EMPLOYMENT

Give employment record as completely as possible listing current or most recent employer first. Show unemployed or self-employed periods and indicate dates and comment on each period. Include part time or summer work.

1. I understand that as part of my application for employment that at any time during the course of such employment, I may be required to be examined concerning my ability to perform any job in a manner that does not endanger my own health or safety or the health or safety of others. I authorize all providers of health care who examine me to disclose to my employer or any of its agents, representatives and employees, including attorneys, all medical information revealed during such examinations. I further authorize my employer to disclose such information to any other persons if at any time my medical condition is put at issue in any proceeding by myself or others. I understand that this Authorization will remain valid for five (5) years from the date of this application, and that if I become employed this Authorization will remain in effect for five (5) years after my employment terminates. I understand that I have the right to receive a copy of this Authorization.

2. Any acceptance of employment will be predicated upon the truthfulness of the written and verbal statements contained within this application and pre-employment process. I understand that should my employer find that any statement I have made is not truthful, any job offer extended to me will be withdrawn and if employed, I may be subject to dismissal.

3. I authorize my employer to make any investigation deemed necessary for employment consideration and promotion within the organization.

4. I understand this employment application is not to be construed as a guarantee of employment for a specific time. I further understand that my employment with the organization does not constitute any form of contract, implied or expressed, and such employment will be terminable at will either by myself or my employer upon notice of one party to the other. My continued employment is dependent on satisfactory performance and the continued need for my services as determined by the organization.

5. I grant my employer approval, after my termination of employment, to release information which it may deem appropriate regarding my employment with or termination from the organization, to anyone who has a reasonable basis for making such inquiry. So long as the information disclosed is not known by the organization to be inaccurate, the organization shall not incur any legal liability of any nature in connection with the furnishing of such information.

6. I understand that my application for employment will be placed in an active status for a period of six (6) months during which time it will be reviewed as job openings occur in my area(s) of job interest. I also understand that should I wish to continue being considered for job openings beyond the six (6) month period, I must reapply by (A) submitting a new application for employment or by (B) submitting a letter requesting renewal of my application and including an update of my qualifications (recent work history, educational achievements, etc).

7. I acknowledge that I have read all of the above statements and that I understand them.

Release and Authorization

In accordance with my right to privacy, I have been advised by JDR Cleaning Service, Inc. that the information described below is required to assist the same in making an employment advancement determination concerning me and that execution of this form is voluntary.

I hereby authorize any qualified agent bearing this document or a copy thereof, to obtain information from all personnel, educational institutions, government agencies, to include The Department of Justice and The Youth Authority, companies, corporations, worker's compensation information, law enforcement agencies or individuals relating to my past activities, to supply any and all information concerning my background, and release same from any liability resulting from providing such information. The information received may include, but is not limited to academic job performance, attendance, personal history, and financial record history, disciplinary and criminal records.

I understand that the information released is for consideration of my employment application, resume and possibly for the purpose of determining my qualifications for future assignment.

I further hereby release any individual associated with the compilation of such information to include custodians, directors, officer, agent, employees, if authorized representatives of the same, from any and all liability for damages of whatever kind of nature, which may at any time accure to me on account of (1) reliance by such person on the information submitted in my employment application; (2) reliance about such persons on the information obtained pursuant to this authorization; (3) compliance with or any attempt to comply with this authorization; and (4) termination of my employment based on information obtained after commencement there of pursuant to validity of this authorization. if adverse action is taken based in whole or in part on the consumer report, we will provide to you a copy of the consumer report and a summary of the consumer's rights as prescribed by the FCR. This report will not be used in violation of any federal or state laws and/or found false or that information has been omitted such false statements or omissions will be just cause for termination of my employment.