APPLICATION FOR EMPLOYMENT
INTERFACE SOLUTIONS, INC.
An Equal Opportunity Employer

I certify that the information and statements included in my application for employment are true and complete. I understand that Interface Solutions, Inc. (ISI) will rely upon the information I have furnished in this application, and any information and statements provided by me in the application process, in deciding whether to hire me. I understand that, if employed, any false statement or omission in this application or during any part of the process whereby ISI is considering me for employment may result in my disqualification or dismissal. I understand and authorize ISI and any of its agents, employees or contractors to perform an investigation of all of the information I have provided. This may include, but not necessarily be limited to prior employment, education, driving record (if appropriate) and criminal conviction history. I hereby fully waive and release any rights or claims I have or may have against ISI, its agents, employees, and contractors as well as any person or entity conducting any part of this investigation, and any person or entity contacted or providing information as part of the investigation, for any and all claims that may result, directly or indirectly from the use, disclosure or release of any such information, whether the information is favorable or unfavorable to me. I authorize a photocopy or telephone facsimile (FAX) copy to be as valid as the original of this authorization and release. If offered employment, I further understand that I may be required to undergo a physical examination which will include a medical and workers' compensation claims history prior to becoming an employee. I further understand that a drug screening test will be required, and that a confirmed positive test result will exclude me from further consideration for employment. I also understand and acknowledge that my employment is at will and that I can be terminated with or without cause and with or without notice at any time, at the option of ISI or myself. I further acknowledge that any ISI policy, manual, handbook, publication, procedures or rule that may now or in the future apply to me or my employment is not intended to be contractual or to create a contract of employment, and is not intended to modify my at will employment relationship with Interface Solutions, Inc.