Job Application

We request the following information to help us make the best possible placement. You should complete all portions of this application that pertain to you. All information given will be held in strict confidence.

If offered employment and accepted, you are required by law to show proof of eligibility to work in the USA.

Personal Information

Record of Employment (Most Recent)

Record of Employment # 2

Record of Employment # 3

High School Education

College / Technical Education

Graduate Education

Other (specify) Education

Skills and Qualifications

References

Resume

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EEOC Compliance

The Company is dedicated to the principles of equal employment opportunity in all terms, conditions, or privileges of employment. The Company does not discriminate against applicants or employees or make decisions on the basis of age, race, sex, color, religion, national origin, disability, or any other status protected by state or local law, and hires, employs and promotes qualified persons without regard to the age, race, sex , color, religion, national origin or disability. A “qualified person” is a person who possesses the education, training, experience, skills, abilities, integrity, disposition to work, reliability, willingness to comply with reasonable rules and regulations, and other job related qualifications required by the Company for the particular position in question.

Employment Disclosure

I certify that I have read and understand this employment application. I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

I understand that, as an applicant for a position with Lisbon Valley Mining Company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it will be conditioned on the successful results of a pre-employment physical exam, a drug screen, an alcohol breathalyzer test, and background check. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that the federal immigration laws require me to complete an I-9 From in this regard.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s General Manager.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.

DO NO SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

I certify that I have read, fully understand and accept all items of the foregoing Applicant Statement and Employment Disclosure.

Sending