Ben Arnold Beverage Company Ridgeway _____ 101 Beverage Blvd Charleston _____ Ridgeway, SC 29130 Greenville _____ (803) 337-3500 Myrtle Beach _____ Hilton Head _____

DRIVER APPLICATION FOR EMPLOYMENT

THE BEN ARNOLD BEVERAGE COMPANY, L.P. IS AN EQUAL OPPORTUNITY EMPLOYER AND WE ACTIVELY

SUPPORT ALL APPLICABLE FEDERAL, STATE AND LOCAL LAWS PROHIBITING ALL FORMS OF

DISCRIMINATION IN EMPLOYMENT. ADDITIONALLY, WE HAVE A ZERO TOLERANCE POLICY FOR ALL FORMS

OF HARASSMENT. I. POSITION APPLIED FOR: SALARY DESIRED:

II. PERSONAL HISTORY (PLEASE PRINT ALL RESPONSES) LAST NAME FIRST NAME MIDDLE SOCIAL SECURITY NUMBER

PRESENT STREET ADDRESS ARE YOU OVER 18 YEARS OF AGE? YES NO

CITY HOW DID YOU FIND OUT ABOUT THIS POSITION:

STATE ZIP/POSTAL CODE TELEPHONE NUMBER ( )

II. PERSONAL HISTORY (CONTINUED) HAVE YOU EVER BEEN EMPLOYED UNDER ANY OTHER NAME? YES NO IF YES, PLEASE PROVIDE OTHER NAME: ARE YOU RELATED TO ANYONE AT THIS COMPANY? YES NO IF YES, PLEASE PROVIDE DETAILS: HAVE YOU EVER APPLIED FOR A POSITION WITH THIS COMPANY PREVIOUSLY? YES NO IF YES, WHEN AND FOR WHAT POSITION? HAVE YOU EVER BEEN EMPLOYED BY THIS COMPANY? YES NO IF YES, PLEASE EXPLAIN: ARE YOU EITHER A UNITED STATES CITIZEN OR AN ALIEN WHO IS AUTORIZED TO WORK IN THE U.S.? YES NO PLEASE NOTE: AS A CONDITION OF EMPLOYMENT, YOU MUST COMPLETE AN I-9 FORM REQUIRED BY THE IMMIGRATION AND NATURALIZATION SERVICE NO MORE THAN THREE (3) BUSINESS DAYS AFTER YOUR HIRE DATE. HAVE YOU EVER BEEN CONVICTED OF A CRIME? (MISDEMEANOR OR FELONY) YES NO A CRIMINAL CONVICTION WILL NOT NECESSARILY BE A BAR FROM EMPLOYMENT. TO HELP EVALUATE YOUR APPLICATION, PLEASE DESCRIBE THE NATURE OF THE CRIME AND YOUR SUBSEQUENT REHABILITATION. __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ III. TO BE COMPLETED ONLY FOR POSITIONS REQUIRING THE USE OF MOTOR VEHICLES

Do You Have A Valid Driver’s License For This State? Yes NO EXPIRATION DATE LICENSE # List All Moving Violation Convictions You Received Within The Past 3 Years?

HAVE YOU BEEN CONVICTED OF DRIVING WHILE INTOXICATED OR HAD YOUR LICENSE SUSPENDED OR REVOKED WITHIN THE PAST 3 YEARS? IF YES, EXPLAIN BELOW. YES NO

IV. EDUCATIONAL HISTORY

NAME OF SCHOOL

ADDRESS DID YOU

GRADUATE? GRADE POINT

AVERAGE COURSE OF STUDY

HIGH SCHOOL

YES NO

COLLEGE

YES NO

GRADUATE

YES NO

OTHER

YES NO

V. PROFESSIONAL REFERENCES

NAME & OCCUPATION ADDRESS TELEPHONE NUMBER RELATIONSHIP TO YOU

VI. UNITED STATES MILITARY SERVICE

Branch of Service FINAL RANK SPECIALTY TYPE OF DISCHARGE

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VII. EMPLOYMENT HISTORY - ACCOUNT FOR ALL EMPLOYMENT BEGINNING WITH YOUR MOST RECENT EMPLOYER (GO BACK AT LEAST 10 YEARS, IF APPLICABLE).

Organization Name and Address Employment Dates Position Held & Description of Duties Employer Date Hired Your Title

Street Address Date Separated Your Job Duties

City State Zip/Postal Code Telephone Number

( )

Starting Base Pay Ending Base Pay Name & Title of Immediate Supervisor

Reason for Leaving May we contact at this time?

