APPLICATION FOR EMPLOYMENT Sunbelt Natural Foods Distributors Thank you for considering applying for a position with Sunbelt Natural Foods (SNF). We appreciate the time you are giving to complete this application form. It is important that you fully, truthfully and accurately complete this form yourself and indicate the positions(s) for which you wish to be considered. Please be very careful completing the application. We use a detailed background and employment screening process that will disclose inaccurate, false, incomplete and/or omitted information. You must complete every question on this application to be considered. Used the back of the page for any additional information. Position to which you are applying: Date: How were you referred? PERSONAL INFORMATION Name: (required) Telephone Number: (required) Your Email (required) Address: (required) GENERAL EMPLOYEMENT INFORMATION Are you applying for: Full-TimePart-TimeTemporary Days/Hours available to work: Minimum Salary Required? Per Hour: Per Month Would you have a reliable means of transportation to and from work? YesNo Are you at least 18 years old with high school or equivalent degree? YesNo If hired, can you submit verification of your legal right to work in the United States? YesNo Have you ever been terminated or asked to resign? YesNo If yes, please explain circumstances. Have you ever used another name? YesNo Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record? YesNo If yes to either of the above, please explain: EDUCATION, TRAINING AND EXPERIENCE College/University: No. of Years Completed Degree or Diploma Vocational/Business: No. of Years Completed Degree or Diploma High School: No. of Years Completed Degree or Diploma Do you have other experience, training, qualifications or skills you feel make you especially suited for work at Sunbelt Natural Foods? Do you speak, write or understand any foreign language? YesNo If yes, which language(s)? EMPLOYMENT HISTORY (At least two 2 experiences) 1. Name of employer: Type of Business: Supervisor: Date of Employment: From To Responsibilities: Reason for leaving: Termination was: YesNo May we contact? YesNo 2. Name of employer: Type of Business: Supervisor: Date of Employment: From To Responsibilities: Reason for leaving: Termination was: YesNo May we contact? YesNo REFERENCES (At least 2 references) List below three persons not related to you, who have knowledge of your work performance within the last three years. Name: Relationship: Phone: Years Known: Name: Relationship: Phone: Years Known: OTHER INFORMATION Have you been convicted of a criminal offense in the last seven (7) years (felony or misdemeanor)? YesNo If yes, please state the nature of the crime(s), when and where convicted and disposition of the case. (Note: Criminal conviction will not necessarily disqualify an applicant from employment.) Have you ever been convicted for driving under the influence (DUI)? YesNo Do you use alcohol or illegal substance to the extent that it would impair your job performance? YesNo BACKGROUND CHECK AUTHORIZATION The following information is required by law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any other purpose. Full Legal Name: Social Security #: Other Names You Have Used: MaleFemale Driver’s License #: Issuing State: Date of Birth (MM/DD/YY): Address History Street Name: City: State: Zip Code: Street Name: City: State: Zip Code: Street Name: City: State: Zip Code: DISCLOSURE The Company will procure a consumer report and/or investigative consumer report on you in connection with your application. A consumer-reporting agency will obtain the report for the Company. The report may contain information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. The types of information that may be obtained include but are not limited to: credit reports, social security number verification, criminal records checks, public court records checks, driving records checks, educational records checks, verification of employment positions held, personal and professional references check, licensing and certification checks, etc. The information contained in the report will be obtained from private and/or public record sources, including sources identified by you or through interviews or correspondence with your past or present coworkers, neighbors, friends, associates, current or former employers, educational institutions or other acquaintances. The nature and scope of any investigative consumer reports that may be requested is explained above. You are none the less entitled to request more information about the nature and scope of such reports by submitting a written request to the Compliance Department of the consumer reporting agency. The Company is furnishing you with a summary of your rights under the Fair Credit Reporting Act in a form prescribed by the Federal Trade Commission. California Residents or Employees: You may view the file maintained on you by the consumer reporting agency. You may also obtain a copy of this file upon submitting proper identification and paying the costs of duplication services, by appearing at the consumer reporting agency office in person, during normal business hours and on reasonable notice, or by mail; you may also receive a summary of the file by telephone. The consumer reporting agency has trained personnel available to explain your file to you, including any coded information. If you appear in person, you may be accompanied by one other person, provided that person furnishes proper identification. AUTHORIZATION I have carefully read and understand the Background Check Authorization form. By my signature below, I consent to the release of consumer reports and investigative consumer reports prepared by a consumer reporting agency to the Company. I understand that if the Company hires me, my consent