Thank you for your consideration,
Holsum Bakery Inc.

There is a required $50.00 non-refundable application fee, payable to initiate the review process. This fee covers processing and screening costs.

EMPLOYER I
Date Employed
From:  *	To:  *
Employer:	*
Address:	*
Telephone:	--  *
Last Position held:	*
Salary:
Start:  *	Final:  *
Supervisor:	*
Work Performed:	*
Reason for Leaving:	*
may we contact this employer? Y N

EMPLOYER II
Date Employed
From:	To:
Employer:
Address:
Telephone:	--
Last Position:
Salary
Start:	Final:
Supervisor:
Work Performed:
Reason for Leaving:
may we contact this employer? Y N

EMPLOYER III
Date Employed
From:	To:
Employer:
Address:
Telephone:	--
Last Position:
Salary
Start:	Final:
Supervisor:
Worked Performed:
Reason for Leaving:
may we contact this employer? Y N

MOTIVATION

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In the box below, please type a short paragraph or two on why you want to become an Independent Distributor of Holsum Bakery products. Be specific and candid so that your interviewer will understand your strengths and inexperience relating to this type of career. There are no right or wrong answers.

TERMS AND CONDITIONS

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I hereby authorize any firm, government agency, person, former employer or investigative agency to furnish HOLSUM BAKERY, INC., (“HOLSUM”) an Arizona corporation, with any records or information they may have regarding my employment history, military history, school history, motor vehicle records, criminal history, credit and any civil and criminal suits. I further do release such firms, government agencies, persons, past employers or investigative agencies from all liability whatsoever for issuing such information to HOLSUM. By my signature below, I affirm that the information herein is correct and true, and further understand that any fraudulent statement or misrepresentation may disqualify my application as well as provide cause now or in the future for such legal remedies as afforded to HOLSUM.

CREDIT APPLICATION FOR HOLSUM BAKERY, INC.

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TERMS OF SALE: Net Seven (7) Days

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The signer(s) hereby authorize(s) Holsum Bakery Inc. to utilize a consumer credit report on the signer(s) in connection with the Distributor Application Process. The signer(s) as individuals hereby knowingly consent to the use of such credit report consistent with the Federal Fair Credit Reporting Act as contained in 15 U.S.C. @ 1681 et seq...

* Signature box

* Spouse Signature box

APPLICANT DRUG SCREEN CONSENT AND RELEASE

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The undersigned applicant hereby authorizes Holsum Bakery, Inc. (herein "Company") to conduct through its designated physician, medical facility or laboratory testing facility, a drug screening test as a requirement of being considered for distributorship. In applying for a distributorship with the Company, I understand that a urine drug screening test will be administered as part of the application process to determine the presence of illegal drugs, controlled substances, and unauthorized prescription drugs. I further understand that the presence of any of thee drugs or substances will cause my rejection from further consideration for distributorship. I agree that test results provided by the Company-approved physicians or testing laboratories shall be conclusive and final, and that test results provided by physicians or testing laboratories not approved by the Company will not be accepted or considered valid. I understand that refusal to submit to the drug screening test will constitute voluntary withdrawal of my application for distributorship. I authorize the results of this urine drug screen test to be given to the Company or any of its agents. I release and hold the Company designated physician, testing laboratory and medical facility harmless for release of this information. I also release and hold harmless the Company, its directors, officers, stockholders and employees for the use of this information for the purpose of evaluating my application for distributorship.