[ ]Yes [ ]No. Application for Employment L.Y. It' c oot. t trg. Position Desired. Location Desired. Major/Minor. o 3. Did you oraduate?

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1 E EEO Emplyer M/F/D/V We appreciate yur interest in applying fr emplyment with the Millard Lumber lnc. We believe every individual shuld be treated fairly, equitably and with dignity. All qualified applicants will receive cnsideratin fr emplyment withut regard t race, clr, religin, gender, sexual rientatin, natinal rigin, age, prtected veteran status, ancestry, marital status, pregnancy, medical cnditin, r status as a disabled individual. Please nte that passing a pre-emplyment drug screening is a cnditin f emplyment with the Cmpany and that yu MUST sign this Applicatin t be cnsidered fr Emplyment. Applicatin fr Emplyment tr +a (u E L r} s TE c t..z (, It' L.Y 6 'L t trg CD.E.g (U l ī (! 3 t tu First, Middle and Last Name Present Address City, State, Zip Cde Address Psitin Desired Lcatin Desired Date Available t Wrk Type f Schl High Schl GED r HS Equivalency Cllege r University Graduate Schl Trade Schl r Junir Cllege Other Prfessinal License r Certificatin Sftware, Equipment, Seminars r Classes Date Hme Phne Alternate Phne Emplvment Preference Earnings Desired Are yu available t travel? Are yu willing t relcate? Name and Lcatin ( ( ) ) Did yu raduate? Majr/Minr 03128/

2 - - iltltrtd L-- Lllflll lrc EEO Emplyer M/F/D/V.9 t IU.= = Dates f Service: Starting Rank: Active [ Branch/Unit: Rank at Discharge: Summarize any training r special skills acquired which wuld be related t the psitin applied fr: Citatins and Awards: Reserve t I List emplyment histry, starting with mst recent emplyment. Emplyer Phne ( ) Address (including city, state and zip cde) Title r Psitin Supervisr Name and Phne May we cntact this emplyer? Duties and Respnsibilities I lyes t ln Fax ( ) Start Date (mnth/year) End Date (mnth/year) Startinq Salary Endinq Salarv Last Bnus r lncentive What did yu like mst abut yur psitin? What did yu least like abut yur psitin? Reasn fr Leaving 03l28l2Ot6 2

3 attltltd lutltb lrr. EEO Emplyer M/F/D/V Emplyer Phne () Address (including city, state and zip cde) Title r Psitin Supervisr Name and Phne May we cntact this emplyer? Duties and Respnsibilities: []Yes[]N Fax () Start Date (mnth/vear) End Date (mnth/year) Starting Salary Ending Salary Last Bnus r lncentive What did yu like mst abut yur psitin? What did yu least like abut yur psitin? Reasn fr Leaving Emplyer Phne ( ) Address (including city, state and zip cde) fitle r Psitin Supervisr Name and Phne May we cntact this emplyer? Duties and Respnsibilities: I lyes t ]N Fax ( ) Start Date (mnth/year) End Date (mnth/year) Startinq Salarv Ending Salary Last Bnus r lncentive What did yu like mst abut yur psitin? What did yu least like abut yur psitin? Reasn fr Leaving 03/28/2016 3

4 - - illlf,rtd L-- lulllii lrt t EEO Emplyer M/F/D/V list d nt include members r wh live with Name Relatinship Phne Occupatin Years Acquainted Can yu submit verificatin f either yur citizenship r yur legal right t wrk in the United States? Are yu 18 years f age r lder and can yu submit verificatin if requested? Have yu submitted an applicatin fr Millard Lumber lnc. befre? lf yes, give date and psitin(s): What shift(s) are yu available t Are yu seeking Fulltime r Part{ime wrk? Are yu able t wrk vertime? Have yu ever wrked fr Millard Lumber lnc. cmpany*? lf yes, when/where? (*Other Millard Lumber lnc. cmpanies include: Spring Hill, Kansas and Waverly, NE) Are any relatives currently emplyed with Millard Lumber lnc. cmpany? lf yes, give full name: Are yu able t perfrm the essential functins f the jb yu are applying fr with r withut reasnable accmmdatin, if needed? []Yes[]N []Yes[]N []Yes[]N _ Day _Afternn _ Evening [ ]Fr [ ]Pr []Yes[]N 03/28/2OL6 4

5 rllf,rtd Ltlfilll lllr EEO Emplyer M/F/Dru Please explain fully any gaps in yur emplyment histry and/r perids f time when yu were nt emplyed. Please prvide dates and details: Have yu ever been terminated r asked t resign frm any jb? Yes I I lf yes, please explain: Nl I Hw did yu hear abut the psitin and the cmany? Advertisement? t 1 Recruiter? t I Current Millard Lumber lnc. Emplvee? t I lf s, where? lf s, wh? lf s, wh? Walk in t I 03/28/2OL6 5

6 ilrlffif l$llltrf lr*- * EEO Emplyer M/F/D/V - Please read and I certify that the infrmatin cntained in this applicatin is true and cmplete t the best f my knwledge. Any misrepresentatin r missins f any fact in this Applicatin r that I have thenuise prvided during the applicatin and hiring prcess can be justificatin fr the Cmpany's refusal f emplyment r, if emplyed, grunds fr my terminatin. I understand that the Cmpany will investigate thrughly my entire wrk and persnal histry and may verify all data I have prvided in this Applicatin, related papers, r ral interview. I specifically authrize any f the r rganizatins referenced in this Applicatin t give the Cmpany any and all relevant infrmatin they may have, persnal r therwise, with regard t any subjects nt cvered by this Applicatin and release all such parties frm liability fr any damage that may result frm furnishing such infrmatin t the Cmpany. I that this inquiry includes infrmatin as t my character, general reputatin and persnal characteristics. I authrize the Cmpany t request and receive such infrmatin. The Fair Credit Reprting Act, Public Law , requires that the Cmpany nti! yu that as part f its emplyment prcedure the Cmpany may investigate yur previus emplyment, credit recrd and drivels license recrd. I understand that I have the right t make a written inquiry within a reasnable perid f time t receive additinal detailed infrmatin abut the nature and scpe f this investigatin. lf I am ffered emplyment, with such ffer cnditined upn the successful cmpletin f a drug screen and/r physical examinatin, I agree t underg said drug screen and/r physica! examinatin t determine if I meet the standards required f the psitin applied fr.!n additin, I expressly authrize r physician, hspital r ther institutin t release any medical recrds f infrmatin with respect t my physical status, either cncurrent with r subsequent t, my emplyment with the Cmpany, in the event such medical recrds r infrmatin are related t any claim made against the Cmpany. I understand that shuld I decline t sign this cnsent r decline t take any f the abve tests, the Cmpany may reject my Applicatin r terminate my emplyment. I understand that if hired, the Cmpany is an emplyer at-will and my emplyment may be terminated with r withut cause r ntice, at any time, at the ptin f either the Cmpany r myself. I further understand that if an ffer f emplyment is made; such ffer may be withdrawn, with r withut prir ntice, at any time, at the ptin f either the Cmpany r me. ln additin, if I am emplyed, I understand that the Cmpany can change wages, benefits, rules, regulatins and the cnditins f my emplyment at any time withut prir ntice t me. lf hired, I agree t cmply with all rules, plicies, prcedures and regulatins f the Cmpany. I acknwledge that I have been advised that this Applicatin will remain active fr n mre than g0 days frm the date it was submitted. Signature Date 03/28/

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