ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK

By signing below you hereby authorize the obtaining of consumer reports by the Company any time after receipt of this authorization and throughout the course of your employment. You understand that the scope of your authorization is not limited to the present and, if you are hired, will continue throughout the course of your employment and allow the Company to conduct future screenings for retention, promotion or reassignment, as permitted by law and unless revoked by you in writing.

By signing below you authorize the obtaining of consumer reports by the Company at any time after receipt of this authorization. To this end, you authorize any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information about you requested by Yardstik, Inc. 4600 West 77th ST. Suite 200, Minneapolis, MN 55435 and/or the Company.

STATE LAW NOTICES AND DISCLOSURES – BACKGROUND INVESTIGATION

The following disclosures are being provided pursuant to state law.

MINNESOTA and OKLAHOMA: If you are a resident of Minnesota or Oklahoma, or applying for employment in one of these states, please check the box if you would like to receive a copy of your consumer report, free of charge, if one is obtained by the Company.

MINNESOTA: If you are a Minnesota resident or applying for employment at a location within Minnesota, you have the right to submit a written request to Yardstik, Inc. 4600 West 77th Street, Suite 200, Edina, MN 55435, for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The consumer reporting agency must provide you with this disclosure within five business days after its receipt of your request or the report was requested by the Company, whichever date is later.

NEW JERSEY: If you are a New Jersey resident or applying for employment at a location within New Jersey, by signing below you acknowledge receipt of the New Jersey Fair Credit Reporting Act provisions.

New Jersey Fair Credit Reporting Act

NEW YORK: If you are a New York resident or applying for employment at a location within New York, you have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting Yardstik, Inc. 4600 West 77th Street, Suite 200, Edina, MN 55435 Phone: 888-278-5042.

NEW YORK: If you are a New York resident or applying for employment at a location within New York, by signing below you acknowledge receipt of a copy of the New York Correction Law.

New York 23-A

RHODE ISLAND: If you are a resident of Rhode Island or applying for employment at a location within Rhode Island, the Company may request a credit report from a consumer reporting agency in connection with your application for employment.

VERMONT: If you are a Vermont resident or applying for employment at a location within Vermont, by signing below you acknowledge receipt of the NOTICE – BACKGROUND INVESTIGATION AND USE OF CREDIT INFORMATION.

Vermont Credit 21 V.S.A. 495i

WASHINGTON STATE: If you are a Washington resident or applying for employment at a location within Washington State, you have the right to request from Yardstik, Inc. 4600 West 77th St. Suite 700, Edina, MN 55435 [888-278-5042] a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.

Washington State Resident FCRA

For WASHINGTON DRIVERS: You are authorizing the release of an abstract of your full driving report to an employer or prospective employer. The party requesting this record has authorized Safety Holdings, Inc. to obtain this record on the party’s behalf. Any information contained in the abstract related to an adjudication that is subject to a court order sealing the juvenile record of an employee or prospective employee may not be used by the employer or prospective employer, or an agent authorized to obtain this information on their behalf, unless required by federal regulation or law.

By signing below, the party requesting this record certifies through its authorized representative that the information is necessary for employment purposes related to driving by the individual as a condition of employment or otherwise at the direction of the employer.