STRATA CORPORATION. PO Box 13500, Grand Forks, North Dakota "AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER"

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1 STRATA CORPORATION PO Box 13500, Grand Forks, North Dakota "AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER" Strata Corporation has a long-standing commitment to the fair and equitable treatment of employees and individuals seeking employment with us. Strata Corporation prohibits unfair treatment, discrimination, or harassment of an employee or job applicant because of their race, color, sex, religion, national origin, disability, status as a protected veteran, age, marital status, creed, status with regard to public assistance, or any other characteristic protected under local, state or federal statute, ordinance, or regulation. APPLICATION FOR EMPLOYMENT Last name First name Middle name Social Security Number Street Address City State Zip Code Application Date: Phone No. Are you 18 years or older? Are you prevented from lawfully becoming employed in this country [ ] yes [ ] no because of visa or immigration status? [ ] yes [ ] no Have you applied for employment with us before? When will you be available to begin work? How did you hear of our organization? [ ] yes [ ] no Position desired (be specific): Other special training (machine operation, etc.) Drivers license number: Class of drivers license you possess: Have you been involved in any traffic accidents or been convicted of violating any traffic laws, or regulations or committed any traffic offenses (either criminal or noncriminal) in the last three (3) years? [ ] yes [ ] no If yes, how many and please explain on a separate sheet of paper? In case of emergency, notify: Name: Phone: Address: EDUCATION Location Course of study No. of years completed Did you graduate? Degree/Diploma High School Technical/Secondary DESCRIBE ANY SPECIALIZED TRAINING IF APPLICABLE: PREVIOUS EMPLOYMENT Date Month and Year From To From To From To From To Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer. Name and Address of Employer Salary Position Reason for Leaving CONTINUE ON THE BACK SIDE OF THIS PAGE Strata Corporation Job Application continued: FOR OFFICE USE ONLY Application received from By Date received Contacted for interview By Result Interviewed by Date Remarks: Appearance Experience Hired: [ ] yes [ ] no Position Crew Salary/Wage Date to report to work Reason for Non-hire

2 The following pages (2 thru 5) must be completed. Have you ever been convicted of a crime? Yes [ ] No [ ] Have you ever committed or been arrested for a crime of violence, theft or dishonesty, and/or a sex offense? Yes [ ] No [ ] If you answered yes to either of these questions, explain fully on page 3, and include where applicable, the name and description of the crime; date and place of conviction, arrest, and/or commission of the crime; the circumstances of crime; and provide any explanation you wish to supply. (Answering yes to these questions is not an automatic bar to employment all circumstances will be considered.) Providing misleading information or omitting answers or requested information will disqualify you from further consideration for employment. List Last Five (5) Years of Former Residences, Use additional sheet if necessary. Street City State From Month/Year To Month/Year * * * * * * * * * * EMPLOYMENT-AT-WILL STATEMENT: The employment relationship which exists between Strata Corporation and each of its employees is employmentat-will. Under this relationship, any employee is free to end his/her employment with Strata Corporation at any time for any reason with or without notice. Strata Corporation may also, at any time, decide to end an individual's employment or change their wages or other terms of employment, with or without cause or prior notice, and at its sole discretion. SUBSTANCE ABUSE POLICY: Strata Corporation has a substance abuse policy in place which may require employee drug/alcohol screening and testing for purposes of hiring, reasonable suspicion, random checks, post accident and return to duty. * * * * * * * * * * I hereby declare the information provided by me in this application for employment, including page 3, is true, correct, and complete to the best of my knowledge. I understand that if employed, any misstatement or omission of facts on this application shall be considered cause for dismissal or denial of a job. I authorize investigation of all statements contained in this application. I have been informed that this Company is an equal opportunity employer and discrimination or harassment because of an employee s or applicant s race, color, sex, religion, national origin, disability, status as a protected veteran, age, marital status, creed, status with regard to public assistance, or any other characteristic protected under local, state or federal statute, ordinance, or regulation is prohibited and will not be tolerated. I further understand and agree that any offer of employment will comply with the employment-at-will statement on this application form. I further affirm that I have not knowingly withheld any facts or circumstances that would detrimentally affect this application. Date Applicant Signature * * * * * * * * * * AUTHORIZATION and RELEASE To Be Read and Signed By Applicant In order to provide Strata Corporation with information and opinions that may be useful to it in its hiring decisions, I authorize any person, school, current or past employer, or other organizations or entities whether disclosed in my application or during my interview or not to provide any information regarding me, including without limitation, information concerning my performance, reputation, work and character. I acknowledge that the information divulged may be negative or positive with respect to me. Nevertheless, pursuant to this authorization, I unconditionally release Strata Corporation and its related entities and any their employees and any other person, school, employer, organization or entity that releases any information from any and all legal liability for furnishing any information and in making such statements and conducting any investigation. I further authorize Strata Corporation to submit my name, date of birth, driver s license number, and social security number (if necessary) to their insurance company, applicable motor vehicle agencies, law enforcement agencies, and others to obtain information about me with regards to my driving records, criminal history records, vehicular accident records, motor vehicle operator s license or registration status, my insurability status, and to obtain other information. A photocopy of this authorization and release shall have the same force and effect as the original signed by me and there is no expiration date. If I am hired, I further authorize Strata Corporation to respond to future prospective employer inquiries regarding my employment with Strata by providing my dates of employment and my last title or classification and to disclose other information regarding myself as may be required by law. Date Applicant Signature

