Fields marked with * are required field. Location Information Location Brazil      Crawfordsville      Greencastle Contact Information Full Name* Home Phone Number* Cell Phone Email Address* Address* City* State* Zip* Birth Date (MM/DD/YYYY)* Employment Information Would you accept full-time work? Yes      No Would you accept part-time work? Yes      No On what date would you be available for work?   (MM/DD/YYYY) Have you ever been employed here before? Yes      No If Yes, employment dates From     To (MM/DD/YYYY)     (MM/DD/YYYY) Do you have a legal right to be employed in the US? Yes      No   (If yes, Proof is required) Are you of legal age to work? Yes      No Educational Background High School Name and Location Did you graduate? Yes      No College Name and Location Course of study Did you graduate? Yes      No Vocational, other training Training undergone Name and Location Course of study Did you graduate? Yes      No Previous Employers and Addresses Employer #1 Company Name Phone Number Contact Name Address Employed From     To (MM/DD/YYYY)     (MM/DD/YYYY) Position Reason for Leaving Last Wage Employer #2 Company Name Phone Number Contact Name Address Employed From     To (MM/DD/YYYY)     (MM/DD/YYYY) Position Reason for Leaving Last Wage Employer #3 Company Name Phone Number Contact Name Address Employed From     To (MM/DD/YYYY)     (MM/DD/YYYY) Position Reason for Leaving Last Wage Employer #4 Company Name Phone Number Contact Name Address Employed From     To (MM/DD/YYYY)     (MM/DD/YYYY) Position Reason for Leaving Last Wage

I certify all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time. In consideration of employment, I agree to conform to the company's rules and regulations and I agree that my employment and compensation can be terminated, with or without notice, at any time, at either my or the companys option. I also understand and agree that the terms and conditions of my employment may be changed with or without cause and with or without notice at any time by the company. I understand that no company representative other than its president and then only when in writing and signed by the president has any authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing.