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<div class=Section1>
<div style='border:none;border-bottom:double windowtext 1.5pt;padding:0in 0in 1.0pt 0in'>
<p class=MsoNormal align=center style='text-align:center;border:none;
mso-border-bottom-alt:double windowtext 1.5pt;padding:0in;mso-padding-alt:0in 0in 1.0pt 0in'><span
style='font-size:22.0pt;font-family:"Arial Black"'>APPLICATION FOR EMPLOYMENT</span><span
style='font-family:"Arial Black"'><o:p></o:p></span></p>
</div>
<p class=MsoNormal align=center style='text-align:center'><span class=GramE><span
style='font-size:14.0pt;font-family:"Arial Black"'>UNITED SPRINKLER COMPANY,
INC.</span></span><span style='font-size:14.0pt;font-family:"Arial Black"'><o:p></o:p></span></p>
<p class=MsoNormal align=center style='text-align:center'><st1:Street><st1:address><span
style='font-family:"Arial Black"'>80 POTOMAC CREEK DR</span></st1:address></st1:Street><span
style='font-family:"Arial Black"'>.<o:p></o:p></span></p>
<p class=MsoNormal align=center style='text-align:center'><st1:place><st1:City><span
style='font-family:"Arial Black"'>FREDERICKSBURG</span></st1:City><span
style='font-family:"Arial Black"'>, </span><st1:State><span style='font-family:
"Arial Black"'>VA</span></st1:State><span style='font-family:"Arial Black"'> </span><st1:PostalCode><span
style='font-family:"Arial Black"'>22405</span></st1:PostalCode></st1:place><span
style='font-family:"Arial Black"'><o:p></o:p></span></p>
<p class=MsoNormal align=center style='text-align:center'><span
style='font-family:"Arial Black"'><o:p> </o:p></span></p>
<div style='border:double windowtext 1.5pt;padding:1.0pt 4.0pt 1.0pt 4.0pt'>
<p class=MsoNormal style='border:none;mso-border-alt:double windowtext 1.5pt;
padding:0in;mso-padding-alt:1.0pt 4.0pt 1.0pt 4.0pt'>United Sprinkler Company
is an equal opportunity employer and does not discriminate against otherwise
qualified applicants on the basis of race, color, creed, religion, ancestry,
age, sex, marital status, national origin, disability or handicap, or veteran
status.<o:p></o:p></p>
</div>
<p class=MsoNormal><span style='font-family:"Arial Black"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black"'>PERSONAL:<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Name:<span
style='mso-spacerun:yes'>� </span>______________________________________<span
style='mso-tab-count:1'>�������� </span><span class=GramE>Date<span
style='mso-spacerun:yes'>� </span>_</span>__________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span
style='mso-spacerun:yes'>����������� </span>(Last)<span style='mso-tab-count:
3'>������������������������� </span>(First)<span style='mso-tab-count:2'>������������� </span>(Middle)<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Address:<span
style='mso-spacerun:yes'>� </span>________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span style='mso-tab-count:
2'>����������������������� </span>(<span class=GramE>number</span> &
street)<span style='mso-tab-count:3'>����������������������������� </span>(City)<span
style='mso-tab-count:2'>�������������� </span>(State)<span style='mso-tab-count:
1'>����������� </span>(Zip)<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Phone Number:<span
style='mso-spacerun:yes'>� </span>_________________<span
style='mso-spacerun:yes'>�� </span>Social Security #:<span
style='mso-spacerun:yes'>� </span>_________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Position Sought:
____________________<span style='mso-tab-count:1'>��������� </span>Full Time
___<span class=GramE>_<span style='mso-spacerun:yes'>� </span>Part</span> Time
____<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Date Available:<span
style='mso-spacerun:yes'>� </span>_______________<span
style='mso-spacerun:yes'>��� </span>Salary Desired:<span
style='mso-spacerun:yes'>� </span>_______________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Are you over 18 years
old?<span style='mso-spacerun:yes'>� </span>Yes ___<span class=GramE>_<span
style='mso-spacerun:yes'>� </span>No</span> ____<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Are you legally eligible for
employment in the </span><st1:country-region><st1:place><span style='font-family:
Arial'>United States</span></st1:place></st1:country-region><span
style='font-family:Arial'>?<span style='mso-spacerun:yes'>� </span>Yes ____ No
____<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>If offered employment, you
will be required to provide documentation, per the attached list of acceptable
documents (detach for your records), to verify eligibility.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Have you ever worked for
this company before?<span style='mso-spacerun:yes'>� </span>Yes ____ No ____<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>If yes, when?<span
style='mso-spacerun:yes'>� </span>_________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Do you have any relative or