3 ADDITIONAL INFORMATION You should use the space below to provide additional information, which you would like considered or where there is not sufficient space to include all necessary information requested on pages 1 and 2 of the application; e.g. list former residences in the last five years and providing information regarding criminal convictions or arrests or convictions for crimes of violence, theft or dishonesty, and/or a sex offense. I hereby declare the additional information provided above is true, correct, and complete to the best of my knowledge. Date Applicant Signature

4 CONSUMER DISCLOSURE AND AUTHORIZATION FORM Disclosure Regarding Background Investigation Strata Corporation (the Company ) may request, for lawful employment purposes, background information about you from a consumer reporting agency in connection with your employment or application for employment (including independent contractor assignments, as applicable). This background information may be obtained in the form of consumer reports and/or investigative consumer reports (commonly known as background reports ). An investigative consumer report is a background report that includes information from personal interviews the most common form of which is checking personal or professional references. These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the Company, throughout your employment or your contract period, as allowed by law. The Company may ask a consumer reporting agency to prepare or assemble the background reports for the Company. The background report may contain information concerning your character, general reputation, personal characteristics, mode of living, and credit standing. The types of information that may be obtained include, but are not limited to: social security number verifications; address history; credit reports and history; criminal records and history; public court records; driving records; accident history; worker s compensation claims; bankruptcy filings; educational history verifications (e.g., dates of attendance, degrees obtained); employment history verifications (e.g., dates of employment, salary information, reasons for termination, etc.); personal and professional references checks; professional licensing and certification checks; drug/alcohol testing results, and drug/alcohol history in violation of law and/or company policy; and other information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. This information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses; educational institutions; former employers; and, for investigative consumer reports, personal interviews with sources such as neighbors, friends, former employers and associates; and other information sources. If the Company should obtain information bearing on your credit worthiness, credit standing or credit capacity for reasons other than as required by law, then the Company will use such credit information to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being evaluated. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company. A summary of your rights under the Fair Credit Reporting Act, as well as certain state-specific notices, are provided below. MINNESOTA EMPLOYEES: You have the right in most circumstances to submit a written request to the consumer reporting agency for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The consumer reporting agency must provide you with this disclosure within 5 days after its receipt of your request or the report was requested by the Company, whichever date is later.

5 Authorization for Background Investigation I, the undersigned, have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency and to the release of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may, as allowed by law, obtain additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period from consumer reporting agencies. I understand that information contained in my employment application, or otherwise disclosed by me before or during my employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services. I hereby authorize all of the following, without limitation, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all other federal, state and local agencies, learning institutions (including public and private schools, colleges and universities), testing agencies, information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and all other individuals and sources with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concerning my employment and earnings history, education, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses. By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I agree that this form in original, faxed, photocopied or electronic (including electronically signed) form; will be valid for any background reports that may be requested by or on behalf of the Company. Minnesota applicants only: Please check this box if you would like to receive (whenever you have such right under the applicable state law) a copy of your background report if one is obtained on you by the Company. Today s Date Signature Print Your Name Here Drivers License Number State of Issue Social Security Number Date of Birth (Needed for MVR, etc.)

