APPLICATION FOR EMPLOYMENT This application is valid for one (1) year Todays Date:

Mission Linen Supply is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable state or federal civil rights laws.

POSITION APPLYING FOR

LAUNDRY TECHNICIAN
DATE AVAILABLE TO START

DESIRED YEARLY SALARY $25,000 FULL-TIME PART-TIME

NOW

PERSONAL INFORMATION
LAST NAME FIRST NAME M. INITIAL HOME PHONE

WILSON
PRESENT STREET ADDRESS

KELLY
CITY

L.
STATE

916-204-6340
ZIP CODE

1177 FLEMING DRIVE

ROSEVILLE

CA.

95747

Name and phone number of the person to be notified in case of emergency:

JUDY JOHNSTON 916-771-6903 RELATIONSHIP-MOTHER

Do you have the legal right to work and be employed in the U.S.? (Proof of identity and legal authority to work in the U.S. is a condition of employment.) Are you at least age 18? (Proof of age and work permits may be required prior to hiring) Do you have a reliable means of transportation to and from work? YES YES YES NO NO NO

EDUCATION
NAME OF SCHOOL AND ADDRESS GRADUATED? # YEARS COURSE OR MAJOR GPA

HIGH SCHOOL COLLEGE OTHER

SANTA ROSA HIGH, 1235 MENDOCINO AVE., SANTA ROSA, CA.

YES NO YES NO YES NO

GEN. ED

2.5

Do you possess a professional or trade license/certificate? NO Type: Issued by:

NONE

Exp. Date:

What business-related machines or equipment can you operate? (Include computer and software):

Extracurricular Activities (You may omit those which indicate your race, color, religion, sex, national origin, ancestry, age, or the existence of a disability):

Employment Application Page 1

EMPLOYMENT / WORK EXPERIENCE

Please list your last three jobs (if applicable, you may list work performed on a voluntary basis. If additional pages are needed, please attach)
COMPANY NO. 1 (most recent) ADDRESS TELEPHONE NUMBER

THE ARBORS @ ANTELOPE

EMPLOYED (Month and Year) FROM TO

3700 NAVAHO DRIVE, ANTELOPE, CA.

TYPE HOURLY

916-344-5222
AVG. # OF HOURS PER WEEK YEARLY

BASE SALARY START ENDING

01-2007

03-2010

$10.00

$10.69 AL SALOMON

40 HOURS

POSITION(S) HELD:

SUPERVISORS NAME AND POSITION:

HOUSEKEEPER
PLEASE DESCRIBE ALL SIGNIFICANT DUTIES:

CLEANED COMMON AREA'S , MODEL UNITS, AND VACANT UNITS.

MAY WE CONTACT THIS EMPLOYER? REASON FOR LEAVING: YES NO

LAID-OFF
COMPANY NO. 2 ADDRESS TELEPHONE NUMBER

ST. ANTONS
EMPLOYED (Month and Year) FROM TO

1801 I STREET, SACRAMENTO, CA

BASE SALARY START ENDING TYPE HOURLY

916-444-9897
AVG. # OF HOURS PER WEEK YEARLY

03-2006

12-2006

$10.00

$10.00 ANDREW WOORLEY

40 HOURS

POSITION(S) HELD:

SUPERVISORS NAME AND POSITION:

HOUSEKEEPER
PLEASE DESCRIBE ALL SIGNIFICANT DUTIES:
CLEANED COMMON AREA'S, VACANT UNITS AND GROUNDS.

MAY WE CONTACT THIS EMPLOYER? REASON FOR LEAVING:

YES

NO

LAID-OFF
COMPANY NO. 3 ADDRESS TELEPHONE NUMBER

JON BERKLEY MANAGEMENT

EMPLOYED (Month and Year) FROM TO

1801 HANOVER STREET, DAVIS, CA.

BASE SALARY START ENDING TYPE HOURLY

530-753-5910
AVG. # OF HOURS PER WEEK YEARLY

11-2004

03-2006

$10.00

$10.00 CINDY POLWORT

40 HOURS

POSITION(S) HELD:

SUPERVISORS NAME AND POSITION:

HOUSEKEEPER
PLEASE DESCRIBE ALL SIGNIFICANT DUTIES:

