NOTE TO APPLICANTS: Smoking is prohibited in all indoor areas of Bentwater POA unless designated smoking areas have been established by a particular location in accordance with the applicable state and local law. NOTE TO RHODE ISLAND APPLICANTS: Bentwater POA is subject to Chapters 29-38 of Title 28 of the General Laws of Rhode Island, and is therefore covered by the state’s workers’ compensation law.

BEFORE Answering the following questions, please read the State Specific Instructions Below if you reside in, or are applying for a position in, California, Connecticut, District of Columbia, Georgia, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Missouri (Columbia), Nebraska, Nevada, New York, New Jersey, Ohio, Oregon, Pennsylvania, Rhode Island, Texas (Austin), or Washington.

Please note that you do NOT have to identify a record of any adult or juvenile arrest, detention or conviction that has been sealed, expunged, annulled, erased, pardoned or statutorily eradicated, set aside or otherwise dismissed by court order. Please note that answering “Yes” to this question will not automatically bar you from employment. Only those crimes which are substantially related to the position you are seeking will be considered.

*** California Applicants: Do not identify any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been dismissed by a court. Also, do not identify the following marijuana-related convictions entered by the court more than 2 years ago: an infraction for unlawful possession of marijuana or a misdemeanor conviction for: (a) transportation or giving away of up to 28.5 grams of marijuana, other than concentrated cannabis or the offering to transport or give away up to 28.5 grams of marijuana, other than concentrated cannabis; (b) possession of paraphernalia used to smoke marijuana; (c) being in a place with knowledge that marijuana was being used; or (d) being under the influence of marijuana. Also, do not identify any arrest or detention that did not result in a conviction or any record of a referral to, and participation in, any pretrial or post-trial diversion program. San Francisco, California Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will be asked to answer criminal history questions at a later point in the hiring process. At that time you will not have to identify any information precluded by California state law or any information relating to: (1) a conviction that has been judicially dismissed, expunged, voided, invalidated, or otherwise rendered inoperative (for example, under California Penal Code sections 1203.4, 1203.4a, or 1203.41); (2) a conviction or any other determination or adjudication in the juvenile justice system, or a matter considered in or processed through the juvenile justice system; (3) a conviction for which more than seven years has passed since the date of sentencing; or (4) an offense other than a felony or misdemeanor, such as an infraction.

Connecticut Applicants: Do not identify any arrest, criminal charge or conviction the records of which have been erased by a court based on sections 46b-146, 54- 760 or 54-142a of the Connecticut General Statutes. Criminal records subject to erasure under these sections are records concerning a finding of delinquency or the fact that a child was a member of a family with service needs, an adjudication as a youthful offender, a criminal charge that has been dismissed or not prosecuted, a criminal charge for which the person was found not guilty, or a conviction for which the offender received an absolute pardon. Any person whose criminal records have been judicially erased under one or more of these sections is deemed to have never been arrested within the meaning of the law as it applies to the particular proceedings that have been erased, and may so swear under oath.

*** District of Columbia Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer these questions if you receive a conditional offer of employment. At that time, you will not have to identify any arrest or criminal accusation that is not pending against you or did not result in a conviction. *** Georgia Applicants: Do not identify any verdict or plea of guilty or nolo contendere that was discharged by the court under Georgia’s First Offender Act. ***Hawaii Applicants: DO NOT RESPOND TO THE QUESTION SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer these questions if you receive a conditional offer of employment. At that time you will be asked whether you have been convicted of a crime within the past 10 years, excluding any period of time when you were incarcerated.

