Tech App Fillable Kirk NationaLease Tech Application * indicates required field Full Name* Social Security Number* Current Address*(Street, City, State, Zip) Years lived at Current Address?* Is this less then 3 years?* YesNo [group yearaddress] Since this is less then 3 years at current address, please provide the following: Previous Address Years lived at Previous Address? [/group] Phone Number* Alt Phone Number Are you at least 18?* YesNo Can you be legally be employed in the USA?* YesNo Email Address* Position Applying For* Shop/Location Preference #1* Shop/Location Preference #2 What shift(s) can you work?* How did you hear about us/referred by* When are you available to start?* Are you willing to relocate? YesNo [group relocate] Where would you like to go? [/group] Have you worked with us in the past? YesNo [group whyleave] Why did you leave? [/group] Have you even been convicted of a felony?* YesNo [group GroupFelony] Conviction Date? Convicted Of? County and State of Conviction? Note: This does not automatically prevent you from being hired. All circumstances will be considered. [/group] Education: Check All That Apply: High SchoolCollegeTrade School [group HS] High School Attended?(Name, City, State) Level Completed? High School GPA Did you Graduate High School? YesNo [/group] [group College] College Attended? Courses Studies? College GPA Did you Graduate College? YesNo [/group] [group TechSchool] Tech School Attended? Courses Studied? Tech School GPA? Did you Graduate Tech School? YesNo [/group] Military Service: Have you served in the Military? YesNo [group militarygroup] Dates of Service? Experience or Courses Completed? Rank? Did you Complete Service? YesNo Do you have another Branch/Tour to add? YesNo [/group] [group militarygroup2] Dates of Service? Experience or Courses Completed? Rank? Did you Complete Service? YesNo [/group] Driver's License/Motor Vehicle Record: Driver's License Issuing State?* Driver's License Number* (Within the last 3 years) Do you have a Motor Vehicle Record to add? YesNo [group mvrecord] Class? Endorse? Expiration Date? Do you have another Motor Vehicle Record to add? YesNo [/group] [group mvadd] Motor Vehicle Record Issuing State? License Number (Within the last 3 years) Class? Endorse? Expiration Date? [/group] Accidents: Have you had any accidents in the last 3 years? YesNo [group accidentsg] Nature of Accident? Fatalities? Injuries? Do you have another accident to add? YesNo [/group] [group accaddg] Nature of Accident? Fatalities? Injuries? [/group] Traffic Convictions: Have you had any traffic convictions and forfeitures for the last 3 years? Other than parking violations? YesNo [group traffconvg] Location of Conviction? (City, County, State) Date? Charge? Penalty? Do you have another traffic conviction to add? YesNo [/group] [group traffaddg] Location of Conviction? (City, County, State) Date? Charge? Penalty? [/group] Have you even been denied a license to operate a motor vehicle in the last 3 years? YesNo Has any Licence, permit or privilege even been suspended, restricted, or revoked? YesNo Are you Brake Certified? YesNo Are you Ref/Recovery Certified? YesNo Are you certified to do DOT inspections? YesNo Do you have any ASE Certifications? YesNo [group asewhich] Which ones? [/group] Experience: Please Indicate the years/months of formal training and/or experience with the following:(e.g 1y6m) Drive Line Components TrainingExperience Diesel engine tune-up and re-build TrainingExperience Engine Rebuilding? TrainingExperience Brakes/ABS TrainingExperience Transmission TrainingExperience Body Work/Repair TrainingExperience Sheet Metal Equipment TrainingExperience Frame and Axle Straitening Equipment TrainingExperience Alignment TrainingExperience PM's TrainingExperience Welding (please note type) TrainingExperience Electronics TrainingExperience Electrical TrainingExperience Electronic Diagnostic Equipment TrainingExperience A/C TrainingExperience Wheel Seals TrainingExperience 5th Wheel TrainingExperience Wheel and Tire Balancing Machine TrainingExperience Diagnostic Tools TrainingExperience Hand Tools TrainingExperience Trailer Body Repair TrainingExperience Lift Gate Repair TrainingExperience Please list any other skills, training, or experience that you would like us to know about Employment: For your current/most recent employer Name and Address Telephone Supervisor Position Held Start Date End Date Reason for leaving Duties Do you have another past employer to add? YesNo [group empad1] Name and Address Telephone Supervisor Position Held Start Date End Date Reason for leaving Duties Do you have another past employer to add? YesNo [/group] [group empad2] Name and Address Telephone Supervisor Position Held Start Date End Date Reason for leaving Duties Do you have another past employer to add? YesNo [/group] [group empad3] Name and Address Telephone Supervisor Position Held Start Date End Date Reason for leaving Duties [/group] I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is if record or not, and I release employers and other person named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant that if offered a position, it may be conditioned on the results of a physical examination and drug test. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. (Initial) I agree that any claim or lawsuit relating to my service with Kirk Nationalease Co. or any of its subsidiaries must be filed no more than 6 months after the date of the employment action that is the subject of the claim or lawsuit. I expressly agree to waive any statue of limitations to the contrary. I understand that if I become an employee of Kirk Nationalease Co., or it's subsidiaries or affiliates, at any time in the future, this application of employment will become a part of my official employment record. I further acknowledge that Kirk Nationalease Co. will be relying on the information contained in this application in any hiring decisions and that I am contractually bound by the terms contained herein. (Initial) I also understand that misrepresentation or omission of information or facts may result in my dismissal. If hired I agree to abide by all company rules. By signing below, I acknowledge that this application was completed be me, and that all entries are true and completed to the best of my knowledge. (Initial) Date: Sign: DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES Disclosure Kirk NationaLease, Co (the "Company") may request from a consumer reporting agency and for employment-related purposes, a "consumer report(s)" (commonly known as "background reports") containing background information about you in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable). HireRight, LLC ("HireRight") will prepare or assemble the background reports for the 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, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit 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. OTHER DISCLOSURES, ACKNOWLEDGMENTS & AUTHORIZATIONS REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES Disclosures Investigative Consumer Report: Kirk NationaLease Co (the "Company") may request an investigative consumer report about you from HireRight, LLC ("HireRight"), a consumer reporting agency, in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable). An "investigative consumer report" is a background report that includes information from personal interviews ( except in California, where that term includes background reports with or without information obtained from personal interviews), the most common form of which is checking personal or professional references through personal interviews with sources such as your former employers and associates, and other information sources. The investigative consumer report may contain information concerning your character, general reputation, personal characteristics, mode ofliving, or credit standing. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company. If the Company hires you or contracts for your services, the Company may obtain additional consumer reports and investigative consumer reports about you without asking for your authorization again, throughout your employment or your contract period, as allowed by law. HireRight Privacy Policy: Information about HireRight's privacy practices is available at www.hireright.com/Privacy-Policy.aspx. Acknowledgments & Authorization I acknowledge that I have received and carefully read and understand the separate "Disclosure and Authorization Regarding Background Investigation for Employment Purposes that has been provided to me by the Company. By my signature below, I authorize the preparation of background reports about me, including background reports that are "investigative consumer reports" by HireRight, and to the furnishing of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment or engagement for services (including independent contractor or volunteer assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may, as allowed by law, obtain from HireRight (or similar consumer reporting agency other than HireRight) additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period. I understand that if the Company obtains a credit report about me, then it will only do so where such information is substantially related to the duties and responsibilities of the position in which I am engaged or for which I am being evaluated. I understand that information contained in my employment ( or contractor or volunteer) application, or otherwise disclosed by me before or during my employment ( or contract or volunteer assignment), if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services. I understand that the information included in the background reports may be obtained from private and public record sources, including without limitation and as appropriate: government agencies and courthouses; educational institutions; and employers. Accordingly, I hereby authorize all of the following, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all other federal, state and local government agencies and courts; educational institutions (public or private); testing agencies; information service bureaus; credit bureaus and other consumer reporting agencies; other public and private record/data repositories; motor vehicle records agencies; my employers; the military; and all other individuals and sources with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concerning my: employment and earnings history; education, credit, motor vehicle and accident history; drug/alcohol testing results and history; criminal history; litigation history; military service; professional licenses, credentials and certifications; social security number verification; address and alias history; and other information. I hereby release any and all individuals connected with obtaining or providing such information from any and all liability for acts arising out of or pertaining to the provision of such information. By my signature below, I also promise that the personal information I provide with this form or otherwise in connection with my background investigation is true, accurate and complete, and I understand that dishonesty or material omission may disqualify me from consideration for employment. I further understand that I have the right to request further disclosures regarding the nature and scope of the report(s) solicited by the Company and, upon my request to the Company, to receive a written summary of my legal rights as they pertain to such reports. I agree that a copy of this document in faxed, photocopied or electronic (including electronically signed) form will be valid like the signed original. Applicant Last Name First Middle Date: Sign: General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse I, ___ (CDL Holder Name), hereby provide consent to KIRK NATIONALEASE, CO. to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (the “Clearinghouse”) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. If KIRK NATIONALEASE, CO. hires me, KIRK NATIONALEASE, CO. may conduct unlimited additional limited queries of the Clearinghouse for the duration of my employment. I understand that the limited query conducted by KIRK NATIONALEASE, CO. indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to KIRK NATIONALEASE, CO. without first obtaining additional specific consent from me. I further understand that if I refuse to provide consent for KIRK NATIONALEASE, CO. to conduct a limited query of the Clearinghouse, KIRK NATIONALEASE, CO. must prohibit me from performing safety-sensitive functions, including driving a commercial vehicle, as requested by FMCSA’s drug and alcohol program regulations. Sign: Date: