Legal First Name✱

Legal Last Name✱

Home Phone

Cell Phone

Email Address✱

If yes, please list employee name:

If yes, please list position:

Degree

Years Attended

Years Attended

Company 1

Title

Phone Number

Years Worked

Manager's Name

Company 2

Title

Phone Number

Years Worked

Manager's Name

Reference 1 Name

Email

Phone Number

Work Relationship

Occupation

Number of Years Acquainted

Reference 2 Name

Email

Phone Number

Work Relationship

Occupation

Number of Years Acquainted

In connection with GoodLeap LLC consideration of me for employment, continued employment, promotion, or reassignment, I understand that GoodLeap LLC may obtain a consumer report and/or an investigative consumer report. GoodLeap LLC may also conduct its own investigative inquiries into my background that may include obtaining such things as criminal, driving, personal reference(s), and job reference(s) pertaining to me. These inquiries will be conducted to provide GoodLeap LLC with information regarding my character, general reputation, personal characteristics, mode of living, work records, salary history, characteristics, skills and abilities, education and training, employment experience, past job performance, reasons for termination of previous employment and other pertinent information. (Please initial.)✱

I understand that for this purpose GoodLeap LLC or persons acting on its behalf will be requesting information from various federal, state, and local governmental agencies, previous employers and their employees, personal acquaintances of mine, and other appropriate resources of information that maintain records or possess knowledge about my education, employment, criminal, driving and other relevant activities, experiences and records, including, but not limited to, my character, general reputation, personal characteristics, and mode of living. I authorize, without reservation, any person or entity contacted by GoodLeap LLC or anyone acting on its behalf, to furnish the above‐stated information, and I release any such person or entity from any and all liability for furnishing such information. I also release GoodLeap LLC from any and all liability for conducting such an investigation. I authorize GoodLeap LLC to disclose my Social Security Number in order to obtain necessary information. I understand that if I refuse to execute this authorization, GoodLeap LLC may refuse to grant employment based on this refusal. A copy of this executed authorization shall be valid as the original. (Please initial.)✱

I understand that this employment application and any other documents, including policies, handbooks, guidelines, practices, benefits or manuals, are not intended to create any contractual obligation which in any way conflicts with GoodLeap’s policy that the employment relationship between GoodLeap LLC and each employee is at‐will and can be terminated, with or without cause, and with or without notice at any time, at the option of either GoodLeap or the employee. I further understand that any oral or written statements to the contrary are expressly disavowed and should not and cannot be relied upon. (Please initial.)✱

I understand that as a condition of employment with GoodLeap LLC successful applicants must provide, within three days after beginning employment, documentation to prove identity and proper authorization to work in the United States. Specific instructions will be given prior to the first day of employment regarding the documents required. (Please initial.)✱

I hereby acknowledge that I have read the above statements and understand them. I certify that I, the undersigned applicant, have personally completed this application. I declare under penalty of perjury that the facts contained in the application (or any resume or other documents submitted) are true and complete to the best of my knowledge. I understand that any misrepresentations or omissions will disqualify me from further consideration for employment, and will be justification for my dismissal from employment, if discovered at a later date. (Please initial.)✱

Please enter your full legal name below as signature:✱