Send Resume to Uranerz Energy
APPLICANT INFORMATION
Last Name: First M.I. Date
Street Address Apartment/Unit #
City Prov / State Postal / Zip
Phone Email
Date Available Social Security No.
Desired Salary
Position Applied for
Are you a citizen of the United States? YES NO
If no, are you authorized to work in the U.S.? YES NO
Have you ever worked for this company? YES NO
If so, when?
EDUCATION
High School
City & State
Dates Attended:
Did you graduate? YES NO
College
City & State
Dates Attended:
Did you graduate? YES NO
Program/Degree
Other/Additional Education
City & State
Dates Attended:
Did you graduate? YES NO
Program/Degree
REFERENCES

Please list three professional references.
Full Name Relationship
Company Phone
Address
Full Name Relationship
Company Phone
Address
Full Name Relationship
Company Phone
Address
PREVIOUS EMPLOYMENT
Company Phone
Address Supervisor
Job Title Starting Salary Ending Salary
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone
Address Supervisor
Job Title Starting Salary Ending Salary
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone
Address Supervisor
Job Title Starting Salary Ending Salary
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
MILITARY SERVICE
Branch From To
Rank at Discharge Type of Discharge
If other than honorable, explain
DISCLAIMER
I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Please read carefully, check each paragraph and submit at the bottom of the page.
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize Uranerz Energy Corporation to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, I authorize the references I have listed to disclose to Uranerz Energy Corporation all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Uranerz Energy Corporation, my former employers and other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
I understand that nothing contained in the application or conveyed during any interview, which may be granted or during my employment, if hired, is intended to create an employment contract between the Company and me. In addition, I understand and agree that if I am employed, my employment is at will and is for no definite or determinable period and may be terminated at any time, with or without prior notice, or with or without cause, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the company's designated representative.
I understand that in connection with my application for employment, the Company may obtain a consumer report and/or investigate consumer reports about me that may contain information as to my character, general reputation, personal characteristics, and mode of living. Such reports may include or consist of my driving history obtained from the Department of Motor Vehicles. I further understand that any job offer extended by the Company is contingent upon receipt of a favorable consumer or investigative consumer report about me.
I understand that in connection with my application for employment, depending upon the position for which I have applied, any offer of employment is conditioned upon my taking and passing a post-offer/pre-employment drug test and, if necessary for the position for which I have applied, a post-offer/pre-employment medical examination. I understand that I may refuse to take any required pre-employment drug test and/or medical examination, but that if I do, any offer of employment will be immediately withdrawn.
I HAVE READ THE ABOVE PARAGRAPHS, UNDERSTAND THEIR IMPORTANCE AND EFFECT UPON MY EMPLOYMENT, AND ACCEPT SAME AS CONDITIONS OF MY EMPLOYMENT WITH COMPANY.
This application, when completed and signed, becomes the property of Company.
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