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I certify that answers given herein are true and complete to the best of my knowledge.

I authorize the JSA Safety & Consulting, Inc. to make an investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the JSA Safety & Consulting, Inc. is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment may not be changed by any written documents or by conduct unless such change is specifically acknowledged in writing and approved by a JSA Safety & Consulting, Inc. owner.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of JSA Safety & Consulting, Inc.