Application for Employment

High School

College

Other Specialized Training

Job History 1

Job History 2

Job History 3

Reference 2

Reference 3

Please read carefully:

I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire, or if hired, dismissal.

I authorize any of the persons or organizations referred to in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. I authorize you to request and receive such information, and I will indemnify you against any liability that may result from making such investigation.

As a condition of my employment with the company, I agree that all information which I receive in the course of my employment relating to any manner to, among other things, the business activities, customers, production processes, financial affairs, programs, concepts, or designs of Millard Sprinkler Company. In addition, I may be required to sign a separate Invention and Confidentiality Agreement.

In consideration for my employment by your company, I agree to conform to the rules and regulations of the company and acknowledge that these rules and regulations may be changed, interpreted, suspended, withdrawn, or added to by your company at any time, at the company’s sole option and without any prior notice to me.

I further acknowledge that my employment is at-will and may be terminated, and any offer of employment, if such is made, or my acceptance of an employment offer, if such is to occur, may be withdrawn, with or without cause, and with or without prior notice, at any time, at the option of the company or myself. I understand that no representative of the company other than the President, and then only in writing, signed by both of us, has any authority to enter into any agreement for employment for any specified period of time or to assure any other personnel action, either prior to commencement of employment or after I have become employed, or to assure any benefits or terms and conditions of employment, or make any agreement contrary to the forgoing. I understand that I cannot rely on any contrary oral or written statements.

I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Millard Sprinkler Company and myself for either employment or for providing of any benefit.

Millard Sprinkler Company reserves the right to search any areas of the Company’s premises and personal article or possession brought onto the premises, including lockers, desks, cars, lunch boxes, or brief cases.

I acknowledge that any offer of employment to me by Millard Sprinkler Company is contingent upon my timely completion of the INS form I-9 and producing the proper documents required by the Immigration Reform and Control Act of 1986. My failure to meet these requirements within the specified time will result in the termination of employment.

I understand that my employment and continued employment, if I am hired, is contingent upon the results of periodic credit reports, and I expressly authorize Millard Sprinkler Company to obtain such credit reports in accordance with the Fair Credit Reporting Act.

If my services terminate after accepting employment, I understand that Millard Sprinkler Company or any of its affiliates may supply, in confidence, my employment record to any prospective employer, with no liability to the Company or its staff.

I acknowledge that I have been advised that this application will remain active for no more than sixty (60) days from the date it was made.

NOTIFICATION OF AND AUTHORIZATION FOR PROCUREMENT OF CONSUMER REPORT

In conjunction with my application for employment (including contract services) with you, my prospective employer, I understand that you may hire CyberChek, LLC to obtain “Consumer Reports” about me as defined in the Fair Credit Reporting Act (FCRA). These “Consumer Reports” may include, but are not limited to information concerning my employment history, credentials, motor vehicle record, credit history, education background, and criminal record.

I understand that you may rely on any or all of the above referenced information in determining whether to extend an offer of employment to me. If you contemplate making an adverse employment-related decision that will affect me based, in whole or in part, upon a “Consumer Report” obtained by CyberChek, LLC, I will be provided with pre-adverse action disclosure, as well as a copy of the “Consumer Report” and a written summary of my “Consumer Rights” under FCRA before you finalize that decision.

I have read the above disclosure and I hereby authorize CyberChek, LLC, or its authorized agents to obtain the above referenced information about me. I also authorize all agencies, bureaus, employers, information service organizations and individuals to provide any of the above referenced knowledge or information they have concerning me. If I am hired, this authorization shall remain on file and shall serve as an ongoing authorization to obtain “Consumer Reports” about me from CyberChek, LLC at any time during my employment with you. A photocopy of facsimile of this authorization shall be as valid as the original.