3DO Employment Application 
An Equal Opportunity Employer	

Please Print  
__/__/__	___________________	___________________	__ 
Date	Last Name 		First Name		Middle 

Present Address
______________________________	_______________	___ 	_____-____ 
No. & Street				City		State	 Zip 

Permanent Address (if different from present address)
______________________________	_______________	___ 	_____-____ 
No. & Street				City	 	State	 Zip 
(___) ________	(___) ________		___-__-____ 
Business Phone		Home Phone		Social Security Number 

Employment Desired       
Position applying for:	 ______________________________________________
Are you applying for:
	Regular full-time work?	  Yes    No
	Regular part-time work?	  Yes    No
	Temporary work, e.g., summer or holiday work?	  Yes    No
What days and hours are you available 
for work?	 ______________________________________________
If applying for temporary work, during what period of time will you be available?
	From: _______________	To: _______________
Are you available for work on weekends? 	  Yes    No
Would you be available to work overtime, if necessary? 	  Yes    No
If hired, on what date can you start work? 	 __/__/__
Salary desired:	 ______________________________________________

Personal Information 
Have you ever applied to or worked for	The 3DO Company………………..before?	  Yes    No 
	 
If yes, when?	___________________________________ 

Do you have any friends or relatives working for	The 3DO Company 	  Yes    No 

If yes, state name(s) and relationship:
________________________________________		_______________ 
Name		Relationship 
________________________________________		_______________ 
Name		Relationship 

Why are you applying for work at 	The 3DO Company? 
	 
	____________________________________________________________ 
	____________________________________________________________ 
Are you at least 18 years old? (If under 18, hire is subject to verification that you are of 
minimum legal age.) 	  Yes    No 
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live 
and work in this country? 	  Yes    No 
Are you able to perform the essential functions of the job for which you are applying, either 
with or without reasonable accommodation?  	  Yes    No 
If no, describe the functions that cannot be performed.
	____________________________________________________________ 
	____________________________________________________________ 
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.) 
Have you ever been convicted of a crime? (Convictions for marijuana-related offenses that are more than two years, convictions for which the criminal record has been expunged, sealed, or eradicated by the court, or misdemeanor convictions for which any probation has been completed and the case dismissed by the court need not be disclosed.)	  Yes    No 
If yes, state nature of the crime(s), when and where convicted and disposition of the case.
	____________________________________________________________ 
	____________________________________________________________ 
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.) 
Are you currently employed?	  Yes    No 
If so, may we contact your current employer? 	  Yes    No 

Education, Training and Experience 
School 	Name 			No. of years	Did you	Degree
	and Address			Completed	Graduate?	or Diploma 
High 	______________________________	___	 Yes   No	________ 
School 	Name 
	______________________________ 
	Address 
	_______________	___	_____-____ 
	City	State	Zip 
College/	______________________________	___	 Yes   No	________ 
University 	Name 
	______________________________ 
	Address 
	_______________	___	_____-____ 
	City	State	Zip 
Vocational/	______________________________	___	 Yes   No	________ 
Business 	Name 
	______________________________ 
	Address 
	_______________	___	_____-____ 
	City	State	Zip 
 
	City	State	Zip 

 	
Answer the following questions if you are applying for a professional position: 
Are you licensed/certified for the job applied for? 	  Yes    No 
	Name of license/certification:	___________________________________ 
	Issuing state:	___________________________________ 
	License/certification number	___________________________________ 
Has your license/certification ever been revoked or suspended? 	  Yes    No 
If yes, state reason(s), date of revocation or suspension and date of reinstatement. 
	____________________________________________________________ 
	____________________________________________________________ 

 	
Employment History 
List below all present and past employment starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.  If you need additional space, please attach an exhibit providing similar information for each employer.       
______________________________ 	(___) ________ 
Name of Employer 	Telephone No. 
______________________________	______________________________ 
Type of Business	Your Supervisor's Name 
______________________________	_______________	___	_____-____ 
Address & Street	City	 State	 Zip 
Dates of Employment:	__/__/__	__/__/__	Weekly Pay: 	________	________ 
	From	To 		Starting	Ending 
____________________________________________________________ 
Your Position and Duties 
____________________________________________________________ 
Reason for Leaving 
May we contact this employer for a reference? 	  Yes    No 