*** Illinois Applicants: DO NOT RESPOND TO THE QUESTION SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer these questions if the Company determines that you are qualified for the position for which you are applying and notifies you that you have been selected for an interview, or if you are extended a conditional offer of employment. *** Maryland Applicants: Baltimore, Maryland Applicants: DO NOT RESPOND TO THE QUESTION SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions if you receive a conditional offer of employment. Montgomery County or Prince George’s County, *** Maryland Applicants: DO NOT RESPOND TO THE QUESTION SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions after an initial job interview or if you receive a conditional offer of employment. *** Massachusetts Applicants: Under Massachusetts law, an employer is prohibited from requesting criminal history information on an initial written application. DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will be asked to answer criminal history questions at a later point in the hiring process. At that time you will not have to identify any record relating to prior arrests, criminal court appearances or convictions for which the record has been sealed and is on file with the Commissioner of Probation. You also will not have to identify prior arrests, court appearances and adjudications in cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution. You also will not have to identify (1) an arrest, detention or disposition regarding any violation of law in which no conviction resulted; (2) first-time misdemeanor convictions for drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace; and (3) convictions for other misdemeanors where the date of conviction or the end of any period of incarceration was more than 5 years ago, unless there have been subsequent convictions within those 5 years. *** Michigan Applicants: Do not identify any misdemeanor arrests, detentions or dispositions that did not result in conviction. *** Minnesota Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions if you receive a job interview or a conditional offer of employment.

*** Missouri Applicants: Columbia, Missouri Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions if you receive a conditional offer of employment. *** Nebraska Applicants: Do not identify a sealed juvenile record of arrest, custody, complaint, disposition, diversion, adjudication or sentence. *** Nevada Applicants: You must disclose all felony convictions, but may limit disclosure of misdemeanor convictions to those that occurred within the last seven years and resulted in imprisonment. Please note that the discharge and dismissal of certain first time drug offenses, after the accused has completed probation and any required treatment or educational programs, does not constitute a “conviction” for purposes of employment. *** New Jersey Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions after the initial application process, including any interview, has concluded. *** New York Applicants: You may answer “no record” concerning any criminal proceeding that terminated in your favor, per section 160.50 of the New York Criminal Procedure Law; any criminal proceeding that terminated in a “youthful offender adjudication,” as defined in section 720.35 of the New York Criminal Procedure Law; any conviction for a “violation” that already has been sealed by the court, per section 160.55 of the New York Criminal Procedure Law; and any conviction that was sealed pursuant to section 160.58 of the New York Criminal Procedure Law. Buffalo, New York Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions if you receive a job interview or a conditional offer of employment. Rochester, New York Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions after an initial job interview or if you receive a conditional offer of employment. New York City, New York Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions if you receive a conditional offer of employment.

*** Ohio Applicants: Do not report any arrest or conviction for a minor misdemeanor drug violation as defined under Ohio Rev. Code 2925.11. *** Oregon Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions after an initial interview or a conditional offer of employment. Portland, Oregon Appljcants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions if you receive a conditional offer of employment. At that time, you will not have to identify (1) an arrest not leading to a conviction, except where a crime is unresolved or charges are pending against you, (2) convictions that have been judicially voided or expunged, or (3) charges that have been resolved through the completion of a diversion or deferral of judgment program for offenses not involving physical harm or attempted physical harm to a person. Pennsylvania Applicants: Do not identify convictions for summary offenses. *** Rhode Island Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history question at an initial job interview or thereafter. *** Texas Applicants: Austin, Texas applicants Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer these questions if you receive a conditional offer of employment. *** Washington Applicants: Do not identify any conviction entered by the court more than 10 years ago unless some period of incarceration resulting from that conviction took place within the last ten years. Seattle, Washington Applicants: DO NOT REPSOND TO THE QUESTONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer these questions after an initial screen.

Please specify your complete full-time and part-time employment history, including self-employment. You may include verifiable work performed on a volunteer basis. Starting with your most recent employer, provide the following information.

Starting with your most recent school attended, provide the following information:

List name and telephone number of three references who are NOT related to you. Business or work references preferred.

*** Massachusetts Applicants: I understand that it is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. *** Maryland Applicants: I understand that under Maryland Law, an employer may not require or demand, as a condition of employment, prospective employment or continued employment, that any individual submit to or take a polygraph or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100.