Corporate Headquarters 6195 Shiloh Road Alpharetta, Georgia USA 30005 (770) 442-9707 Fax

Corporate Headquarters  3970 Johns Creek Court, Suite 325 Suwanee, GeorgiaUSA 30024 (678) 542-3185  Fax: (678) 542-3285

EMPLOYMENT APPLICATION

PolyVision Corporation is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, religion, gender, national origin, age, marital or veteran status, the presence of a non-job related medical condition or disability, or any other legally protected status.

PERSONALPLEASE PRINT LEGIBLY IN INK

Last Name: / First Name: / M.I.: / Preferred Name: / Date:
Telephone No. (Include Area Code): / Are You Eligible to Work in the U.S.? / Last 4 Digits of SSN:
Address: / City: / State: / Zip:
Position Desired: / Are You Available for Full Time or Part Time Work?
Date Available: / Salary Expected: / E-mail address:
Have You Ever Been Employed Under Another Name? (If yes, state name.)
Are Any Of Your Relative(s) Employed, In Any Capacity, By PolyVision or Steelcase Corporation?
Have You Ever Been Convicted of a Crime? If yes, please explain. (A conviction does not necessarily disqualify you from employment.)
Have You Ever Been Involved As A Named Defendant In Any Professional Liability Action? If Yes, Please Explain.

EDUCATION AND PROFESSIONAL TRAINING

Name and Address of School / Graduated
Yes / No / Diploma
Yes / No / Degree
(Type) / Course
Major/Minor
High School or Highest Grade Attended:
College or University:
Business or GraduateSchool:
Professional or TechnicalSchool:
Special Skills (i.e., Engineering, Computer Skills, etc.):
Professional, Trade or Technical Registration or License No. (Include State): / Date Received? / Date Expires?
Employment Application / Revision: 02 / Effective Date: Sep 08
Page 1 of 2

EMPLOYMENT HISTORY (List most recent employment first. Use additional sheet if necessary.)

(All blocks must be completed)

From (Mo/Yr): / Employer: / Type of Business:
To (Mo/Yr): / Address (Include city, state, and zip code):
Name/Title of Supervisor: / Phone Number (Include Area Code): / Position(s):
Duties Performed:
Reason for Leaving: / Last Salary:
From (Mo/Yr): / Employer: / Type of Business:
To (Mo/Yr): / Address (Include city, state, and zip code):
Name/Title of Supervisor: / Phone Number (Include Area Code): / Position(s):
Duties Performed:
Reason for Leaving: / Last Salary:
From (Mo/Yr): / Employer: / Type of Business:
To (Mo/Yr): / Address (Include city, state, and zip code):
Name/Title of Supervisor: / Phone Number (Include Area Code): / Position(s):
Duties Performed:
Reason for Leaving: / Last Salary:

PROFESSIONAL REFERENCES (Employment is contingent upon a satisfactory reference check)

(1) Name: / Title/Position: / Telephone No. (Include Area Code):
Address (Include city, state and zip code):
(2) Name: / Title/Position: / Telephone No. (Include Area Code):
Address (Include city, state and zip code):
(3) Name: / Title/Position: / Telephone No. (Include Area Code):
Address (Include city, state and zip code):

I understand that employment with PolyVision Corporation is terminable-at-will (unless expressly prohibited by state law or contract), that I am not being employed for any specific time, and that this application is not and is not intended to be a contract for continued employment. I hereby affirm that the information provided in this application (and accompanying resume, if any) is true and complete. I also agree that any information or omissions may disqualify me from consideration for employment or continued employment. I authorize a thorough investigation of my past education, employment and personal activities, agree to cooperate in such investigation and release from all liability or responsibility all persons or entities requesting or supplying such information. I hereby agree to submit to any lawful drug or medical testing that may be required as a condition of employment and/or continued employment and understand that refusal to submit to such lawful testing during the course of my employment may result in disciplinary action, up to and including discharge. I understand that according to federal law all individuals who are hired must produce certain documentation to verify their identity and their legal right to work in the U.S. I understand that any offer of employment is contingent on my ability to produce the required documentation within the time period required by law.

Signature of Applicant: ______ / Date:______
Employment Application / Revision: 02 / Effective Date: Sep 08
Page 2 of 2