E-Mail Address_______________________________________________________________________________
 PO Box 1527 • 5121 Martin Luther King Jr. Hwy
Greenville, NC 27835-1527
Tel (252) 752-2111 Fax; (252) 752-4217
GRADY WHITE

AN EQUAL OPPORTUNITY EMPLOYER Date___/___/

Have you ever pled guilty or been convicted of a crime other than a minor traffic violation? Do not include
sealed and expunged convictions, this includes misdemeanors and felonies.
(Grady-White Boats does conduct criminal background checks.) ❑ Yes ❑ No
A “yes” answer to this question does not necessarily preclude consideration for employment

If yes, please explain:

Are you authorized to work for any employer in the US? Yes No

Do you now or in the future will you require sponsorship by the company to retain employment
in the US? Yes No

If yes, please explain

(A "yes" answer to this question does not necessarily preclude consideration for employment)

Educational Data
Circle Highest Grade Completed:

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 1 2 3 4
Grade, Junior High or High School College or University Graduate School
Major Subject or
Type of School Name of School Location Did You Graduate?
Course of Study
High School

College
Business or
Trade School
Correspondence School

Other (Specify)

Graduate School

List Degree(s) Obtained

 PO Box 1527 • 5121 Martin Luther King Jr. Hwy
Greenville, NC 27835-1527
Tel (252) 752-2111 Fax; (252) 752-4217
GRADY WHITE

AN EQUAL OPPORTUNITY EMPLOYER Date___/___/

Employment

Position Desired Salary desired

Previous employment by Grady White:  Yes  No When?
If yes, give the name(s) if different from the one given on this application
When could you report for work?
Referred by:_______________________________(person’s name)

Relatives/Friends employed by Grady White

Name Relationship Name Relationship

Work History (Listing current/last job first)

From (mo. /yr.) Company Telephone Starting Salary
AREA
( ) $ per
To (mo. /yr.) Address City State Zip Final Salary

$ per
Supervisor’s Name/Title Type of Business May we  Yes
contact?  No
Your Position/Title Responsibilities/Duties

Specific Reason for Leaving

From (mo. /yr.) Company Telephone Starting Salary

AREA
( ) $ per
To (mo. /yr.) Address City State Zip Final Salary

$ per
Supervisor’s Name/Title Type of Business
May we  Yes
contact?  No
Your Position/Title Responsibilities/Duties

Specific Reason for Leaving

 PO Box 1527 • 5121 Martin Luther King Jr. Hwy
Greenville, NC 27835-1527
GRADY WHITE Tel (252) 752-2111 Fax; (252) 752-4217

AN EQUAL OPPORTUNITY EMPLOYER Date___/___/

Work History Continued…

From (mo. /yr.) Company Telephone Starting Salary
AREA
( ) $ per
To (mo. /yr.) Address City State Zip Final Salary

$ per
Supervisor’s Name/Title Type of Business
May we  Yes
contact?  No
Your Position/Title Responsibilities/Duties

Specific Reason for Leaving

From (mo. /yr.) Company Telephone Starting Salary

AREA
( ) $ per
To (mo. /yr.) Address City State Zip Final Salary

$ per
Supervisor’s Name/Title Type of Business
May we  Yes
contact?  No
Your Position/Title Responsibilities/Duties

Specific Reason for Leaving

From (mo. /yr.) Company Telephone Starting Salary

AREA
( ) $ per
To (mo. /yr.) Address City State Zip Final Salary

$ per
Supervisor’s Name/Title Type of Business
May we  Yes
contact?  No
Your Position/Title Responsibilities/Duties

Specific Reason for Leaving

 PO Box 1527 • 5121 Martin Luther King Jr. Hwy
Greenville, NC 27835-1527
Tel (252) 752-2111 Fax; (252) 752-4217
GRADY WHITE

AN EQUAL OPPORTUNITY EMPLOYER Date___/___/

Military
Branch of Service:
Duties in the service, including schools and training:

Special Skills
What knowledge, special technical or computer skills, and/or other qualifications have you acquired from
employment or other experience? Include any specific equipment you can operate. Hand & power tools, special
carpentry, auto body/detail work, fiberglass, maintenance/repair that you can proficiently operate and/or any
software applications you are proficient in. Please list any skills as applicable.

List any first aid or emergency response training for which you are currently certified (give date of
certification).

