Employment Application CERTIFICATION & RELEASE I understand that this application form is intended for use in evaluating my qualifications for employment and that this is not an offer of employment. I further understand that if hired, my employment will be considered “at-will” and my employment may be terminated for any reason, with or without cause or notice, at any time by me or the Company, and this application is not intended to constitute a contract of continued employment. I certify that the information submitted by me on this application is true and complete. I understand that any false information, misrepresentations or omissions on this application, on other written materials, or provided during any interviews will lead to the rejection of my application or, if I am employed, discipline up to and including termination at the time such false information or omission is discovered. I understand that additional testing of job-related skills and for the presence of drugs may be required prior to employment. I also understand that after an offer of employment and prior to reporting to work, I may be required to submit to a medical review and depending on Company policy and the needs of the job, I may be required to complete a medical history form and be examined by a medical professional designated by the company. I also understand that I may not be under the influence of drugs or alcohol during employment and that if Company policy requires, I may be required to submit to drug and/or alcohol testing at an approved testing facility. I understand that smoking is prohibited in all indoor areas of the Company’s facilities unless designated smoking areas have been established at a particular location in accordance with applicable state and local law. I understand that a consumer report and/or an investigative consumer report (background check report) may be required. I authorize the Company and/or its agents, including consumer reporting bureaus, to investigate and verify any of the information provided by me. I authorize my former employers, educational institutions, references and any relevant agencies to provide information to the Company and/or its agents concerning my background and experience. I release the Company and all parties providing information to the Company about my background and experience from any liability whatsoever arising therefrom. Applicant Signature Date DD dash MM dash YYYY This application will only be considered for 60 days. If you have not been hired within 60 days of filling out this application and you wish to be considered for future employment, you must complete a new application. Individuals who need assistance with any phase of the application process should notify the person who provided the application to request reasonable support. Complete all pages. Print clearly; incomplete orillegible applications will not be processed. Please note “Not Applicable or N/A”if question does not apply. Provide only requested information. Failure to do so may result in disqualification of your application. Some packets may include an EEO Self Identification Form. This information is being gathered for federal recordkeeping and/or affirmation action purposes only. The information requested is voluntary and will be kept confidential. An applicant will not be subject to any adverse treatment for refusing to complete the questionnaire. Hydro Resources is an equal opportunity employer and does not discriminate against any applicant or employee due to race, color, religion, gender, national origin, age, disability, veteran status, citizenship or any other characteristic protected by federal, state, or local laws.Position(s) Applied for and Preferred Location Applicant Name First Middle Last Today’s Date MM slash DD slash YYYY Home PhoneWork PhoneCell PhoneSalary ExpectationName of Employee Who Referred You First Current Address Street Address City ZIP / Postal Code Previous Address Street Address City ZIP / Postal Code Are you at least 18 years of age? Yes No Are you legally eligible to work in the United States? Yes No Proof of employment eligibility will be required if hired. AVAILABILITYWhat date can you start? MM slash DD slash YYYY What category would you prefer? Full Time Part Time Temporary Labor Pool Which schedule are you available for? Weekdays Weekends Nights Overtime Shift *Reasonable efforts will be made to accommodate sincerely held religious beliefs.ESSENTIAL JOB FUNCTIONSHave you been given a job description or had the essential functions of the job explained to you? Yes No Do you understand these functions? Yes No After carefully reviewing the job description and physical requirements of the job for which you are applying, are you able to perform the essential functions of the job with or withoutreasonable accommodation? Yes No PROFESSIONAL LICENSES & CERTIFICATES Do you hold any professional licenses or certificates? Yes No Name of license/certificate Issuing State License/certification number REFERENCES Include only individuals familiar with your work ability. Don not include relatives or names of supervisors listed. NAME 1 ADDRESS/PHONE 1 YRS. KNOWN/RELATIONSHIP 1 NAME 2 ADDRESS/PHONE 2 YRS. KNOWN/RELATIONSHIP 2 NAME 3 ADDRESS/PHONE 3 YRS. KNOWN/RELATIONSHIP 