CLEANED COMMON AREA'S, VACANT UNITS AND GROUNDS

MAY WE CONTACT THIS EMPLOYER? REASON FOR LEAVING: YES NO

LAID-OFF
Employment Application Page 2

PLEASE IDENTIFY AND EXPLAIN ALL PERIODS OF UNEMPLOYMENT IN THE LAST FIVE YEARS:

Please list any job-related professional, trade, business, or civic activities, organizations, and associations (you may omit those which indicate race, color, religion, national origin, ancestry, sex, age, or the existence of a disability): NONE

PLEASE PROVIDE THE NAMES, ADDRESSES, AND TELEPHONE NUMBERS OF AT LEAST TWO PROFESSIONAL REFERENCES WHO ARE NOT RELATED TO YOU: NAME ADDRESS TELEPHONE NUMBER

JANIE BORGMAN
NAME

ADDRESS

916-344-5222
TELEPHONE NUMBER

TRENT DODGE
NAME

ADDRESS

530-681-0513
TELEPHONE NUMBER

PATTY LUTZ
NAME

ADDRESS

530-368-9146
TELEPHONE NUMBER

GENERAL INFORMATION
PLEASE NOTE: CERTAIN POSITIONS MAY BE REQUIRED TO COMPLETE A SUCCESSFUL BACKGROUND CHECK HAVE YOU EVER APPLIED FOR A POSITION WITH OR WORKED FOR THIS COMPANY BEFORE? IF YES, SPECIFY DATES: FROM TO ARE YOU RELATED TO OR KNOW SOMEONE EMPLOYED AT MISSION LINEN SUPPLY? IF YES, PLEASE LIST NAMES:

YES

NO

YES

NO

ARE YOU A VETERAN OF THE UNITED STATES MILITARY SERVICE? IF YES, PLEASE STATE BRANCH OF SERVICE:

YES

NO

HAVE YOU BEEN CONVICTED OF A FELONY OR MISDEMEANOR WITHIN THE LAST SEVEN YEARS? YES

NO

(NOTE: Please exclude traffic violations: misdemeanor convictions for marijuana-related offenses more than two years old; convictions that have been sealed, expunged, or legally eradicated; and misdemeanor convictions for which probation was successfully completed or otherwise discharged and the case was judicially dismissed. A conviction is not an automatic bar to employment. Each case will be considered on its own merits.).

IF YES, PLEASE EXPLAIN AND STATE THE CHARGE, THE COURT, THE DATE OF THE CONVICTION, AND THE DISPOSITION OF THE CASE:

Employment Application Page 3

I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked by Mission Linen Supply unless I have indicated to the contrary. I authorize the references listed above, as well as all other individuals whom Mission Linen Supply contacts, to provide any and all information concerning my previous employment and any other pertinent information that they may have. Furthermore, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to Mission Linen Supply as well as from any use or disclosure of such information or any of its agents, employees, or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, my immediate dismissal from employment upon discovery. In consideration of my employment, I agree to conform to the rules and standards of Mission Linen Supply. I further understand my employment is an at-will relationship that either party may terminate for any reason. I further understand that this policy cannot be changed except in writing and then only when signed by an authorized representative of the company. I also understand that all offers of employment are conditioned on the Company's receipt of satisfactory responses to reference requests, the provision of satisfactory proof of an applicant's identity and legal authority to work in the United States, and upon acceptable results of a pre-employment drug screen and background check. For certain positions offers of employment are also conditioned on the satisfactory completion of a post-offer medical examination. SIGNATURE OF APPLICANT ____________________________________________________ DATE ________________________

AN EQUAL OPPORTUNITY EMPLOYER

Mission Linen Supply: An Employer of Choice

Employment Application Page 4

Employment Application Page 5

DO NOT ATTACH TO EMPLOYMENT APPLICATION

APPLICANT DATA COLLECTION FORM

Mission Linen Supply is a Federal Contractor, and the law requires employers to request information from each job applicant concerning the applicant's race, sex, national origin, and the job for which the applicant is applying. This form is used to provide each applicant with an opportunity to furnish such information voluntarily. Accordingly, if you decide not to provide the information, your decision will not be held against you. All information that is provided will be used for record-keeping purposes only and will be kept separate from an employee's main personnel file. Furthermore, such information will not be used for any discriminatory purpose. If you wish to provide this information, please do the following: 1. Enter the date and position applying for 2. Check the applicable boxes

This form will not be kept with your employment application

YOUR NAME:

KELLY WILSON INTERNET

MALE

FEMALE

TODAYS DATE:

POSITION APPLIED FOR:

10-19-2010

LAUNDRY TECHNICIAN

HOW DID YOU HEAR ABOUT THIS JOB?

