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PERSONAL
EMPLOYMENT DESIRED
EDUCATION
High School
College/University
Other
EMPLOYMENT EXPERIENCE List all former and current employers with the most recent employer
MILITARY
REFERENCES (Please list two prior supervisors/managers, and one co-workers)

By signing the release below, I hereby authorize KENTWOOL. to contact any and all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county, and federal courts, military services to release information about my background including, but not limited to, information about employment, education, consumer credit history, driving record, criminal record and general public records history to KENTWOOL. I release from all liability all persons, companies, schools supplying such information. I indemnify KETNWOOL. against any liability, which may result from making such requests. This release shall remain in effect for the length of my employment. I understand and I may have a right to request additional disclosures regarding the nature and scope of the investigation. I agree and understand that any action or suit against the Company arising out of my employment or termination of employment, including, but not limited to, claims arising under State or Federal Civil Rights statues, must be brought within 180 days of the event, giving rise to the claims or be forever barred. I waive limitation periods to the contrary.

I certify that I am not currently bound by any non-compete agreement or other restrictive covenant, which would disqualify or prevent me from becoming employed with the Company. If employed, I understand that if I am or become disabled and I'm in need of accommodations for employment under the Americans With Disability Act, I must notify the Company's Human Resources Manager in writing.

In consideration of my employment, I agree to conform to the rules and regulations of the company. I agree that my employment and compensation can be terminated at any time with or without cause and with or without notice at the option of either the Company or myself. I further acknowledge that no one has made any representations or statements contrary to the Company's At Will policy to me, either orally or in writing, and I acknowledge and understand that no one has the authority to make such representation or statements to the contrary in the future. I certify the information in this application is complete and correct to the best of my knowledge and that all information I have provided in this application is accurate, true and correct. I understand that any falsification, misrepresentation or omission of this information is grounds for a rejection of this application or dismissal of any employment if I am hired. I certify I fully understand the terms of this Disclosure to Employment Application. PRINT -Applicant Name

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