friends that work for the company? Yes ___ No ___<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>If yes, who and where do
they work?<span style='mso-spacerun:yes'>�
</span>_________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'>EDUCATION:<span style='mso-spacerun:yes'>� </span></span><span
style='font-family:Arial'>Please indicate education or training which you
believe qualifies you for the position you are seeking.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'>High School:<span style='mso-spacerun:yes'>�
</span>________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'><span style='mso-spacerun:yes'>����������������������� </span></span><span
style='font-family:Arial'>(Name of School)<span style='mso-tab-count:3'>����������������������������������� </span>(City,
State)<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span style='mso-tab-count:
1'>����������� </span><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span style='mso-tab-count:
1'>����������� </span>No. of years completed (circle one<span class=GramE>)<span
style='mso-spacerun:yes'>� </span>1</span><span style='mso-spacerun:yes'>���
</span>2<span style='mso-spacerun:yes'>��� </span>3<span
style='mso-spacerun:yes'>��� </span>4<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span style='mso-tab-count:
1'>����������� </span>Diploma:<span style='mso-spacerun:yes'>� </span>Yes ___<span
class=GramE>_<span style='mso-spacerun:yes'>� </span>No</span> ____<span
style='mso-spacerun:yes'>��� </span>G.E.D.:<span style='mso-spacerun:yes'>�
</span>Yes ____<span style='mso-spacerun:yes'>� </span>No ____<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'>College and/or Vocational School:<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>________________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span
style='mso-spacerun:yes'>� </span>(Name of School)<span style='mso-tab-count:
5'>��������������������������������������������������� </span>(City, State)<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>No. of years <span
class=GramE>completed<span style='mso-spacerun:yes'>� </span>(</span>circle
one)<span style='mso-spacerun:yes'>� </span>1<span style='mso-spacerun:yes'>���
</span>2<span style='mso-spacerun:yes'>��� </span>3<span
style='mso-spacerun:yes'>��� </span>4<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Major
________________________<span class=GramE>_<span style='mso-spacerun:yes'>�
</span>Degree</span>(s) Earned __________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'>Other Training or Degrees:<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>________________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span
style='mso-spacerun:yes'>� </span>(Name of School)<span
style='mso-spacerun:yes'>�������������������������������������������������
</span>(City, State)<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Course _______________<span
class=GramE>_<span style='mso-spacerun:yes'>� </span>Degree</span> or
Certificate Earned __________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'>SKILLS:<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in;text-indent:-.5in'><span
style='font-family:Arial'>Data Entry:<span style='mso-spacerun:yes'>�
</span>Excel ____<span style='mso-tab-count:1'>������ </span>Lotus 1<span
class=GramE>,2,3</span> ____<span style='mso-tab-count:1'>������ </span>Typewriter
____ wpm <span style='mso-tab-count:1'>��������� </span><span
style='mso-spacerun:yes'>���������������</span><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in;text-indent:-.5in'><span
style='font-family:Arial'><span style='mso-spacerun:yes'>�������������������
</span>Other ____<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in;text-indent:-.5in'><span
style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Word Processing:<span
style='mso-spacerun:yes'>� </span>WordPerfect ____<span style='mso-tab-count:
1'>������ </span>MS Word ____<span style='mso-tab-count:1'>��������� </span>Other
____<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Other Skills:<span
style='mso-spacerun:yes'>�
</span>______________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'>RECORD OF CONVICTION:<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>During the last ten years,
have you even been convicted of a crime other than a minor traffic
offense?<span style='mso-spacerun:yes'>� </span>Yes ____ No ____<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>If yes, explain<span
class=GramE>:_</span>____________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>________________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>(A conviction will not
necessarily automatically disqualify you for employment.<span
style='mso-spacerun:yes'>� </span>Rather, such factors as age and date of
conviction, seriousness and nature of the crime, and rehabilitation will be
considered.)<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'>EMPLOYMENT:<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>List last employer first,
