Authorization and Acknowledgements I affirm that the information I have provided in this application is true to the best of my knowledge, information, and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is a ground for rejection of my application, and if hired is grounds for discharge. This is true of information provided during the interview process as well. This application is valid for 30 days, after that time I must reapply for consideration.

I authorize Coalfield Development to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.

I understand, that as a final candidate for hiring by Coalfield Development, I will receive a conditional offer for employment based, in part, on my consent and voluntary submission to a drug test. If I refuse to take that test or test positive, I will not qualify for employment and any employment offer extended will be withdrawn. If I am hired, I understand that either Coalfield Development or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Coalfield Development has the authority to make any assurance to the contrary.

Once employed I will be provided with the company policies and understand it is my obligation to obey and stay up to date on policies that include but not limited to the Personnel Manual, Drug Free Workplace Program, Safety & Health policy, program guidelines and financial policies.

“Coalfield participates in Policy Analysis Exercises through some universities and our trainings that includes a review of employee data provided by the employee to Coalfield. These studies are conducted pursuant to data confidentiality provisions but may include data such as employee birth dates, training and coaching documentation, and employee submitted doctor’s appointment notifications. As a condition of any employment with Coalfield, the undersigned acknowledges and consents to this limited disclosure of such employee information in strict compliance with the confidentiality provisions of the Policy Analysis Exercises.”