will apply throughout my employment unless I revoke or cancel it by sending a signed letter to the Compliance Department of the consumer reporting agency. I understand that, to the extent allowed by law, information contained in my job application or otherwise disclosed by me before, during or after my employment, if any, maybe utilized for the purposes of obtaining consumer reports or investigative consumer reports. By my signature below, I also authorize the disclosure of information concerning my employment history, earnings history, education, credit history, credit capacity and credit standing, motor vehicle history and standing, criminal history, and all other information deemed pertinent by the consumer reporting agency to the agency by the following: past or present employers; learning institutions, including colleges and universities; law enforcement agencies; federal, state and local courts; the military; credit bureaus; and motor vehicle records agencies. For residents of or for jobs located in California, Minnesota and Oklahoma only: You will be provided with a free copy of any consumer reports or investigative consumer reports if you check the box below. You may obtain information or copies from the Company’s investigative report file at any time prior to your receipt of such copies, to the extent available, by contacting the Compliance Department. I request a copy of the report. Signature of Applicant: Date: HONESTLY AND ACCURATELY COMPLETED FORM By my signature below, I promise that I have personally completed this application. I declare under penalty of perjury that the information provided in this employment application (and accompanying resume, if any) is true and complete. I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment, if discovered at a later date. I agree to notify the Company immediately if I should be convicted of a crime while my job application is pending, or, if hired, during my employment. AUTHORIZATION TO OBTAIN INFORMATION I voluntarily and knowingly authorize the investigation of all statements contained in this application (and accompanying resume, if any). I further authorize any present of past employer to supervisor; college or university or other institution of learning; administrator, law enforcement agency, state agency, local agency, federal agency, finance bureau/office; credit bureau; investigative consumer reporting agency, collection agency; private business; military branch or the national personnel records center; personal reference; and/or other persons to give records or information they may have concerning my criminal history, motor vehicle history, social security number, earnings history, credit history, character and employment (including reasons for termination) or any other information requested by SNF. OTHER EMPLOYMENT I understand that, if hired, I will not hold other employment or engage in other activities that create a conflict of interest with my position with SNF unless I have been given written permission by SNF. RELEASE I voluntarily, knowingly and unconditionally release any and all named or unnamed informant (persons and organizations) from any and all liability resulting from furnishing information or opinion pertinent to this application (which is truthful or made in good faith). I further hereby voluntarily waive all recourse and release SNF and its representatives, directors, officers, employees, agents, affiliates, or successors from any and all lability regarding the use of information supplied. I hereby release SNF, including any individual participant in any drug and alcohol examination and any third party from potential liability arising out of any examination. COMPLIANCE WITH RULES If I become employed, in consideration of my employment, I agree to comply with the rules, regulations, policies and procedures of SNF. AGREEMENT FOR AT-WILL EMPLOYMENT In keeping with the at-will employment relationship, I understand and hereby agree that SNF and I each have the right to terminate my employment at any time, with or without cause and with or without notice. In addition, SNF reserves the right to change any terms and conditions of my employment, including but not limited to my hours, duties, wages, benefits and working conditions at any time, in its sole discretion, and with or without cause or notice. I understand and agree that no manager, supervisor or representative of SNF has authority to enter in any agreement, express or implied, for employment for any specific period of time, or make any agreement for employment other than at-will. I understand and agree that no statement in this Application or other representation creates or is intended to create a promise or representation of continued employment. SIGNATURE: PRINT NAME: DATE: NOTICE: Thank you for completing this application form. This Application is not an offer of employment or an employment contract. If there is a current opening in the position(s) you are seeking and the information in your application suggest you meet qualifications and are among the best qualified candidates for that position, you may be contacted for an interview. If you are interviewed, you will be informed of a final decision once the entire interview process is completed, which may include a background check and pre-employment drug test. If there is no opening in the position(s) you are seeking, your application will be kept active for six months. Thank you for your interest in Sunbelt Natural Foods Dist, LLC. SNF: is an equal opportunity employer. It is SNF’s policy to consider all job applications on the basis of merit without regard to race, color, religion, sex, pregnancy, age, national origin, ancestry, marital status, veteran status, disability, medical condition, sexual orientation, or any other protected characteristic.