6 IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service 1. In connection with your application for employment with STRATA CORPORATION ( Prospective Employer ), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: 2. I authorize STRATA CORPORATION ( Prospective Employer ) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee. 3. I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication. 4. Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. I have read the above Notice Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this consent form, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above. Date: Signature Name (Please Print)

7 Para informacion en espanol, visite o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington DC A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment or to take another adverse action against you must tell you, and must give you the name, address, and phone number of the agency that provided the information. You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your file disclosure ). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: a person has taken adverse action against you because of information in your credit report; you are the victim of identity theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See for additional information. You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See for an explanation of dispute procedures. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate. Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to You may limit prescreened offers of credit and insurance you get based on information in your credit report. Unsolicited prescreened offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at

8 You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. Identity theft victims and active duty military personnel have additional rights. For more information, visit States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For Information about your Federal rights contact: TYPE OF BUSINESS: 1. a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates. b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the CFPB: 2. To the extent not included in item 1 above: a. National banks, federal savings associations and federal branches and federal agencies of foreign banks b. State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies and Insured State Branches of Foreign Banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations d. Federal Credit Unions CONTACT: a. Consumer Financial Protection Bureau 1700 G Street NW Washington DC b. Federal Trade Commission: Consumer Response Center FCRA Washington DC (877) a. Office the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street, Suite 3450 Houston TX b. Federal Reserve Consumer Help Center PO Box 1200 Minneapolis MN c. FDIC Consumer Response Center 1100 Walnut St., Box #11 Kansas City MO d. National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street Alexandria VA Air carriers Assist. General Counsel for Aviation Enforcement & Proceedings Aviation Consumer Protection Division Department of Transportation 1200 New Jersey Avenue, S.E. Washington DC Creditors Subject to Surface Transportation Board Office of Proceedings, Surface Transportation Board Department of Transportation 395 E Street, S.W. Washington DC Creditors Subject to Packers and Stockyards Act, 1921 Nearest Packers and Stockyards Administration area Supervisor 6. Small Business Investment Companies Associate Deputy Administrator for Capital Access United States Small Business Administration 409 Third Street, SW, 8 th Floor Washington DC Brokers and Dealers Securities and Exchange Commission 100 F Street, N.E. Washington DC Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks and Production Credit Associations 9. Retailers, Finance Companies, and All Other Creditors Not Listed Above Farm Credit Administration 1501 Farm Credit Drive McLean VA FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center FCRA Washington DC (877)

9 VOLUNTARY EEO/AA SELF - IDENTIFICATION FORM Dear Applicant: Thank you for your interest in a position at Strata Corporation. We would appreciate your completing the following information. Strata Corporation is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, Strata Corporation invites job applicants and employees to voluntarily self-identify their race and ethnicity as well as other information. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. This self-identification is completely voluntary. Refusal to provide this information will not influence your status as an applicant or subject you to any adverse treatment. It will NOT be used as part of your application file or employee file. Our company provides equal opportunity in employment to all applicants for employment and employees. No person shall be discriminated against on the basis of age, race, color, creed, national origin, religion, membership or activity in a local commission, gender, sexual orientation, marital status, pregnancy, physical or developmental disability, status as a protected veteran, disabled veteran status, public assistance status, or any other legal protected basis. Please Print Name: Date: Last First Middle Address: Street City State Zip Telephone No.: Date of Birth: Specific Position Applied For: Sex: ( ) Male ( ) Female U.S. Citizen: ( ) Yes ( ) No - If no, give visa classification: Your Race and Ethnic Identification: Are you Hispanic or Latino? ( ) YES ( ) NO Report the race/races that you consider yourself to be if your answer was NO to the question above. ( ) White (Not Hispanic or Latino) ( ) Black or African American (Not Hispanic or Latino) ( ) Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) ( ) Asian (Not Hispanic or Latino) ( ) American Indian or Alaskan (Not Hispanic or Latino) ( ) Two or More Races--(Not Hispanic or Latino) How did you hear about this position? ( )Job Service ( )Word of Mouth ( )Referral Agency ( )Radio ( )Career Fair ( )College/University Career Office ( )Newspaper: ( )Employee Referral ( )Walk In ( )Internet ( )Other: VOLUNTARY SURVEY Thank you for completing this Voluntary EEO/AA Self - Identification Form.

10 Staple To: EEO Officers Strata Corporation PO Box Grand Forks, ND Fold