APPLICATION FOR EMPLOYMENT

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APPLICATION FOR EMPLOYMENT

IMPORTANT: There are several important aspects of employment with the North American Risk Services, Inc. (NARS) that you should be aware of before completing this Application for

Employment.

First: I understand that employment with the North American Risk Services, Inc. (NARS) companies is at-will, which means that either the employee or NARS can terminate the employment relationship at any time, for any (or no) reason, with or without notice. This at-will employment relationship can only be modified in a writing signed by the CEO of the company.

Second: I understand that NARS may seek to verify the information I have provided in this Application for Employment. By signing below, I authorize NARS and any of its (their) representatives or agents (collectively referred to as NARS) to contact the persons or organizations that I have listed (or others) and to discuss with or obtain information about my background from them. By signing below I also release NARS and all of the persons, organizations and their agents who are contacted by NARS for this purpose, from any and all claims, of any kind or nature, which may arise now or in the future from or in any way connected with the process of verifying the information that I have provided.

Third: I certify that all of the information which I have provided on this Application for Employment is true and complete to the best of my knowledge, and I understand that, if I am employed, any incomplete, false or

misleading statements on this application, even if that determination is made years later, shall be grounds for my dismissal.

Fourth: In consideration of my employment, I agree to conform to NARS rules, regulations, and policies, and agree that my employment and compensation can be terminated with or without cause, and with or without notice at any time, at the option of either NARS or myself. I understand that no supervisor, manager, officer or

representative of NARS or any other entity, other than the CEO has any authority to enter into any agreement for any specified period of time or to make any agreement contrary to the foregoing, and that any exception must be in writing and signed by the CEO and by me.

Fifth: NARS is a drug-free workplace. I understand that I will be required to submit to a pre-employment drug test. In addition, I understand that I may also be required by the Company to submit to a drug/alcohol test if reasonable suspicion exists to believe that an employee is using drugs or alcohol in violation of this policy. A reasonable suspicion is a belief that an employee is using or has used drugs or alcohol in violation of this policy drawn from specific objective and articulable facts and reasonable inferences drawn from those facts in light of experience.

I understand and agree to the provisions stated above.

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APPLICATION FOR EMPLOYMENT

North American Risk Services, Inc. and its subsidiaries and affiliates are equal opportunity/affirmative action employers. All qualified applicants will be considered without regard to race, color, sex, age, religion, national origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

1. Today’s Date: 2. Full Legal Name:

3. Social Security Number:

4. Current Home Address:

City: State: Zip Code:

5. Telephone #: Cell Phone#:

5a. Email address:

6. Position Applying for:

7. How did you hear about this position? 7. What are your salary expectations?

8. If offered employment, can you provide documentation that you have a right to work in the United States?

YES NO

9. If under 18 years of age and it it required, can you furnish a work permit? YES NO If NO, please explain:

10. Have you interviewed with any of the North American Risk Services, Inc. companies before? YES NO

If yes, list date(s), job title(s), and locations:

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APPLICATION FOR EMPLOYMENT

12. Do you have any relatives that are or have been employed by the North American Risk Services, Inc companies? YES NO

If yes, list relative(s) name and work location:

13. Check which job status you will accept: Full-time Part-time Temporary 14. Are you willing to accept employment that requires you to travel? YES NO

15. Are you able to perform the “essential functions” of the job for which you are applying for (with or without reasonable accommodation)? YES NO

EMPLOYMENT HISTORY

Starting with your current position and going backward, please provide the following information about all employment you have held since completing your full-time education. You may attach a resume that contains this information as long as it includes all of the requested information.

Use supplementary Experience Form(s) for additional space. Place an X by the employer (s) you DO NOT want us to contact.

1. Employer:

Address: City:

State: Zip:

Phone: Immediate Supervisor:

Your Job Title: Duties:

Salary (start): (finish):

Full-Time Part-Time

Dates(month/year): to (month/year):

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APPLICATION FOR EMPLOYMENT

2. Employer:

Address: City:

State: Zip:

Full-Time Part-Time

Reason for leaving:

3. Employer:

Address: City:

State: Zip:

Full-Time Part-Time

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APPLICATION FOR EMPLOYMENT

4. Employer:

Address: City:

State: Zip:

Full-Time Part-Time

Reason for leaving:

5. Employer:

Address: City:

State: Zip:

Full-Time Part-Time

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APPLICATION FOR EMPLOYMENT

EDUCATION

Please provide the following information about all formal education you have received. You may attach a resume that contains this information as long as it includes all of the requested information.

A. High School

Name and Address of Institution:

Degree Received: YES NO

B. College/Technical

Name and Address of Institution: Major of Specialty:

Minor:

Degree Received : YES NO Type of Degree Received:

C. Graduate School

Minor:

Degree Received : YES NO Type of Degree Received:

D. Other

Minor:

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APPLICATION FOR EMPLOYMENT

MISCELLANEOUS

1. If your responses to the above questions, do not account for all of the years since high school, please describe your activities during the times unaccounted for.

2. Use this space for any additional information you think would help us evaluate your application for this position, including training, seminars, workshops, special achievements or specialized skills.

3. List any memberships you have in professional, trade, scientific or civic organization relevant to the position.

REFERENCES

4. Please provide the names of three (3) individuals willing to provide professional references for you. Name:

Phone Number: Years Known:

Name:

Phone Number: Years Known:

Name:

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APPLICATION FOR EMPLOYMENT

5. When will you be available to start work?

6. So that we may verify the information which you have provided in this application, have you ever been known by any other name which might identify you on employment, education or other records? Please list the names and indicate dates when they applied.

Name: Dates used: