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Provide the following information, starting with your present or most recent job, and include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, sex/gender, national origin, ancestry, disability or other protected status.

Give names, addresses and telephone numbers of three references that are not related to you.

DRUG TEST AND PHYSICAL – In applying for employment, I understand that I have agreed to undergo a urine screening test to determine the presence of certain drugs. I further understand that the presence of one or more of those drugs may cause my rejection from further consideration for employment. If I am offered a job, I also understand that I have agreed to undergo a physical to determine if I am physically able to perform the required job duties. I further understand that failure of the physical may cause my rejection from further consideration for employment.

I hereby authorize the Kyburz Carlson Construction to conduct through its designated physician or laboratory testing facility a drug screening test and a physical as a requirement of employment.

I also understand that refusal to submit to the drug screening test and physical will constitute voluntary withdrawal of my application for employment.

In the event that I fail to pass the drug screening test or that I do not remain employed by the Company for a period of at least thirty working days, I will be required to reimburse the Company for the testing procedures performed.

ITEMS YOU MUST PROVIDE – In order to be employed by the Kyburz Carlson Construction, an employee must have the following items when reporting to work each day:

• Hard Hat
• Hammer
• Pliers
• 25' Tape Measure
• Utility Knife
• Leather Work Boots (No Tennis Shoes)
• Prescription Safety Glasses (If Prescription Glasses are Needed)
• In addition, carpenters will need to provide standard carpentry hand tools.

In order to be employed by Kyburz Carlson Construction, an employee must have the following items when reporting to work each day:

• Leather Work Boots (No Tennis Shoes)
• Prescription Safety Glasses (If Prescription Glasses are Needed).

WORKING HOURS – Although the regular hours for the Company vary between 7:00 AM and 5:00 PM, the actual working hours are determined by the job superintendent for the crew to which an employee will be assigned.

I have read and understand the requirements for prospective applicants listed above and agree to comply with them in the event of being hired for employment.

I certify that I am at least eighteen years of age.

I certify that the answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

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

I understand that if I am hired and issued a Company hard hat and if I do not remain employed with the Kyburz Carlson Construction for thirty working days, I will be required to return the Company issued hard hat. I also understand that if I do not return the Company issued hard hat upon departure from employment, the cost will be deducted from my paycheck.