EMPLOYMENT APPLICATION

First Name *

Last Name *

Middle Initial

Current Mailing Address *

City *

State *

Zip *

Country

Primary Phone Number *

Secondary Phone Number

Email Address *

Are you authorized to work in the United States? *

Yes

Have you ever been convicted of, pled guilty or nolo contendere to, or been granted deferred adjudication for a felony? (Conviction is not an automatic disqualification for employment) *

Yes

Please explain *

Education / Skills

High School

High School City, State

Did you graduate

Yes

College / University

College City, State

Did you graduate

Yes

Special Training/ Vocational Training/ Languages/ Certifications

What skills/ qualifications do you bring to Moonlight Basin?

Employment History

Employer 1- Name *

Employer 1- City, State *

Employer 1- Supervisor Name *

Employer 1- Phone *

Employer 1- Position Title *

Employer 1- Wage *

Employer 1- Description of Position's Responsibilities *

Employer 1- Start Date *

Employer 1- End Date

Employer 1- Reason for Leaving *

Employer 1 - Are you eligible for rehire?

Yes

Employer 2- Name

Employer 2- City, State

Employer 2- Supervisor Name

Employer 2- Phone

Employer 2 Position Title

Employer 2- Wage

Employer 2- Description of Position's Responsibilities

Employer 2- Start Date

Employer 2- End Date

Employer 2- Reason for Leaving

Employer 2 - Are you eligible for rehire?

Yes

Employer 3- Name

Employer 3- City, State

Employer 3- Supervisor Name

Employer 3- Phone

Employer 3- Position Title

Employer 3- Wage

Employer 3- Description of Position's Responsibilities

Employer 3- End Date

Employer 3- Start Date

Employer 3- Reason for Leaving

Employer 3 - Are you eligible for rehire?

Yes

References

Please provide references that are job related (i.e. co-workers) not related to you.

May we contact your present employer? *

Yes

Reference Name

Reference Occupation/ Relationship

Reference Phone

Reference 2 Name

Reference 2 Occupation/ Relationship

Reference 2 Phone

Reference 3 Name

Reference 3 Occupation/ Relationship

Reference 3 Phone

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Applicant Release and Certification

Please read carefully before submitting application. E-Signature required. By completing the eSignature process, I understand that I am signing the Moonlight Basin Management LLC application for employment, which includes agreeing to all terms and conditions of the application as set forth below.

I certify that all the information I supply in this application and all additional information I may have submitted is true and complete to the best of my knowledge. I understand that giving false information, misrepresenting facts, and material omissions may be grounds for denial of employment or immediate discharge if hired. I authorize Moonlight Basin Management LLC to contact my references, as well as current and previous employers, to obtain information on my work history and qualifications for employment. I release Moonlight Basin Management LLC, my former employers and all other persons, corporations, partnerships and associations from all claims, demands and liabilities arising out of or related to these investigations. I understand that any offer of employment is conditional upon the satisfactory completion of the verification process and may also be contingent upon successful completion of a background check that may include criminal history, driving records and/or drug screen. I further understand that if hired, I will be an “at-will” employee and agree my employment relationship may be terminated at any time, for any lawful reason, with or without notice and with or without cause by the Company or me. This application for employment does not constitute an offer of employment or an employment contract.

I have read, understand and agree to these statements