including U.S. Military Service.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Are you presently employed?<span
style='mso-spacerun:yes'>� </span>Yes ____ No ____<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>If yes, may we contact your
present employer?<span style='mso-spacerun:yes'>� </span>Yes ____ No ____<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>If any employment was under
a different name, indicate name _______________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>________________________________________________________________<o:p></o:p></span></p>
</div>
<span style='font-size:12.0pt;font-family:Arial;mso-fareast-font-family:"Times New Roman";
mso-ansi-language:EN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA'><br
clear=all style='page-break-before:always;mso-break-type:section-break'>
</span>
<div class=Section2>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Employer:<span
style='mso-spacerun:yes'>� </span>____________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Address:<span
style='mso-spacerun:yes'>�
</span>________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Telephone number:<span
style='mso-spacerun:yes'>� </span>_________________<span style='mso-tab-count:
1'>���������� </span>Position:<span style='mso-spacerun:yes'>�
</span>___________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Dates of Employment:<span
style='mso-spacerun:yes'>� </span>From ________ <span class=GramE>To</span>
________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span style='mso-tab-count:
3'>����������������������������������� </span><span
style='mso-spacerun:yes'>���������������� </span>Mo/Yr<span style='mso-tab-count:
1'>�������� </span><span style='mso-spacerun:yes'>������� </span>Mo/Yr<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Salary:<span
style='mso-spacerun:yes'>� </span>________________<span style='mso-tab-count:
1'>��������� </span>Supervisor:<span style='mso-spacerun:yes'>�
</span>___________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Department:<span
style='mso-spacerun:yes'>� </span>______________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Duties:<span
style='mso-spacerun:yes'>�
</span>__________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>FT ____ PT ____<span
style='mso-tab-count:2'>���������������� </span>No. of Hours ________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Reason for Leaving:<span
style='mso-spacerun:yes'>� </span>_______________________________________________<o:p></o:p></span></p>
<div style='border:none;border-bottom:solid windowtext 1.5pt;padding:0in 0in 1.0pt 0in'>
<p class=MsoNormal style='border:none;mso-border-bottom-alt:solid windowtext 1.5pt;
padding:0in;mso-padding-alt:0in 0in 1.0pt 0in'><span style='font-family:Arial'><o:p> </o:p></span></p>
</div>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Employer:<span
style='mso-spacerun:yes'>� </span>____________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Address:<span
style='mso-spacerun:yes'>�
</span>________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Telephone number:<span
style='mso-spacerun:yes'>� </span>_________________<span style='mso-tab-count:
1'>���������� </span>Position:<span style='mso-spacerun:yes'>�
</span>___________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Dates of Employment:<span
style='mso-spacerun:yes'>� </span>From ________ <span class=GramE>To</span>
________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span style='mso-tab-count:
3'>����������������������������������� </span><span
style='mso-spacerun:yes'>���������������� </span>Mo/Yr<span style='mso-tab-count:
1'>�������� </span><span style='mso-spacerun:yes'>������� </span>Mo/Yr<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Salary:<span
style='mso-spacerun:yes'>� </span>________________<span style='mso-tab-count:
1'>��������� </span>Supervisor:<span style='mso-spacerun:yes'>�
</span>___________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Department:<span
style='mso-spacerun:yes'>� </span>______________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Duties:<span
style='mso-spacerun:yes'>�
</span>__________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>FT ____ PT ____<span
style='mso-tab-count:2'>���������������� </span>No. of Hours ________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Reason for Leaving:<span
style='mso-spacerun:yes'>�
</span>_______________________________________________<o:p></o:p></span></p>
<div style='border:none;border-bottom:solid windowtext 1.5pt;padding:0in 0in 1.0pt 0in'>
<p class=MsoNormal style='border:none;mso-border-bottom-alt:solid windowtext 1.5pt;
padding:0in;mso-padding-alt:0in 0in 1.0pt 0in'><span style='font-family:Arial'><o:p> </o:p></span></p>
</div>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Employer:<span
