The facts set forth in my application are true and complete. I authorize the investigation of all statements contained in this application
and hereby authorize my former employers to furnish all information pertaining to my work record. I hereby release my former
employers from all liability on account of furnishing such information. I understand that if employed, false statements, omissions or
misleading statements on this application shall be considered sufficient cause for dismissal and I agree that my employer shall not be
held liable in any respect if my employment is terminated because of such omissions or false or misleading statements. Omni
Resource, Inc./Blair Construction, LLC is hereby authorized to investigate my employment history, including the contacting of the
employers listed on the previous page. (If there is a particular employer you do not wish contacted, please indicate which one and
why.)