To the best of my knowledge, I have truthfully disclosed all information asked for in this application.

I authorize contact with any person or entity named in this application and any other person or entity who may have knowledge concerning my past for the purpose of obtaining information material to my qualifications and suitability for employment.

I authorize all those with whom I am acquainted - previous employers, physicians, professionals, institutions, neighbors, friends, agencies asked to provide criminal conviction history and others - to furnish any and all information they may have concerning me which may be material to my qualifications and suitability for the job for which I have applied.

I understand and agree that nothing in this application is intended to imply or create an employment relationship or contract of employment. I also understand and agree that, if hired, my employment is for no definite period and may, regardless of date of payment of my wages, be terminated at any time at the sole discretion of the company or by me with or without prior notice, with or without reason. I acknowledge that no representative of the company other than a designated executive officer can enter into any agreement to the contrary. I also understand that any employment with the company will require me to observe company rules, policies and procedures which I realize may be changed at any time without notice. I hereby fully release the company, its agents and any person or entity that provides or receives information pursuant to this Affidavit from any and all liability and any damage which may arise there from.

This application will be kept under active consideration for thirty (30) days from the date of application shown below.

*Applicant Signature Date: Thursday, November 20, 2008

HSI is an equal opportunity, affirmative action, and drug free employer. No question on this application is asked for the purpose of excluding any applicant's consideration for employment because of race, color, religion, sex, age, national origin, veteran's status or disability or any other status protected by state and federal law.

In an effort to comply with government record keeping requirements, we ask that you VOLUNTARILY complete this form. The U.S. government is empowered to require employers to report the number of their applicants and employees in the racial, ethnic and veteran groups listed below. While employers are permitted to determine the group identification listed below by visual survey, we believe that in order to avoid mistakes and misunderstanding, every applicant should have the opportunity to answer the questions personally.

This information will only be used for reporting to governmental agencies. It will not be used in determining eligibility for employment and will be kept separate from the application form.