Synopsys Employment Application

	APPLICATION FOR EMPLOYMENT
	MUST BE COMPLETED AND SIGNED EVEN IF ATTACHING A PERSONAL RESUME

AN EQUAL OPPORTUNITY EMPLOYER Synopsys is an affirmative action employer and is committed to equal employment opportunity regardless of race, color, religion, sex, Vietnam era Veteran status, age, national origin, disability, marital status, or sexual orientation. We also seek ways in which positive actions can help to reinforce this commitment. In recruiting hiring, and promoting personnel, qualifications for the position being filled continue to be the determining factor. Compensation, benefits, transfers, layoffs, and training practices are guided by the company’s Equal Employment Opportunity Policy.

PERSONAL DATA
Name: Last, First, Middle Initial	Other names under which you have been employed or attended school:
Address: Street and Number, City, State, Country and Zip/Postal Code
Home Phone Number Email Address	Business Phone Number and Extension

SECURITY

If under age of 18, do you have a work permit?

[ ] Yes
[ ] No

Social Security Number:

Can you, upon employment, furnish documents in original form, which prove your identity and that you have the legal right to work in the U.S.?

[ ] Yes
[ ] No

Have you ever been convicted of a felony? (Conviction will not necessarily disqualify applicant from consideration for employment.)

[ ] Yes
[ ] No

If yes, please give details

Offense/Date/Disposition of Case

REFERRAL SOURCE

[ ] Advertisement

[ ] Walk-In

[ ] Employee Referral/Name of Employee

[ ] Other

EMPLOYMENT INTEREST

Type of Position Desired:

Date Available:

[ ] Full-Time

[ ] Part-Time

[ ] Summer Intern

[ ] Temporary

Geographic Preference

Have you ever applied to Synopsys or a Synopsys subsidiary before?

[ ] Yes
[ ] No

If yes, when and where?

EDUCATION AND TRAINING Name and Location of College/University/High School (List in order of highest degree attained.):	Major/Degree Obtained:



Additional education, vocational and/or professional information:
Please list any equipment you are qualified to operate (e.g. word processor, test equipment) with words per minute where appropriate.

EMPLOYMENT HISTORY
Account for at least the last ten years of employment, if applicable. List present or most recent employers first. List additional employers in next table. If you worked as a consultant or a temporary worker through an agency, please indicate the name of the agency.

Employer:

Employment Dates:

From

Address: (Street Number and Name, City, State, Country, Zip/Postal Code)

Phone Number:
( )

Job Title:

Supervisor's Name:

Beginning Salary:

Ending Salary:

Desciption of duties:

Reason for leaving:

Account for time between jobs:

Employer:

Employment Dates:

From

Address: (Street Number and Name, City, State, Country, Zip/Postal Code)

Phone Number:
( )

Job Title:

Supervisor's Name:

Beginning Salary:

Ending Salary:

Desciption of duties:

Reason for leaving:

Account for time between jobs:

Employer:

Employment Dates:

From

Address: (Street Number and Name, City, State, Country, Zip/Postal Code)

Phone Number:
( )

Job Title:

Supervisor's Name:

Beginning Salary:

Ending Salary:

Desciption of duties:

Reason for leaving:

Account for time between jobs:

ADDITIONAL EMPLOYERS
Name and Address	From (Mo/Yr)	To (Mo/Yr)	Job Title	Reason for Leaving

REFERENCES
List three business or professional references that we may contact.

May we contact your present employer?

[ ] Yes [ ] No

Name

How Known?

Phone Number/E-mail Address

Name

How Known?

Phone Number/E-mail Address

Name

How Known?

Phone Number/E-mail Address

U.S. MILITARY SERVICE
(U.S. Applicants)

Indicate branch in which you served

Duties and training during service

Rank at Discharge

APPLICANT'S STATEMENT

I certify that the information provided in this application is accurate. I understand that the withholding of information or the giving of false information on this application or my resume will result in a refusal to hire or in disciplinary action up to and including the termination of my employment.

I hereby grant permission to any person, firm or corporation to release to the Company or its representative any and all information regarding my past work or employment and my background. I waive any and all claims I might have with respect to the providing of such information.

I understand and agree that if I am offered employment by the Company, it will be for an indefinite term and on an at-will basis. This means that either I or the Company may terminate the employment relationship at any time, with or without cause. I understand that this "at-will" relationship may be changed only by a written agreement entered into for this purpose and signed by the Company's Chief Executive Officer. I also understand that other terms and conditions of my employment will be governed by various policies and programs of the Company, in writing and otherwise, and that those policies and programs may be changed from time to time by the Company at its discretion without affecting the "at will" nature of employment.

If I am offered employment, I agree that on or before my hire date, I will provide original documents to Synopsys which verify my identity and right to work under the Immigration Reform and Control Act of 1986 ("IRCA"). I also agree that Synopsys may provide photocopies of the form on which my identity and right to work is verified (the "I-9 Form") and any supporting documentation submitted by me to any person who, in connection with effecting compliance with IRCA, has a legitimate interest in the information contained therein.

I understand that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that effect is executed by the employer and employee in writing.

I HAVE READ THE ABOVE PRIOR TO SIGNING THIS APPLICATION.

