I certify that the answers given to the questions and the statements made (including statements on the attached resume, and inserted forms, if any) on this application and in the hiring process are true. I understand that a false statement, a false answer, an omission, or a misleading statement may result in a decision not to hire me, the withdrawal of any offer of employment, or the termination of my employment with MICA regardless of when such false, misleading, or erroneous information is discovered.

I understand that if hired, unless I am employed under a specific written contract or collective bargaining agreement, my employment with MICA will be "at will" and that my employment may be terminated at any time with or without cause and with or without notice. I understand that no representative of the Company has any authority to make any assurances, representations or promises contrary to the "at-will" nature of my employment unless it is in writing signed by an authorized officer of MICA. I understand that I may terminate my employment with or without cause and with or without notice at any time. I further agree that MICA reserves the right to make unilateral changes to the terms and conditions of my employment.

I authorize MICA or its agents to investigate my references and communicate with my former employers concerning my employment unless specifically stated otherwise in this application. I authorize all individuals, schools, and employers named, and all financial institutions, law enforcement agencies, and all persons except as specifically limited on this application to provide information requested about me, and I promise I will not bring any legal claims or actions against my current or former employers due to their responses to any job reference request. I understand that my prior employers may be contacted and the information that I provide may be used for the purpose of investigating my background as required by § 391.23.

I further understand that the completion of an application with MICA is a preliminary step to employment. It does not obligate MICA to offer employment to me, or for me to accept employment. I further acknowledge that if offered employment, any such offer may be conditional pending successful completion of a motor vehicle record check, drug screening, alcohol screening and a physical examination.

I confirm that I have seen a description of the major job duties and physical requirements of the job that I am applying for and I understand that my application will only be considered for this specific job.

Pursuant to § 391.21(d), you are hereby informed that the information you provide in the Employment History may be used, and your prior employers may be contacted for the purpose of investigating your safety performance history information. Pursuant to § 391.21(i), you have the following rights: (i) the right to review information provided by previous employers; (ii) the right to have errors in the information corrected by the previous employer or for that previous employer to resend the corrected information to MICA; and, (iii) the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and you cannot agree on the accuracy of the information.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.