Employment Application

Personal Information

Name(Required)

First Last

Phone(Required)

Social Security Number:(Required)

Are you 18 years or older?(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment Desired

Position(Required)

Salary Desired(Required)

Date you can start(Required)

Are you employed now?(Required)

Yes

If yes, may we contact your present employer?(Required)

Yes

Ever applied to this company before?(Required)

Yes

When?(Required)

Are you willing to work overtime?(Required)

Yes

Are you willing to work night shift?(Required)

Yes

Education

Highest Education Attained(Required)

Number of Years Attended(Required)

Degree Attained(Required)

Subject Studied(Required)

(N/A if High School)

It is Lowe’s Pellets & Grain, Inc’s policy that equal employment opportunities be available to all employees and applicants without regard to race, sex, age, color, religion, national origin, participation in military service, disability, or any other protected status or characteristic. Lowe’s Pellets & Grain, Inc. will comply with its obligation to provide reasonable accommodation to qualified individuals with disabilities.

*This application is valid and will be considered for only 60 days after it is signed and dated.

Emergency - In Case of Emergency, Please Contact:

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Employment History: List the last 4 Employers below, starting with the most recent employment first. EXCLUDING TRUCK DRIVERS- SEE ATTACHMENT A.

Employer 1 Name(Required)

Date Started(Required)

Date Ended(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Salary(Required)

Position(Required)

Reason For Leaving(Required)

Employer 2 Name

Date Started

Date Ended

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Salary

Position

Reason for Leaving

Employer 3 Name

Date Started

Date Ended

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Salary

Position

Reason for Leaving

Employer 4 Name

Date Started

Date Ended

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Salary

Position

Reason for Leaving

References - (PLEASE INCLUDE ONE PERSONAL AND TWO PROFESSIONAL REFERENCES)

Name of Reference 1(Required)

Company Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Years Known(Required)

Name of Reference 2(Required)

Company Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Years Known(Required)

Name of Reference 3(Required)

Company Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Years Known(Required)

Applicant Statement: Please Read and Sign Below.(Required)

I have read and agree to the terms and conditions by confirming with my signature below.

1. I hereby certify that all responses set forth during my employment application process are true and complete. My signature also authorizes Lowe’s Pellets & Grain, Inc., or its authorized agents to conduct a thorough investigation of all statements, written and oral, made by me during the employment application process, including without limitation, information concerning my prior employment positions, law enforcement record and educational background. I hereby authorize all persons, companies, or other entities connected with such informational requests to provide any and all information they may have regarding my employment. I release and agree to indemnify Lowe’s Pellets & Grain, Inc., its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of such investigation, including without limitation, any liability for furnishing information or for taking any action based on the information provided.

2. I understand and agree that any falsification, misrepresentation, or omission either on the employment application form or in my responses to questions asked during the interviewing or examination process may disqualify me from further consideration for employment, or if employed by Lowe’s Pellets & Grain, Inc. will subject me to immediate termination, whenever the falsification or omission is discovered. In this regard, where an item is left blank on the employment application, it is because there is no information within its scope.

3. I understand that a chemical test for the presence of illegal and controlled substances may be required before the commencement of and/or during my employment. I release and agree to indemnify Lowe’s Pellets & Grain, Inc., its authorized agents, its employees, and all other persons, companies, and other entities from any and all liability arising out of any chemical testing or for the taking of any action based on the results of any chemical testing.

4. I understand that I may be required to take a physical examination before starting work if an offer of employment is made. I release and agree to indemnify Lowe’s Pellets & Grain, Inc., its authorized agents, its employees, and all other persons, companies, and other entities from any and all liability arising out of any physical examination or for the taking of any action based on the results of any physical examination.

5. I certify that I am a citizen of the United States, or, if not, I can provide the required documentation permitting me to work in the United States

6. I understand and agree that if I am employed by Lowe’s Pellets & Grain, Inc., my employment is at-will so I may terminate my employment at any time and for any or no reason. Likewise, Lowe’s Pellets & Grain, Inc. can terminate my employment at any time, with or without notice, and for any or no reason. I also understand and agree that nothing contained in the employment application or in the granting of an interview or anything outlined in any oral or written statement, communication, or policy now or in the future constitutes or is intended to constitute or to create a contract between me and for either employment or for the providing of benefits. No promises regarding employment have been made to me and I understand and agree that no such promise or guarantee is binding on Lowe’s Pellets & Grain, Inc. unless they are expressed as promised, made in writing, and signed by the President.

Signature(Required)

Date Signed(Required)