3 EDUCATION Check the highest grade completed High School 7 8 9 10 11 12 College 1 2 3 4 4+ If your school records are under a different name other than the one listed on this application, please indicate the name you were enrolled under. HIGH SCHOOL CITY/STATE GRADUATED Yes No DEGREE TYPE COLLEGE CITY/STATE GRADUATED Yes No DEGREE TYPE OTHER CITY/STATE GRADUATED Yes No DEGREE TYPE PREVIOUS EMPLOYERS PLEASE NOTE: Do not provide salary history in Alabama, California, Connecticut, Delaware, Illinois, Maine, Massachusetts, North Carolina, Ohio, Oregon, Vermont, and Washington.MOST RECENT EMPLOYERAre you currently working for this employer? Yes No PhoneMay we contact this employer? Yes No FaxCompany Name City & State Date Employed From MM slash DD slash YYYY Date Employed To MM slash DD slash YYYY Supervisor Job Title Salary $ Per Hr. Week Month Reason for leaving PRIOR EMPLOYER Are you currently working for this employer? Yes No PhoneMay we contact this employer? Yes No FaxCompany Name City & State Date Employed From MM slash DD slash YYYY Date Employed To MM slash DD slash YYYY Supervisor Job Title Salary $ Per Hr. Week Month Reason for leaving PRIOR EMPLOYER Are you currently working for this employer? Yes No PhoneMay we contact this employer? Yes No FaxCompany Name City & State Date Employed From MM slash DD slash YYYY Date Employed To MM slash DD slash YYYY Supervisor Job Title Salary $ Per Hr. Week Month Reason for leaving PRIOR EMPLOYERAre you currently working for this employer? Yes No PhoneMay we contact this employer? Yes No FaxCompany Name City & State Date Employed From MM slash DD slash YYYY Date Employed To MM slash DD slash YYYY Supervisor Job Title Salary $ Per Hr. Week Month Reason for leaving DRIVER’S LICENSE INFORMATIONDo you have a valid driver’s license? Yes No Name on driver’s license State of issue Do you hold any endorsements? Yes No List Endorsements: Have you had any moving violations or accidents within the last three (3) years? Yes No Type of violation/accident(s) CRIMINAL RECORD Have you ever been convicted of or pleaded guilty to a crime? Do not include convictions that were sealed, erased, annulled or expunged pursuant to a court order. NOTE: BEFORE ANSWERING THIS QUESTION REGARDING CRIMINAL CONVICTIONS, PLEASE REFER TO THE INSTRUCTIONS BELOW IF YOU RESIDE OR ARE APPLYING FOR A POSITION IN CALIFORNIA, CONNECTICUT, DISTRICT OF COLUMBIA, GEORGIA, HAWAII, ILLINOIS, MASSACHUSETTS, MINNESOTA, NEW JERSEY, NEW MEXICO, NEW YORK, NEVADA, OREGON, RHODE ISLAND, VERMONT, AND WASHINGTON. Yes No Please explain any “Yes” answer. Use additional paper if necessary. Are you currently awaiting trial for any criminal offenses? Yes No Please explain any “Yes” answer. Use additional paper if necessary INSTRUCTIONS FOR ANSWERING CRIMINAL CONVICTION INQUIRY California, Connecticut, District of Columbia, Hawaii, Illinois, Massachusetts, Minnesota,New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington Do not answer the questions in this section at this time. The Company may make further inquiries into past convictions during the hiring process. This could include, depending on the State, questions during the interview process and review of a background check before or after being provided a conditional offer of employment. Georgia Applicants Do not identify and guilty plea that was discharged by the court under Georgia’s First Offender Act. Nevada Applicants Only disclose misdemeanors that result in imprisonment and all felonies. New York Applicants Do not disclose information regarding any criminal proceeding that terminated in a “youthful offender adjudication”, as defined in section 720.35 of the New York Criminal Procedure Law.This Organization Participates in E-Verify This employer will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s Form I-9 to confirm work authorization. IMPORTANT: If the Government cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact DHS and/or the SSA before taking adverse action against you, including terminating your employment. Employers may not use E-Verify to pre-screen job applicants and may not limit or influence the choice of documents you present for use on the Form I-9. To determine whether Form I-9 documentation is valid, this employer uses E-Verify’s photo matching tool to match the photograph appearing on some permanent resident cards, employment authorization cards, and U.S. passports with the official U.S. government photograph. E-Verify also checks data from driver’s licenses and identification cards issued by some states. If you believe that your employer has violated its responsibilities under this program or has discriminated against you during the employment eligibility verification process based upon your national origin or citizenship status, please call the Office of Special Counsel at 800-255-7688, 800-237-2515 (TDD) or at www.justice.gov/crt/osc. E-Verify Works for Everyone For more information on E-Verify, please contact DHS: 888-897-7781 www.dhs.gov/E-Verify N O T I C E: Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. E-VERIFY IS A SERVICE OF DHS AND SSA The E-Verify logo and mark are registered trademarks of Department of Homeland Security. Commercial sale of this poster is strictly prohibited.