Employment Questions

Education

Skills and Training

Attendance and Punctuality Information

References

Notification and Agreement

PLEASE READ CAREFULLY BEFORE SIGNING

I certify that all answers given by me are true, accurate and complete. I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause of denial of employment or immediate termination of employment, regardless of when or how discovered.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

If hired, I agree to abide by all of the company rules and regulations, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me. I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, shall constitute a contract of employment. I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the Company, has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the President or Executive Vice President, or to make any agreement to the contrary to the foregoing.

I agree that any claim or lawsuit relating to my service with AIP Logistics, Inc. or any of its subsidiaries must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I expressly agree to waive any statute of limitations to the contrary. I understand that if I become an employee of AIP Logistics, Inc. at any time in the future, this application of employment will become a part of my official employment record. I further acknowledge that AIP Logistics, Inc. 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.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

Consent to Drug Test

I understand that AIP Logistics, INC. is a drug-free workplace and that a drug test is a condition of employment.

I agree that if I am offered and accept a position with the company that I will be required to take a urine test to screen for the use of illegal drugs, including medically-prescribed marijuana.

I acknowledge that I have been informed of the scope of the test, including which drugs are being screened for, as well as the sample collection procedure. I hereby consent to this test.

Furthermore, I am aware that these results will become part of my employment record and that positive results can affect whether I am hired. I hereby authorize the release of the test results to AIP Logistic, INC.

Reference and Records Authorization

I understand that as a result of making an application for employment, AIP Logistics (the “Company”), its officers, agents, representatives, or its duly authorized employees, may request, and I also authorize and request, each former employer and each person, firm, or corporation which I have given as a reference to furnish any information that may be sought by the Company concerning me and my work, my habits, character, or skill, and I hereby waive any privileges and release the Company and all referring entities from any liability involved in providing this information.

I further authorize the Company, and its officers, agents, representatives, its duly authorized employees or any third party retained by the Company to make any lawful examination of my criminal record and credit history, and I release any and all individuals connected therewith, from all liability in providing such information. The information solicited may include in-depth information about your character, general reputation, personal characteristics, mode of living, and your criminal, driving and work history, among other things.

I 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 authorize the Company to obtain the reports referenced herein at any time in the future so long as I am an employee of the Company.

Applicant and Employee Consent Form to Investigate and Disclose Background Data

I hereby authorize American Industrial Partners (hereinafter “Company”) and its designated agents and representatives to investigate my background for employment, promotion, or retention as an employee. I understand that the scope of the investigation may include, but is not limited to, contacting and investigating my former and current employers, personal references, educational institutions where I enrolled, reviewing my criminal history records, sexual offender’s list, motor vehicle records, license verification, and my credit history. I authorize Company to use any and all information acquired to make decision regarding my employment, which may be disclosed to third parties.

I hereby authorize the complete release, without reservation, of the described records, information, or data pertaining to me which any individual, company, firm, corporation, or public agency may have. I authorize the full release of this information throughout the duration of my employment with Company.

I understand that as part of the interview process, Company requires all applicants to disclose pertinent data concerning previous work history, police and criminal records, and educational information and activities. I understand and agree that if any material facts are discovered which differ from those facts stated by me on my employment application, at my interview, or at any time prior to my commencing employment at Company (if I am offered a position with Company), I will not be offered the job. Furthermore, I understand and agree that if material facts are later discovered which are inconsistent with or differ from facts I furnished before taking the job that the Company will discipline me, which may include immediate discharge without warning. I further understand that I have the right to request disclosures regarding the nature and scope of the report(s) solicited by Company and, upon my request to Company, to receive a written summary of my legal rights as they pertain to such reports.

The cost of this investigation will be paid by Company. Nonetheless, I hereby, release and forever discharge and hold Company and its subsidiaries and affiliated companies, agents and employees, as well as the third parities supplying such information, harmless form any and all claims, demands, judgments and legal fees arising out of or in connection with this investigation, the results, or any lawful use of the results or disclosure thereto.