Pipe Crew Member

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Employment History:

The last two (2) positions held, name and # of supervisor, and reason left.

Company 1

Company 2

Have you ever been convicted of a felony? (exclude any sealed or expunged convictions. Conviction will not
necessarily disqualify you for employment.) If yes, explain.

Is there anything that will prevent you from working Monday through Friday on job's regular
hours?

yesno

If yes, explain

Signature

Date

I understand and acknowledge the following:*

If I am offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United States.

I understand that, if I am employed, any false statement, misrepresentation or omission of facts on this application, on any supporting documents, or provided orally, regardless of when discovered to be false, will result in my immediate dismissal.

I understand and agree that, if I am offered a position, it will be offered on condition that my employment shall be at will and for no definite period, and that my employment may be terminated, at any time, with or without cause and with or without prior notice.

I understand that no supervisor or manager may alter or amend the above conditions except in writing, signed by a company officer.

In exchange for the company’s considering my application for employment, I authorize investigation of all statements contained in this application and any supporting documents. I authorize Vertical Earth, Inc. to secure information about my experience from former employers, educational institutions, government agencies, or any references I have provided, and for those parties to provide such information concerning the subjects covered herein, and I hereby release all parties from any liability arising from such investigation.

Failure of employee to give two-week notice of termination of employment may cause forfeiture of last paycheck.

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Pipe Crew Member

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