Employment History, continued
______________________________	(___) ________ 
Name of Employer 	Telephone No.
______________________________	______________________________ 
Type of Business	Your Supervisor's Name	 
______________________________	_______________	___	_____-____ 
Address & Street	City	 State	 Zip 
Dates of Employment:	__/__/__	__/__/__	Weekly Pay:	________	________ 
	From	To		Starting	Ending 
____________________________________________________________ 
Your Position and Duties 
____________________________________________________________ 
Reason for Leaving 
May we contact this employer for a reference? 	  Yes    No 
______________________________	(___) ________ 
Name of Employer 	Telephone No.
______________________________	______________________________ 
Type of Business	Your Supervisor's Name	 
______________________________	_______________	___	_____-____ 
Address & Street	City	 State	 Zip 
Dates of Employment:	__/__/__	__/__/__	Weekly Pay:	________	________ 
	From	To		Starting	Ending 
____________________________________________________________ 
Your Position and Duties 
____________________________________________________________ 
Reason for Leaving 
May we contact this employer for a reference? 	  Yes    No 
______________________________	(___) ________ 
Name of Employer 	Telephone No.
______________________________	______________________________ 
Type of Business	Your Supervisor's Name	 
______________________________	_______________	___	_____-____ 
Address & Street	City	 State	 Zip 
Dates of Employment:	__/__/__	__/__/__	Weekly Pay:	________	________ 
	From	To		Starting	Ending 
____________________________________________________________ 
Your Position and Duties 
____________________________________________________________ 
Reason for Leaving 
May we contact this employer for a reference? 	  Yes    No 

Employment History, continued
______________________________	(___) ________ 
Name of Employer 	Telephone No.
______________________________	______________________________ 
Type of Business	Your Supervisor's Name	 
______________________________	_______________	___	_____-____ 
Address & Street	City	 State	 Zip 
Dates of Employment:	__/__/__	__/__/__	Weekly Pay:	________	________ 
	From	To		Starting	Ending 
____________________________________________________________ 
Your Position and Duties 
____________________________________________________________ 
Reason for Leaving 
May we contact this employer for a reference? 	  Yes    No 

 	

 References 
List below three persons not related to you who have knowledge of your work performance within the last three years.     
___________________	___________________		(___) ________ 
First Name	Last Name			Telephone No 
______________________________	_______________	___	_____-____ 
Address & Street		City		State	 Zip 
_____________________________	__  
Occupation		No. of Years Acquainted 

___________________	___________________		(___) ________ 
First Name	Last Name			Telephone No 
______________________________	_______________	___	_____-____ 
Address & Street		City		State	 Zip 
_____________________________	__  
Occupation		No. of Years Acquainted 

___________________	___________________		(___) ________ 
First Name	Last Name			Telephone No 
______________________________	_______________	___	_____-____ 
Address & Street		City		State	 Zip 
_____________________________	__  
Occupation	 	No. of Years Acquainted 

Please Read Carefully, Initial Each Paragraph and Sign Below 

______	I hereby certify that I have not knowingly withheld any information that might adversely affect my
 Initials	chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment may be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

______	I hereby authorize The 3DO Company to thoroughly investigate my past employment history,
Initials	 references, work records, education, and other matters connected in any manner to my suitability for employment with 3DO or any of its subsidiaries or affiliates.  I further authorize the references I have listed and any representatives of my former employers and schools to disclose to 3DO any and all records, reports, correspondence and other information related to my past employment and educational history, without giving me prior notice of such disclosure.  In addition, I hereby release 3DO, my former employers and all other persons, or entities from any and all claims, demands, or liabilities arising out of or in any way related to any such investigation and/or disclosure.

______	I understand that nothing contained in the application, or conveyed during any interview which may
 Initials	be granted or during my employment, if hired, is intended to create an employment contract between me and the company for any specific period of time. In addition, I understand and agree that if I am employed, my employment is at will and for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s designated representative.

____________ 	____________________________________________________________________
Date	Applicant’s Signature