List Employment starting with present or most recent employment.

Please list (3) references familiar with your work life, character and abilities. Do not include family members who live with you.

Please carefully read and sign by initialing the statement below. Applications without signature will not be considered for employment.

I certify that the answers given by me to the foregoing questions and statements are true and correct to the best of my knowledge without consequential omissions of any kind. I agree that JAY-K shall not be held liable in any respect if my employment is rejected or subsequently terminated because of false statement, answers or omissions made by me in this application. I understand that any misleading or incorrect statements may render this application void, and if employed, may lead to employment termination. I understand that a medical examination based on the requirements of the position for which I am being considered may be required, and drug testing may be included as part of the regular pre-employment physical. I also voluntarily and knowingly authorize companies, schools or persons named above to give any information requested regarding my former employment, character and qualifications. I hereby voluntarily and knowingly full release and discharge, absolve, indemnify, and hold harmless said companies, schools or persons from any and all liability for any damages for issuing this information, except for the malicious and willful disclosure of derogatory facts concerning my employment made for the express purpose of preventing me from obtaining employment, which the party disclosing such facts known to be untrue. In consideration of my employment, I agree to conform to the rules and regulations of this organization. My employment and compensation can be terminated with or without cause and with or without notice, at any time, and the option of either my employer or myself.

If required for employment I understand that a consumer credit report may be obtained on my credit and personal history and authorize JAY-K Independent Lumber Corp. to obtain one. If I request, I will be informed of the name and address of the consumer reporting agency that furnished the report. If hired, subsequent consumer reports may be requested in connection with my employment should JAY-K Independent Lumber Corp. feel this would be appropriate and necessary for continued employment. I understand that if an adverse employment decision is made due to totally or partially to the information of the credit report, the credit reporting agency will give me a copy of the credit report, a summary of my rights under the Fair Credit Reporting act, and the source of the credit report so that I may contact them.

I understand that if this application is for a Driving Position that a thorough Motor Vehicle check will occur and that I will be subject to the Department of Transportation regulations including ongoing drug testing.

JAY-K Independent Lumber Corp. reserves the right to conduct further background checks on any applicant and will request further authorization if and when any further background checks are thought to be necessary.