D&H DISTRIBUTING COMPANY APPLICATION FOR EMPLOYMENT D&H is an Equal Opportunity Employer

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1 D&H DISTRIBUTING COMPANY APPLICATION FOR EMPLOYMENT D&H is an Equal Opportunity Employer Name: Last First M.I. Date (Street) ( ) Daytime Phone No. City State Zip Cell Phone No. address Have you previously applied to this company (if yes, list date(s) & location(s)) Position Applying for: Date Available to start Desired Pay Full Time Part Time Seasonal Flexible Days Available Hours / Shift Yes No Yes No Yes No Yes No S M T W Th F S Are you legally able to work in the U.S.? Yes No How did you learn of our company? Newspaper TV Radio Job Fair Referral - List Name(s) Internet (list site): CareerBuilder Craig s List D & H Indeed Linkedin Pennlive Other - List COMPLETE THIS SECTION IF YOU HAVE SERVED IN THE MILITARY Branch of service Dates of duty Rank at discharge Discharge date Special Skills or Training EDUCATION Name & City / State of school Course of study Last year Graduated Degree or Completed diploma High College Trade Other

2 EMPLOYMENT HISTORY Page 2 Start with current employer See Resume is not acceptable 1. Company Dates of employment 2. Company Dates of employment 3. Company Dates of employment 4. Company Dates of employment

3 UNEMPLOYMENT RECORD Page 3 Account for all periods of unemployment of one-month duration or more. From To State what you were doing CRIMINAL BACKGROUND During the past five (5) years, have you ever been convicted of, plead no contest (nolo contendere) or plead guilty to any crime, including DUI or DWI, which has not been pardoned, had the record sealed or expunged? (Do not disclose any convictions which have been sealed or expunged). No Yes - If yes, give date of conviction, the location (city, county, state) of the court in which you were convicted, and a description of the crime; state if you were fined, imprisoned, or placed on probation. Note: Convictions are not an automatic bar to employment, all circumstances will be considered. List names of friends or relatives working with us: What machines can you operate? Have you ever been discharged or asked to resign from a job? No Yes If yes, describe. May we communicate with your current employer? No Yes. Please provide name and number of contact: PROFESSIONAL REFERENCES Name Telephone Number (s) Yrs. known Accuracy of Information 1. I certify that the facts set forth in the above Employment Application are true and complete to the best of my knowledge. I understand that any false or misleading statements on this Application, or any omissions of fact will result in my disqualification for hire or for dismissal in the event I am hired. Employment at Will 2. I understand and agree that, if employed, I will conform my conduct to D&H s rules and regulations. I also understand that I have the right to terminate my employment at any time for any reason and that D&H has the same right.

4 Protection of Information 3. I understand that in the event I become employed by D&H Distributing, D&H may disclose to me, or I may have access to: confidential business information, including but not limited to sales reports, customer lists, price sheets, financial data, strategic plans, salary information, personnel information, trade secrets, and the like (thereinafter collectively referred to as confidential business information ). I agree that D&H is the exclusive owner of such confidential business information. I agree that I will only communicate confidential business information to other employees of D&H on a need-to-know basis: that neither during my employment with D&H nor at any time after the termination of my employment, shall I, directly or indirectly, use for myself or another, or disclose to another, any confidential business information of D&H except if such disclosure or use is required in connection with my employment with D&H or is consented to in writing by D&H. I agree that upon the request of D&H at any time, including after the termination of my employment, I shall promptly deliver to D&H, without retaining any copies, all notes, memoranda, journals, notebooks, records, photographs, photocopies, recordings, film, videotapes and any other instrument or device which, through which, or on which confidential business information has been recorded or preserved and which have been or are in my possession, custody or control. I understand that this information must remain confidential for the entire time that I work for D&H, and for two years thereafter. I agree that in the event of such use or disclosure, not only may D&H ask a court to impose damages against me but also agree to the issuance of a permanent injunction against me restraining such disclosure and use. Responsibility for Company Property 4. I further understand that I am responsible for Company Property issued to me. I understand that I am to exercise care in the use of this Company Property and to use such property only for authorized purposes. Should this Company Property be lost, stolen, damaged or destroyed for whatever reason, and the company determines that I am at fault, I agree that I will owe the value of this property to D&H and that D&H may deduct that value of this property from any money due me at any time while employed by D&H or following the termination of my employment. In addition, if D&H advances money to me for travel expenses, or for other authorized petty cash expenses, etc. and I do not submit necessary documentation to substantiate these advances, I agree that D&H may deduct the advances from any money due me by D&H following the termination of my employment. If D&H issues me an employee loan, I agree that the balance will be deducted from any money due me by D&H following the termination of my employment. In the event of my termination, all Company Property will be returned to D&H. In the event that I do not return this Company Property, or I have not submitted the proper documentation to substantiate any advance, I agree that the value of this Company Property or the advance, may be deducted from any money due me at the time of my termination or due to me in the future such as bonuses, commissions, or spiffs. In the event that the money I owe D&H exceeds the amount of money that D&H deducts from the money due me, I agree (upon demand of D&H) to promptly pay the difference to D&H. If I do not promptly pay the difference, I agree that D&H may bring lawsuit against me for the difference, and I authorize the court to enter a judgment against me. Legal Action Possible 5. In the event I do not comply with the promises I made in paragraphs (3) and (4) above and D&H brings a lawsuit against me to enforce these promises, I agree to pay all costs incurred by D&H to enforce paragraphs (3) and (4) above including but not limited to reasonable attorney s fees. I also agree that any court of competent jurisdiction selected by D&H shall have personal jurisdiction over me. Finally, I understand and agree that the provisions of this paragraph shall continue in full force and effect after the termination of my employment with D&H for whatever reason. Life of this Application 6. This application is current for 60 days. At the conclusion of this time, if I have not heard from D&H and still wish to be considered for employment, it will be necessary for me to fill out a new application. Date Signature

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