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PERSONAL INFORMATION

EMPLOYMENT DESIRED
Position
Date You Can Start*
Salary Desired
Education
Name and Location of School
Last Year Completed
Did you Graduate?
Subjects Studied and Degrees Received
Grammer School
High School*
College
Trade,Business or Corrospondence School
GENERAL

EXCLUDE ORGANIZATIONS, THE NAME OR CHARACTER OF WHICH INDICATES THE RACE, SEX, COLOR OR NATIONAL ORIGIN OF ITS MEMBERS

former-employerList below your last four employers, starting with the last one first
Date month And Year Name and Address of Employer Salary(Upon Leaving) Position Reason of Leaving
Date month And Year
From*To*
Name and Address of Employer
Salary(Upon Leaving) Position Reason of Leaving
Date month And Year
FromTo
Name and Address of Employer
Salary(Upon Leaving) Position Reason of Leaving
Date month And Year
FromTo
Name and Address of Employer
Salary(Upon Leaving) Position Reason of Leaving
Date month And Year
FromTo
Name and Address of Employer
Salary(Upon Leaving) Position Reason of Leaving
REFERENCESList below three persons not related to you, whom you have known for at least one year.
Name Address Position Year Acquainted
Name1* Address Position Year Acquainted
Name2* Address Position Year Acquainted
Name3 Address Position Year Acquainted

If you are to be hired by Toms Sierra Company, Inc. dba Sierra Energy, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

AUTHORIZATION

I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by Sierra Energy.
I understand that if a condition of employment is to run a credit or background check, I hereby authorize Sierra Energy to do so. If a credit or background check is ran, I understand that I will have the opportunity to obtain a copy of such report upon my request. I authorize Sierra Energy to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to Sierra Energy, without giving me prior notice of such disclosure. In addition, I release Sierra Energy , any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

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 without prior notice, at the option of either myself or Sierra Energy. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Sierra Energy unless made in writing.

If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by Sierra Energy and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to Sierra Energy the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by Sierra Energy's Drug and Alcohol Policy.

I understand that filling out this form does not indicate there is a position open and does not obligate Sierra Energy to hire. If hired, I agree to abide by all Company work rules, policies and procedures. Sierra Energy retains the right to revise its policies or procedures, in whole or in part, at any time.