COMING SOON!!   Medlin Equipment Company Employment Application Please Fill Out the Form Below: Personal Information *First Name:      Middle Initial:    *Last Name:   Current Address:   City:   Zip: Permanent Address:   City:   Zip: Social Security Number: Phone: Email: Are you 18 Years of age or older? Yes No Are you a U.S. citizien or Alien authorized to work in the U.S.? Yes No Special Questions It is optional to answer any of the questions UNLESS the employer has specifically placed an check (X) preceding a question. If the question has been checked it is required by the employer for benefits purposes, or, is permitted by law.     (X)  Date of Birth:     (  )  Have you been convicted of a felony within the last five years? Yes No           If YES, please describe briefly:            I understand that I may be required to take one or more: 1). Physical Exam, 2). Lie detector test, 3). Drug testing.     (  )  (Any testing requirement(s) will be as established by and in compliance with State and/or Federal law, and, other than as legally            prescribed, will nt be a basis for denial of employment, except as allowed by law.)      (  )  I have been advised that lie detector tests, as a condition of hiring or continued employment are prohibited by law. Yes No        *The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age, with respect to individuals who are at least 40 but less than 70 years of age. Employment Desired      Position:       Date You Can Start:       Salary Desired:       Currently Employed: Yes No      If "YES" may we contact your employer? Yes No Education Name & Location of School No. Years Attended Did You Graduate Subjects Studied Elementary School: Yes No High School: Yes No College/University: Yes No Trade Business Correspondence: Yes No

Medlin Equipment Co.   |   2000 Outer Road   Charleston, MO   63834   |   101 County Line Road   Sikeston, MO   63801