Signature

Date

U.S. EXPORT CONTROL COMPLIANCE QUESTIONNAIRE

NAME:
	(print name)
U.S. EXPORT LAWS RESTRICT THE TRANSFER OF TECHNOLOGY TO CITIZENS OF CERTAIN COUNTRIES. IF YOU ARE FROM ONE OF THESE COUNTRIES, SYNOPSYS MAY BE REQUIRED TO OBTAIN AN EXPORT LICENSE BEFORE YOU ARE PERMITTED TO COMMENCE EMPLOYMENT. THE FOLLOWING INFORMATION IS REQUIRED TO DETERMINE WHETHER AN EXPORT LICENSE IS NECESSARY.
PLEASE READ THE QUESTIONS BELOW AND RESPOND.

1. Are you one of the following: U.S. Citizen, alien lawfully admitted for permanent residence, alien admitted as a refugee under 8 U.S.C. 1157, or alien granted asylum under 8 U.S.C. 1158? [ ] Yes [ ] No 2. If you answered “No” to Question 1 above, are you a foreign national of Cuba, Iran, North Korea, Sudan or Syria? [ ] Yes [ ] No 3. If you answered "No" to Question 1 above, are you a foreign national of any of the following countries: Albania; Armenia; Azerbaijan; Belarus; Burma; Cambodia; China; Georgia; Iraq; Kazakhstan; Kyrgyzstan; Laos; Libya; Macau; Moldova; Mongolia; Russia; Tajikistan; Turkmenistan; Ukraine; Uzbekistan or Vietnam? [ ] Yes [ ] No If yes, identify country:




I understand that Synopsys has no obligation to apply for an export license if one would be required for me to work at Synopsys. Further, if Synopsys does apply for such a license, any offer of employment may be contingent upon such prior authorization from the appropriate governmental agencies in charge of export licenses.
Signature:		Date:

VOLUNTARY EQUAL EMPLOYMENT OPPORTUNITY SURVEY
(U.S. APPLICANTS ONLY)

Name:

Date:

Last

First

Middle

Position:

PURPOSE:

Employers are subject to certain governmental record keeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite you to voluntarily self-identify your race/ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment.

The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government of civil rights enforcement. When reported, this data will not identify any specific individual.

1. Please indicate your gender:

[ ] Male [ ] Female

2. Are You Hispanic or Latino?
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

[ ] Yes [ ] No

3 . If you are not Hispanic or Latino, please identify yourself by selecting one of the following:
[ ] a. White:	A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
[ ] b. Black or African-American:	A person having origins in any of the Black racial groups of Africa.
[ ] c. Native Hawaiian or Other Pacific Islander:	A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
[ ] d. Asian:	A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
[ ] e. American Indian or Alaska Native:	A person having origins in any of the original peoples of North and South American (including Central America), and who maintains tribal affiliation or community attachment.

Background Verification Authorization

The purpose of this form is to notify you that a Consumer Background Report will be conducted on you in the course of employment with SYNOPSYS, INC. or any of its subsidiary or affiliated companies.

I understand that this report may be used to make decisions about my employment, including one or more of the following: hiring, firing, promotion, and reassignment. According to the Fair Credit Reporting Act (FCRA), I am entitled to know if employment will be and is ultimately denied or any other adverse action taken because of information obtained by my prospective employer from a consumer-reporting agency. If so, I will be advised by this employer, provided a copy of the report and be given the name of the agency or source of this information to dispute the information contained therein.

The investigation will be conducted by Parkin Security Consultants, 160 Albright Way, Suite D, Los Gatos, CA 95032 phone 408-871-7120 or toll-free 888-931-9900. I understand that SYNOPSYS, INC. has asked this agency to prepare a report that will include a seven year criminal records search, social security number check, a driving record check if applicable, and verification of past employment and education. I hereby authorize any and all public and private record holders of such information to release same to Parkin Security Consultants, Inc.

I understand that I have the right to inspect the report at the investigative agency's offices during normal business hours and after reasonable notice to the agency. I can also inspect the report by certified mail or by telephone. I must show proper identification and pay for any costs involved with the inspection. I have the right to be accompanied by one other person who must also show proper identification. The investigative agency will explain any of the information in the report and will provide a written explanation of any coded information. I also understand that I may request additional information about the nature and scope of the investigation and a summary of my rights under the consumer reporting laws.

I release both SYNOPSYS, INC. and Parkin Security Consultants, Inc., and all their predecessors, successors, partners, heirs, representatives, assigns, agents, employees, shareholders, officers, directors, attorneys, insurers, associates, subsidiaries, divisions and affiliated and/or sibling corporations, and all others from all claims, liability, and damages that may result from negligently investigating, furnishing, communicating, reviewing, or evaluating information pursuant to this investigation and from the use of the report. This release means I am waiving claims for negligence, misrepresentation, emotional distress, invasion of privacy, interference with prospective business relations or contract, breach of contract, and any other negligent act. I expressly intend that this release is as broad and inclusive as is permitted by law. Also, if any portion of this release is held invalid, the balance will continue in full legal force.

I've read this Notice, Authorization and Liability Release and understand and agree with each of its terms. I voluntarily authorize Parkin Security Consultants to conduct an investigation of me and to provide a report on me to SYNOPSYS, INC.. I further authorize a telephone facsimile (FAX) or photographic copy of this release to be as valid as the original.

I understand that any offer of employment from SYNOPSYS, INC. will be contingent upon the results of a number of factors including, but not limited to, this background check.

First Name:

Middle:

Last:

Other names used:

Drivers License Number:

State of issue:

Social Security Number:

Current address:

Number Street Apt.# City State Zip

Applicant's Signature:

Date:

If a background report is generated, I wish to receive a copy of the background report : Yes

Send the copy to me at this home, email or other address:

Return this signed release to Synopsys with your completed application Last Modified: 11/12//2008