style='mso-spacerun:yes'>� </span>____________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Address:<span
style='mso-spacerun:yes'>�
</span>________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Telephone number:<span
style='mso-spacerun:yes'>� </span>_________________<span style='mso-tab-count:
1'>���������� </span>Position:<span style='mso-spacerun:yes'>� </span>___________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Dates of Employment:<span
style='mso-spacerun:yes'>� </span>From ________ <span class=GramE>To</span>
________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span style='mso-tab-count:
3'>����������������������������������� </span><span
style='mso-spacerun:yes'>���������������� </span>Mo/Yr<span style='mso-tab-count:
1'>�������� </span><span style='mso-spacerun:yes'>������� </span>Mo/Yr<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Salary:<span
style='mso-spacerun:yes'>� </span>________________<span style='mso-tab-count:
1'>��������� </span>Supervisor:<span style='mso-spacerun:yes'>�
</span>___________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Department:<span
style='mso-spacerun:yes'>� </span>______________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Duties:<span
style='mso-spacerun:yes'>� </span>__________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>FT ____ PT ____<span
style='mso-tab-count:2'>���������������� </span>No. of Hours ________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Reason for Leaving:<span
style='mso-spacerun:yes'>�
</span>_______________________________________________<o:p></o:p></span></p>
<div style='border:none;border-bottom:solid windowtext 1.5pt;padding:0in 0in 1.0pt 0in'>
<p class=MsoNormal style='border:none;mso-border-bottom-alt:solid windowtext 1.5pt;
padding:0in;mso-padding-alt:0in 0in 1.0pt 0in'><span style='font-family:Arial'><o:p> </o:p></span></p>
</div>
<p class=MsoNormal><o:p> </o:p></p>
<p class=MsoNormal><o:p> </o:p></p>
<p class=MsoNormal><span style='font-family:Arial'>Employer:<span
style='mso-spacerun:yes'>� </span>____________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Address:<span
style='mso-spacerun:yes'>�
</span>________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Telephone number:<span
style='mso-spacerun:yes'>� </span>_________________<span style='mso-tab-count:
1'>���������� </span>Position:<span style='mso-spacerun:yes'>�
</span>___________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Dates of Employment:<span
style='mso-spacerun:yes'>� </span>From ________ <span class=GramE>To</span>
________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span style='mso-tab-count:
3'>����������������������������������� </span><span
style='mso-spacerun:yes'>���������������� </span>Mo/Yr<span style='mso-tab-count:
1'>�������� </span><span style='mso-spacerun:yes'>������� </span>Mo/Yr<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Salary:<span
style='mso-spacerun:yes'>� </span>________________<span style='mso-tab-count:
1'>��������� </span>Supervisor:<span style='mso-spacerun:yes'>�
</span>___________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Department:<span
style='mso-spacerun:yes'>� </span>______________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Duties:<span
style='mso-spacerun:yes'>�
</span>__________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>FT ____ PT ____<span
style='mso-tab-count:2'>���������������� </span>No. of Hours ________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Reason for Leaving:<span
style='mso-spacerun:yes'>�
</span>_______________________________________________<o:p></o:p></span></p>
<div style='border:none;border-bottom:solid windowtext 1.5pt;padding:0in 0in 1.0pt 0in'>
<p class=MsoNormal style='border:none;mso-border-bottom-alt:solid windowtext 1.5pt;
padding:0in;mso-padding-alt:0in 0in 1.0pt 0in'><span style='font-family:Arial'><o:p> </o:p></span></p>
</div>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>If you wish to describe
additional work experience, attach the above information <span class=GramE>for</span>
each position on a separate piece of paper.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Explain any gaps in work
history:<span style='mso-spacerun:yes'>�
</span>_____________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>________________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><o:p> </o:p></p>
<p class=MsoNormal><span style='font-family:Arial'>Have you ever been
discharged or asked to resign from a job?<span style='mso-spacerun:yes'>�
</span>Yes ___ No ___<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>If yes, explain:<span
style='mso-spacerun:yes'>�
</span>________________________________________________________________________________________________________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'>REFERENCES:<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial Black";mso-bidi-font-family:
Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span style='mso-tab-count:
1'>����������� </span><b style='mso-bidi-font-weight:normal'>PROFESSIONAL<span
style='mso-tab-count:4'>��������������������������������������� </span>PERSONAL<o:p></o:p></b></span></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span
style='font-family:Arial'><o:p> </o:p></span></b></p>
<p class=MsoNormal><span style='font-family:Arial'>Name:<span
style='mso-spacerun:yes'>� </span>_____________________<span
style='mso-spacerun:yes'>������ </span><span
style='mso-spacerun:yes'>���������</span>Name:<span style='mso-spacerun:yes'>�
</span>____________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Address:<span
style='mso-spacerun:yes'>� </span>___________________<span
style='mso-spacerun:yes'>���������������� </span>Address:<span
style='mso-spacerun:yes'>� </span>___________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span style='mso-tab-count:
1'>����������� </span><span style='mso-spacerun:yes'>�</span><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span
style='mso-spacerun:yes'>��������������� </span>___________________<span
style='mso-spacerun:yes'>��������������������������������
</span>___________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Phone:<span
style='mso-spacerun:yes'>� </span>(______) _____________<span
style='mso-spacerun:yes'>��������������� </span>Phone:<span
style='mso-spacerun:yes'>� </span>(______) _____________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Name:<span
style='mso-spacerun:yes'>� </span>_____________________<span
style='mso-spacerun:yes'>��������������� </span>Name:<span
style='mso-spacerun:yes'>� </span>_____________________<span
style='mso-spacerun:yes'>����������� </span><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Address:<span
style='mso-spacerun:yes'>� </span>___________________<span
style='mso-spacerun:yes'>��������������� </span>Address:<span
style='mso-spacerun:yes'>� </span>____________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><span
style='mso-spacerun:yes'>��������������� </span>___________________<span
style='mso-spacerun:yes'>���������������������������� </span><span
style='mso-spacerun:yes'>���</span>____________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Phone:<span
style='mso-spacerun:yes'>� </span>(______<span class=GramE>)<span
style='mso-spacerun:yes'>� </span>_</span>___________<span
style='mso-spacerun:yes'>���������������� </span>Phone:<span
style='mso-spacerun:yes'>� </span>(______)<span style='mso-spacerun:yes'>�
</span>_____________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal align=center style='text-align:center'><span
style='font-family:"Arial Black";mso-bidi-font-family:Arial'>APPLICANT�S
CERTIFICATION AND AGREEMENT<o:p></o:p></span></p>
<p class=MsoNormal align=center style='text-align:center'><span
style='font-family:"Arial Black";mso-bidi-font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'>As a
condition of employment, I understand that the company requires the successful
completion of a urinalysis for drug testing purposes and I hereby agree and
consent to this test.<span style='mso-spacerun:yes'>� </span>Though a negative
drug test result must be received before a final offer of employment is
considered, it does not guarantee that a final offer of employment will be
made.<span style='mso-spacerun:yes'>� </span><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'>I hereby
certify that the facts set forth in the above employment application are true
and complete to the best of my knowledge.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'><span
style='mso-spacerun:yes'>�</span><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'>I
understand that, if employed, falsified statements of any kind or omissions of
facts called for on this application shall be considered sufficient basis for
dismissal.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'>I
understand that in connection with my application for employment or employment
with United Sprinkler, consumer reports or investigative consumer reports,
which may contain public record information, may be requested or made on me,
including my creditworthiness or similar characteristics, employment and
education verifications, social security verification, criminal (*see end of
paragraph) and civil history, personal interviews, DMV records, any other
public records and any other information bearing on my credit standing, credit
capacity, character, general reputation, personal characteristics or mode of
living, and trustworthiness.<span style='mso-spacerun:yes'>� </span>These
reports will/may include both experience and performance along with reasons for
termination of past employment.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'>* If a
criminal history record is needed you can request this information, at your
expense, and bring it to us or we can request it, at our expense, for you.<span
