* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):

Yes   No

* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):

Yes   No

* Have you ever worked for Heartland RV?:

Yes   No

If Yes, please provide details (Where/When/Job Title):

* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:

Yes   No

If no, please explain:

* Have you ever worked for another Thor Industries, Inc. company?:

Yes   No

If yes, please provide company names, dates and previous supervisor.:

* Have you ever been convicted of, or pled 'no contest to', a criminal offense (felony or misdemeanor)? (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense . The date of the offense, the nature of the offense, including any significant details that affect the description of the event , and the surrounding circumstances and the relevance of the offense to the position (s) applied for may, however, be considered.):

Yes   No

If yes, please explain:

* If hired, are you willing to submit to and pass a controlled substance test?:

Yes   No

* Have you graduated from high school or received your G.E.D.?:

Yes   No

* Do you have any post high school education?:

Yes   No

* When would you be available to begin work?:

* Type of employment desired:

Full-Time Part Time Seasonal

* Hourly rate/salary desired:

* Are you currently employed?:

Yes   No

If so may we inquire of your present employer?:

Yes   No

If presently employed, why are you considering leaving?:

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location	Did you Graduate?	Degree Received	Subjects Studied/Major
*	* Yes   No	*	*
	Yes   No
	Yes   No

Give your full employment record, starting with your current or most recent employment

Dates Employed	Employer Name & Address	Employer Phone
From: * To: *	* *	*
Job Title	Supervisor Name & Title	May we Contact?
*	* *	* Yes No
Responsibilities	Reason for Leaving	Salary/Hourly Rate
*	*	Start: * End: *

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving	Salary/Hourly Rate
		Start: End:

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving	Salary/Hourly Rate
		Start: End:

Name	Relationship	Phone Number	Email

Please read the following paragraphs carefully and acknowledge your understanding by signing your name in the space below.

Consent to Conduct Background Investigation. As a condition of, and in consideration for the company's consideration of my application for at -will employment, I give permission to the company to investigate my personal and employment history. I understand that this background investigation will include, but not be limited to, verification of all information on this application, as well as interviews with past employers. I further give permission to the company to conduct this investigation and to discuss the results of this investigation in connection with my application for employment.

Consent to Contact Past Employers. I give permission to the company to contact all employers listed in my application (except those specifically excluded) for references. I further give permission to all current or previous employers and/or managers or supervisors to discuss my relevant personal and employment history with the company. I further waive any rights I may have to receive a copy of any written statement provided by any of my former employers to the company. I further agree to indemnify all past employers for any liability they may incur because of their reliance upon this release.

Consent to Contact Government Agencies. I give permission to any agent, attorney, or representative of the company to receive a copy of any information obtained in the file of any federal, state, or local court, government agency, law enforcement agency, or investigator concerning or relating to me. I further consent to the release of such information and waive any right under state law concerning notification of the request for a release of such information. In the event a state law does not provide for prospective employers to have access to information, I hereby delegate the company as my agent for receipt of information. I understand that the scope of this investigation will be limited to criminal and/or civil records that relate to my honesty, integrity, and/or abilities.

Cooperation with Investigation. I agree to fully cooperate in the company's background investigation and to sign any waivers or releases that may be necessary to obtain access to relevant information. In the event that any former employer of federal, state, or local government agency will not release reference information or criminal history information directly to the employer, I agree to personally request such information to the extent permitted by law.

Falsification Statement. I understand that any falsification or willful omission of fact made in my application for at-will employment or in connection with any background investigation may be sufficient grounds for rejection of my application , or, if discovered after an offer of employment, for immediate dismissal.

Employment "œAt Will". In consideration of my employment, I agree to conform to the rules and regulations of the company, and my employment and compensation is "œat will" in that they can be terminated with or without cause, and with or without notice, at any time, at the option of either the company or myself except as otherwise provided by law. I understand that no manager or representative of the company, other than the president of the company, has authority to enter into any agreement for employment for any specific period of time or to make any agreement or contract to the foregoing, and that any promises to the contrary will only be relied upon by me if they are in writing and signed by the president of the company.

* Signature (type name):

* Date: