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EMPLOYMENT APPLICATION

The Company is an equal opportunity employer which seeks and employs qualified persons in all job classifications. All personnel actions are administered without discrimination based upon race, color, religion, sex, marital status, age, national origin, disability or veteran status.

IMPORTANT: PLEASE READ BEFORE COMPLETING APPLICATION


It is important that you supply all of the information requested, as incomplete applications will not be considered. APPLICANT INFORMATION LOCATION APPLIED TO: Last Name Street Address City Phone Date of Applicatio Position Applied for Are you legal to work in the U.S.? Are you 21 years of age or older? Have you ever been convicted of a Felony or Misdemeanor? EDUCATION High School Fro m College Fro To m Other (military, on-the-job, Fro To m Did you graduate? To Did you graduate? Addres s YES Addres s YES Addres s Did you graduate? YES State: NO State: NO Degree City: Degree City: City: Date Available State E-mail Addres Desired Pay First Social Security Number: Apartment/Uni t# M.I. ZIP

YES YES YES

NO NO NO

If no, are you authorized to work in the U.S.?

YES

NO

If yes, explain

State: NO Degree

AVAILABILITY Hours Available Friday Saturday Sunday Monday Tuesday Wednesday Thursday

From Total Hours Available Per Week: To

PREVIOUS EMPLOYMENT 11/1/2010 Cinebarre

Please list your last three jobs beginning with the most recent. Account for all periods of employment and military service. Explain any lapse of time over three weeks between employment in the comments section below. Failure to provide complete information will result in disqualification of your application. Use a supplemental sheet, if necessary. May attach resume as supplemental information but not in lieu of completing information below. Company Address Job Title Responsibilities Month : Reason for Leaving May we contact? From Company Address Job Title Responsibilities Month : Reason for Leaving May we contact? From Company Address Job Title Responsibilities Month Day: Year: To : Reason for Leaving May we contact? YES COMMENTS: (including additional working experience, explanation From Month : Day: Year : City Starting Salary Day: Year: To Month : Day: Year : City Starting Salary Day: Year: To Month : Day: Year : City Starting Salary Phone State $ ( ) Supervisor Ending Salary $

YES

NO Phone State $ ( ) Supervisor Ending Salary $

YES

NO Phone State $ ( ) Supervisor Ending Salary $

NO of any gaps in employment, special employment training, etc.)

State whether you have ever been terminated or suspended from any previous employment and describe the circumstances: PROFESSIONAL/EDUCATIONAL REFERENCES Give the names, addresses and phone numbers of three professional/educational persons not related to you, whom you have known at least one year. Name Address Business Phone/Area Code Street: City: State: Street: City: State: Street: City: State:

DISCLAIMER AND SIGNATURE


I authorize this employer or its duly authorized representative to verify all statements contained in this application, to conduct any background investigations deemed necessary, and I release from all liability whatsoever all persons, companies and corporations supplying such information. I expressly agree to indemnify the Company against any liability which might result from making such investigation. I understand that any false answers, statements or implications made by me in this application shall be considered sufficient cause for denial of employment or discharge. Additionally, I understand that nothing contained in this employment application or in the granting of any interview is intended to create an employment contract between the Company and myself for either employment or the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the company unless in writing and signed by the Chief Executive Officer of Cinebarre LLC. If an employment relationship is established, I shall confirm to Company policies and procedures. I understand that I have the right to terminate my employment at any time for any reason, and that the Company retains a similar right. My signature below is an acknowledgement that I

Signature

Date Date

GM Signature 11/1/2010 Cinebarre

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