INSTRUCTIONS:

Beginning with your present or most recent employer, list all employers for whom you have worked for the last 10 years.

Please enter all information even when submitting a resume

PLEASE READ THE FOLLOWING STATEMENT CAREFULLY AND SIGN BELOW.

In consideration of the acceptance of my application by Lemcon, I understand, agree and/or certify to the following:

1. I certify that all information I have provided on this application, and on any other documents submitted with it, is true, accurate, and complete to the best of my knowledge and belief. I understand that falsification, misrepresentation or omission of any information on my application, resume, or any other materials, or which I supply during any interviews, will be justification for withdrawing any offer of employment or, if employed, termination from employment, regardless of when the falsification, misrepresentation or omission is discovered by the Company

2. Any offer of employment I may receive from (Lemcon) is contingent upon my successful completion of the company’s total pre-employment screening process. This process may include, but not be limited to, the following:

a. Receipt by the company of references that it considers satisfactory;

b. My satisfactory completion of any post-offer pre-employment medical examination that company may require;

c. Passing a screening for alcohol and/or drugs. I also understand and agree that, if employed, I may be required to submit to a medical examination or an alcohol and/or drug screening at any time at the discretion of the Company. I hereby consent to having the results of any such post-offer pre-employment or post-employment medical exam or alcohol and/or drug screening disclosed to (Lemcon).

3. I hereby grant (Lemcon) permission to contact all of my present and former employers and those individuals I have listed as personal references (unless specifically excluded in writing). I authorize and request that such employers and references furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities, and other qualities pertinent to my qualifications for employment. Further, and in accordance with the Authorization to Obtain a Consumer Report, which has been provided me, I authorize (Lemcon), or its agent, to obtain transcripts from all educational institutions I have attended and to conduct whatever additional investigation (e.g., educational verification, criminal check, motor vehicle record, and credit check) which may be needed to obtain or verify information regarding my application, resume, any other materials, or any interviews, or concerning my qualifications for employment

4. I also understand that, if hired, my employment is to be “At Will” and that either I or Lemcon may terminate my employment at any time, with or without cause, unless the “At Will” arrangement is modified by a written agreement signed by both me and the owner(s) of the Company.

5. I authorize Lemcon to deduct and/or withhold from my final paycheck any amounts due and owing by me for my failures, and to return any Company property and/or to satisfy any financial obligations that I have, arising or occurring prior to the date of the issuance of my final paycheck.

6. I understand that my application will remain active for 60 days, and that to be considered for a job with Lemcon after that, I must reapply.