Race/Ethnic Group: Native American Indian Black / African American Asian Pacific Islander Hispanic/Latino White Other (Please specify) Two or more races

DO NOT ATTACH TO THE EMPLOYMENT APPLICATION

CALIFORNIA RESIDENTS ONLY

NOTIFICATION TO APPLICANT OR EMPLOYEE THAT A CONSUMER REPORT MAY BE OBTAINED In compliance with the Federal Fair Credit Reporting Act (15 USC 1681 et seq) and the California Consumer Credit Reporting Agencies Act (Civil Code Section 1786, as amended September 2002) this notice is to inform you that Mission Linen Supply may obtain a consumer report, investigative consumer report, or other investigative reports in connection with your application for employment and for other employment-related reasons, including investigations of character, general reputation, personal characteristics and mode of living. This report is being compiled by SafeCare Information Services, 315 Meigs Rd. Suite H, Santa Barbara, CA 93109, Phone: 805-8841022. You are entitled to receive a copy of any consumer report, investigative consumer report, or other investigative report obtained as a result of your signed authorization within three (3) business days or its receipt by the employer from a Credit Reporting Agency (CRA). You must check the box below and provide your mailing address in order to receive a copy. You are entitled to receive a copy of any background reports based on a public records search including, but not limited to, records of criminal or civil court proceedings, bankruptcy proceedings, or other similar records. I hereby waive my right to receive copies of any and all reports that contain consumer and/or investigative information about me and are obtained by the Employer in connection with this Application for Employment. I hereby request copies of any and all reports that contain consumer and/or investigative information about me and are obtained by the Employer in connection with this Application for Employment.

Applicants address to which copies of consumer reports and other investigative reports should be mailed:

1177 FLEMING DRIVE, ROSEVILLE, CA 95747

DO NOT ATTACH TO THE EMPLOYMENT APPLICATION

CALIFORNIA RESIDENTS ONLY

Summary of Title 1.6A. Investigative Consumer Reporting Agencies Article 2. Obligations of Investigative Consumer Reporting Agencies California Civil Code 1786.22 (a) An investigative consumer-reporting agency shall supply files and information required under Section 1786.10 during normal business hours and on reasonable notice. (b) Files maintained on a consumer shall be made available for consumers visual inspection, as follows: (1) In person, if he appears in person and furnishes proper identification. A copy of his file shall also be available to the consumer for a fee not to exceed the actual costs of duplication services provided. (2) By certified mail, if he makes a written request, with proper identification, for copies to be sent to a specified addressee. Investigative consumer reporting agencies complying with requests for certified mailings under this section shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the investigative consumer reporting agencies. (3) A summary of all information contained in files on a consumer and required to be provided by Section 1786.10 shall be provided by telephone, if the consumer has made a written request, with proper identification for telephone disclosure, and the toll charge, if any for the telephone call is prepaid by or charged directly to the consumer. (c) The term proper identification as used in subdivision (b) shall mean that information generally deemed sufficient to identify a person. Such information includes documents such as a valid drivers license, social security account number, military identification card, and credit cards. Only if the consumer is unable to reasonably identify himself with the information described above, may an investigative consumer reporting agency require additional information concerning the consumers employment and personal or family history in order to verify his identity. (d) The investigative consumer reporting agency shall provide trained personnel to explain to the consumer any information furnished him pursuant to Section 1786.10 (e) The investigative consumer-reporting agency shall provide a written explanation of any coded information contained in files maintained on a consumer. The written explanation shall be distributed whenever a file is provided to a consumer for visual inspection as required under Section 1786.22. (f) The consumer shall be permitted to be accompanied by one person of his choosing, who shall furnish reasonable identification. An investigative consumer-reporting agency may require the consumer to furnish a written statement granting permission to the consumer reporting agency to discuss the consumers file in such persons presence.