Professional References
Give three references who are not relatives or former employers.
Years
Name Occupation Phone Address
Known
 PO Box 1527 • 5121 Martin Luther King Jr. Hwy
Greenville, NC 27835-1527
GRADY WHITE Tel (252) 752-2111 Fax; (252) 752-4217

AN EQUAL OPPORTUNITY EMPLOYER Date___/___/

Affidavit
I authorize, without liability, investigation of all statements in this application.

I authorize all schools which I attended and all previous employers to furnish to Grady-White Boats, Inc. my record,
reason for leaving and all information they may have concerning me, and hereby release them and Grady-White Boats,
Inc. from all liability for any damage whatsoever arising therefrom.

I authorize my neighbors, friends or others with whom I am acquainted or who are acquainted with me to furnish Grady-
White Boats, Inc. with information used in connection with the evaluation of my qualifications as a prospective employee.
I release such persons and organizations from any legal liability in making such statements.

I understand that in the event of my employment by Grady-White Boats, Inc. it shall be sufficient cause for dismissal if
any of the information I have given in this application is false or if I have failed to give any information herein requested.
I understand that proof of identity and work authorization will be required upon employment in accordance with federal
regulations. In the event of my employment by Grady-White Boats, Inc., I agree to abide by all present and subsequently
issued rules of the Company.

If hired, in consideration of my employment, I agree to comply with the policies, standards, and business ethics of Grady-
White Boats, Inc.). I understand that my employment is at will and may be terminated by me or the company at any time
without additional consideration or notice. I understand that no representative of Grady-White Boats, Inc. (except an
Executive Officer) has the authority to commit to any definite term of employment or alter the at-will employment
agreement, and any such agreement must be in writing.

It is the policy of Grady-White Boats, Inc. to provide a drug-free workplace. Please be advised that all offers of
employment are contingent upon satisfactory results of a drug screening test. All applicants who are considered for
employment will be requested to sign a consent release form authorizing the company to have its designated clinic,
hospital or laboratory perform the drug screening test. Applicants who refuse to sign the consent form will not be
considered for employment. Appropriate considerations will be made for applicants providing proof of taking prescription
drugs under the direction of a physician.

I hereby certify that the entries on this application and the statements made by me are true and correct, and I acknowledge
that any falsification of this form could result in immediate dismissal. I affirm that I have a genuine intent and no other
purposes in applying for a job with this company. By submitting this application and affixing my signature hereto, I agree
to submit to a Polygraph (lie detector) examination during investigations of theft or other crimes if the company declares
in writing that it has reasonable suspicion that workers could be implicated. Furthermore, I have read the above drug
screening notice and understand that all offers of employment are contingent upon satisfactory results of this test

Signature_________________________________________________ Date____________________________________
Comments
Please answer the questions below:
Name:___________________________ Date:__________
Phone number (best way to contact you):_(___)_____________

1. Are you able to pass a pre-employment drug screen today? Yes No

2. Have you applied or worked with Grady-White Boats before? Yes No

3. Are you currently employed? Yes NO If yes, where?___________ Fulltime Part-time

4. What type of work have you done in the past? Be specific.

5. What kind of work are you looking for today? What do you enjoy?

6. Have you held a job performing the type of work you are requesting? Yes NO

7. What tools do you have experience using?

8. Can you read a tape measure? Yes NO

9. Have you ever worked around fiberglass before? Yes No

10. Will you need to miss work for any reason in the next 6 months? Yes No When?_____

11. Have you worked with one company for more than one year? Yes No If yes, Where?

12. Are you currently in school? Yes NO Do you plan to attend school? Yes No When?

13. Are you looking for 1st 2nd or 3rd shift?

14. Have you EVER been terminated from a position? Yes No Where?

15. (Circle one) No HS Diploma HS Diploma/GED Associate Undergraduate Graduate Degree

16. Do you have a valid Driver’s License? Yes No

17. Do you have your own transportation to and from work? Yes No

18. Are you able to meet the essential functions of the job to include lift, push and pull up to 50 lbs with
or without reasonable accommodations? Yes No

19. Are you from this area? Yes No If not, from where did you move?
What brings you here?

20. Are you looking for Fulltime Part-time or Temporary work?

21. What hours are you available to work?

22. What is the minimum amount of pay you are able to take?

23. What are some of your hobbies?

24. Did someone specific refer you? Yes No Who?

If not, how did you hear about Grady-White Boats?