Employment Application

Sign: Disclosure and Authorization Regarding Backgrounds Investigation for Employment Purposes - Crown Supply Company may request from a consumer reporting agency and for employment related purposes a "consumers report(s)" (commonly know as "background reports") containing background information about you in connection with your employment or application for employment (including independent contractor or volunteer assignments, as applicable). HireRight, Inc. ("HireRight") will prepare or assemble the background reports for Crown Supply Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA, 92612, (800) 400-2761, www.hireright.com The background report(s) may contain information concerning your character, general reputation, personal characteristics or mode of living. The types of background information that may be obtained included, but are nit limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; verification of your education; employment and earnings history; professional licensing; credential and certification checks; drug/alcohol testing results and history; military service;and other information. By signing this disclosure I am hereby authorizing the company to obtain the consumer reports described above about me.

Sign: Consent to Pull Your Motor Vehicle Record - Hire Rite Provides Motor Vehicle Reports as part of Crown Supply Company's evaluation of my job application or employment. The reports may be procured by Hire Rite on behalf of Crown Supply Company and will include my driving record and an assessment of my insurability under Crown Supply Company's Insurance coverages. By signing this disclosure, I hereby authorize the company to procure such reports, as it deems appropriate to evaluate my insurability.

Authorization-Sign and Date to certify that the facts contained in this application (and accompanying resume, if included) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on the included forms is sufficient cause for refusal to hire, or dismissal no matter when discovered by Crown Supply Company. I understand Crown Supply Company may thoroughly investigate all statements contained herein, and that my former employers and references may disclose information regarding my former employment, character and general reputation to Crown Supply Company without giving me prior notice of such disclosure. I release Crown Supply Company, any former employers and references listed herein from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure. I understand that any employment will be conditioned on a formal background check. I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and with or without prior notice, at the option of either myself or Crown Supply Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Crown Supply Company unless made in writing. If I am offered employment I agree to submit to a medical examination and drug test before starting fork. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by Crown Supply Company and as permitted by law. I consent to such examinations and test and requests that the examining doctor disclose to Crown Supply Company the results of the examination, which results shall remain confidential and segregated from my personal life. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug tests, and if I am hired, a condition of my employment will be that I abide by Crown Supply Company's Drug and Alcohol Policy. I understand that filling out this form does not indicate there is a position open and does not obligate Crown Supply Company to hire. If hired I agree to abide by all Crown Supply Company work rules, policies and procedures. Crown Supply Company retains the right to revises is policies or procedures at any time.