style='mso-spacerun:yes'>� </span>If we request it for you, the applicant or
the <span class=GramE>employee,</span> will need to come in to complete an
additional form.<span style='mso-spacerun:yes'>� </span>This form authorizes
the applicable agency to directly release this information to United
Sprinkler.<span style='mso-spacerun:yes'>� </span>You must give your consent in
writing, under oath and your signature must be notarized.<span
style='mso-spacerun:yes'>� </span>We have a Notary Public on staff that you are
welcome to use in completing this form.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'>I hereby
authorize and consent to United Sprinkler�s procurement of consumer and/or
investigative consumer reports and the verification of same for use in making
employment decisions.<span style='mso-spacerun:yes'>� </span>I further
authorize ongoing procurement of the above mentioned reports at any time during
my employment with United Sprinkler.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'>I
understand that, pursuant to the federal Fair Credit Reporting Act, United
Sprinkler will notify me if it uses such a report in making an adverse decision
regarding my fitness for employment with the Company.<span
style='mso-spacerun:yes'>� </span>I further understand that if such report is
used to make an adverse employment decision, United Sprinkler will provide me a
copy of the Summary of Rights under FCRA along with the name, address, and
telephone number of the consumer reporting agency that furnished the report,
along with a statement that the consumer reporting agency did not make the
decision to take the adverse action and is unable to provide me with the specific
reasons why the adverse action was taken.<span style='mso-spacerun:yes'>�
</span>I further understand that I have the right to obtain a free copy of my
consumer report from the consumer reporting agency that provided the report to
United Sprinkler, so long as my request is made within 60 days of the Company�s
notification that an adverse employment decision has been made.<span
style='mso-spacerun:yes'>� </span>I further understand that I have the right to
dispute the accuracy or completeness of any information contained in the
consumer report directly with the consumer reporting agency.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'>I hereby
release the consumer reporting agency, United Sprinkler, and any and all
persons, business entities and governmental agencies, whether public or
private, from any and all liability, claims and/or demands, of whatever kind,
to me, my heirs, or others making such claim or demand on my behalf, for
procuring, selling, providing, brokering, verifying the accuracy of, and/or
assisting with the compilation or preparation of the consumer report and/or
investigative consumer report hereby authorized.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'>I
understand that should an employment offer be extended to me and accepted, that
I will fully adhere to the policies, rules and regulations of employment of the
Employer.<span style='mso-spacerun:yes'>� </span>However, I further understand
that neither the policies, rules, regulations of employment nor anything said
during the interview process shall be deemed to constitute the terms of an
implied employment contract.<span style='mso-spacerun:yes'>� </span>I
understand that any employment offered is for an indefinite duration and at
will and that either I or the Employer may terminate my employment at any time
with or without notice or cause.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Name As It Appears on
Drivers License: ________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Drivers License Number: </span><st1:place><st1:PlaceName><span
style='font-family:Arial'>_____________________<span class=GramE>_</span></span></st1:PlaceName><span
class=GramE><span style='font-family:Arial'><span style='mso-spacerun:yes'>�
</span></span></span><st1:PlaceType><span class=GramE><span style='font-family:
Arial'>State</span></span></st1:PlaceType></st1:place><span style='font-family:
Arial'> Issued: __________<o:p></o:p></span></p>
<p class=MsoNormal><u><span style='font-size:10.0pt;font-family:Arial'><o:p><span
style='text-decoration:none'> </span></o:p></span></u></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Signature of Applicant:<span
style='mso-spacerun:yes'>� </span>_______________________________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:Arial'>Date:<span
style='mso-spacerun:yes'>� </span>_______________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal align=center style='text-align:center'><span
style='font-family:"Arial Black";mso-bidi-font-family:Arial'><o:p> </o:p></span></p>
<p class=MsoNormal align=center style='text-align:center'><span
style='font-family:"Arial Black";mso-bidi-font-family:Arial'><o:p> </o:p></span></p>
</div>
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