Last Name First Name Middle Name. Address City State Zip Code. Social Security Number Home Telephone Mobile Telephone

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1 Momentum Rental and Sales EMPLOYMENT APPLICATION/CAREER HISTORY FORM Return to : joannad@momentumrentalandsales.com Momentum Rental and Sales is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, age, sex, veteran status, national origin or disability. Position Applied For Date of Application Employment Type Applied For: Full-time POOL Part-time Last Name First Name Middle Name Address City State Zip Code Social Security Number Home Telephone Mobile Telephone How did you find out about this position? Are you eligible to work in the United States? Yes No Are you over the age of 18 years? Yes No Have you ever worked for Momentum before? Yes No Have you ever been convicted of a felony? Yes No If yes- What Date/Year: Please Explain: Is anyone related to you employed by Momentum? Yes No If yes, please give name and relation to you Have you ever been terminated or asked to resign from a job? Yes No If yes, explain What salary or rate of pay do you expect to receive if employed? per On what date would you be available to work? Check all shifts you available to work: Day Night Weekend List your professional licenses. Indicate all active Certifications and their expiration date: CDL exp date TWIC exp date Other exp date Other exp date Name & Location of School (City & State) # of Years Complete EDUCATION Received Degree/ Diploma Yes/No Degree type Earned (Associate, Bachelors, Masters) Course Study/Major High School College Vocational

2 CAREER HISTORY Begin with most recent employer. Do not exclude any employment during the past ten years. Include any applicable temporary employment Supervisor Name and Phone # What is your best guess as to how your Manager would rate your overall performance? Excellent Very Good Good Fair Poor Impossible to Say Supervisor Name and Phone #

3 Supervisor s Name and Phone # Supervisor Name & #

4 Supervisor Name and # Supervisor Name and #

5 APPLICANT ACKNOWLEDGEMENT AN AUTHORIZATION ***Please read carefully before signing*** I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. I understand that, should an offer of employment be extended by Momentum Rental and Sales l that such employment with Momentum Rental and Sales at-will, with no specified duration and may be terminated by either Momentum or myself at any time, with or without cause or notice. In consideration for employment with Momentum if employed, I agree to conform to the rules, regulations, policies and procedures of the Company at all times and understand that such obedience is a condition of employment. I understand that due to the nature of Momentum s, attendance and punctuality are considered essential requirements of every job at Momentum and that poor attendance or tardiness will result in disciplinary action including but not limited to termination. I understand I will be required to submit to a pre-employment drug screening and background check as a condition of employment. I understand that unsatisfactory result from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer. I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to Momentum and/or any of its representatives, agents or vendors. By initializing this box I acknowledge that I have read, understood and agree to the above statements. I understand that my initials represent my electronic signature when submitting this application by . Applicant signature date List 3 Professional Business References: Name # List your High School Diploma information: (please also bring a copy into HR if you are selected) High School Name: City/State: Post Secondary Education List Below: (please also bring a copy into HR if you are selected) College Name: City/State: Major:

6 I authorize Momentum to contact my References and education information. - Employee Signature Date