Please list your current personal State Drivers License Number or permit:

Other than your current personal State Drivers licence number or permit number listed above, please list the last two States in which you held a personal State Drivers license number or permit number:

Please list your current CDL/Permit Number:

Other than your current CDL/Permit Number listed above, please list any CDL/Permit Numbers you have held in the last two years

Please list all motor vehicle accidents in which you were involved during the last three years

List below your last four employers; do not skip any employers.

List three persons not related to you, whom you have known at least one year.

PLEASE READ CAREFULLY

I understand that providing false information on an application for employment is grounds for the Company to refuse to hire me, or to terminate my employment in the event that the misrepresentation is discovered after I have been hired.

In submitting this application for employment, I authorize the Company to investigate all statements contained in it, and I understand that my current and/or former employers may be contacted to provide information concerning my suitability for employment, and that the references whom I have listed above will be contacted concerning my suitability for employment. I expressly authorize the Company to conduct such inquires and I release the Company and any responding parties from any and all liability associated with such inquiries.

I understand and agree that I may be asked to undergo a post-offer, pre-employment medical examination, which will include a substance abuse test. The substance abuse test includes a breathalyzer and a urine sample. I understand that if I refuse to sign this employment application and or refuse my test, my application will not be considered further. I understand that if the initial breathalyzer test is positive, it will be followed by a second breathalyzer test. Additionally, I understand that if the urine test is positive, it will be followed by a confirmation test of the same urine sample. If the second breathalyzer or urine test is also positive, I understand that my application will not be considered further.

I understand that in the event that I am hired, I will be hired as an at-will employee, and my employment may be terminated at any time, with or without cause, at the option of either the Company or myself. I understand that no representative of the Company except the President has any authority to enter into any legally binding employment agreement.

I certify that I have read this entire employment application, including all information that I have provided on the application, and the entire statement set forth immediately above. I further certify that all of the information that I have provided on this employment application is true and correct.

Various government agencies require periodic reports of Equal Employment compliance and Affirmative Action. This information is not utilized in the employment decision, is kept separate and confidential, and is used for statistical analysis and compliance only. A refusal to provide this information will not subject you to any adverse treatment.