Organization Name and Address Employment Dates Position Held & Description of Duties

Employer Date Hired Your Title

Street Address Date Separated Your Job Duties

City State Zip/Postal Code Telephone Number ( )

Starting Base Pay Ending Base Pay Name & Title of Immediate Supervisor

Reason for Leaving

Organization Name and Address Employment Dates Position Held & Description of Duties

Employer Date Hired Your Title

Street Address Date Separated Your Job Duties

City State Zip/Postal Code Telephone Number ( )

Starting Base Pay Ending Base Pay Name & Title of Immediate Supervisor

Reason for Leaving

Organization Name and Address Employment Dates Position Held & Description of Duties

Employer Date Hired Your Title

Street Address Date Separated Your Job Duties

City State Zip/Postal Code Telephone Number ( )

Starting Base Pay Ending Base Pay Name & Title of Immediate Supervisor

Reason for Leaving

VIII. COMPUTER/PC SKILLS INDICATE YOUR COMPUTER/PC SKILLS LEVEL EXCELLENT VERY GOOD GOOD FAIR POOR CHECK THE SOFTWARE YOU ARE FAMILIAR WITH: MICROSOFT WORD MICROSOFT OUTLOOK LOTUS NOTES MICROSOFT EXCEL WORD PERFECT OTHER________________________________________ MICROSOFT POWERPOINT LOTUS 1 2 3 ________________________________________________

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IMPORTANT-READ BEFORE SIGNING

IX. APPLICANT’S STATEMENT AND AGREEMENT I understand that completion of this application is valid only for the position as listed on page one of this application. I also understand that if I wish to apply for any other open position, I will have to complete another application specific for that open position. I understand that if hired, my employment with the Company, or any of its affiliated companies would be an indefinite period of time and may be terminated by me or the Company at any time for any or no reason and that my employment is at-will. Likewise, no oral statements or assurances by any person within the Company will constitute an employment contract which can only be entered into by an individualized written agreement signed by me and an officer of the Company. I agree that, if I am hired, I will conform with all company policies and procedures and understand that the Company may modify, amend, and/or revoke any of its employment policies, practices, and benefits without prior notice or my consent. Furthermore, I agree that if I am hired, the Company will have the right to withhold all or part of my wages to offset any financial liability I may have to the Company, including loss of product and/or equipment through theft, carelessness or negligence. I understand that if I am hired, I will be an “introductory” employee during the first 90 days of employment and that after completion of this period I understand the employment relationship will continue to be an employment at will relationship, terminable at any time without cause or notice by either me or the Company. I understand that if hired, I may be required at any time to submit to a drug test, alcohol test, and/or medical examination, to the extent permitted by law, conducted by an approved medical professional selected by the Company at Company expense and I further understand that if substances detected by these tests are at or exceed the minimum acceptable levels as set forth by the DOT, it may result in my termination of employment. I hereby give a continuing authorization to any hospital or other health care facility and to any physician or other person conducting such medical examinations and/or tests, to furnish to the Company or its designated agent, any medical records or medical information resulting from such examinations and/or tests as permitted by current HIPAA regulations. I further authorize the release to the Company of my medical records and medical information as may be relevant and necessary to the disposition or investigation of any claim against the Company or the insurance carriers of the Company, including any claim I may have for workers’ compensation. I understand that the Company reserves the right to use any method of investigation which, in its sole discretion, it deems reasonable and necessary to determine whether any employee has engaged in conduct warranting disciplinary action. As a condition of employment, if hired, I agree to cooperate in any such investigation. As a condition of my employment, I voluntarily agree to cooperate in submitting to any urine or blood tests requested by the Company, as well as any searches of my person or property while employed by the Company and I recognize that refusal to cooperate in such tests or searches would be grounds for discipline, including termination. I understand that the Company may investigate my work and personal history. I authorize all persons, schools, companies, corporations, credit bureaus and law enforcement agencies to supply any information concerning any background and release them from any liability and responsibility from their doing so, I also authorize the Company to provide truthful information concerning my employment with the Company to future prospective employers and I agree to hold the Company harmless for providing such information. Federal law prohibits the employment of unauthorized aliens. If hired, I agree to comply with the law by signing required forms and by submitting satisfactory proof of employment authorization and identity within three (3) days of being hired. Failure to do so will result in immediate termination. I certify that I have read and understand the above paragraphs and that this application was completed by me. I further certify that all the information submitted on this application is true and correct to the best of my knowledge. I understand that any false information, omission, or misrepresentation of facts called for in this application or in interviews may be cause for the denial of my application or, if I am employed, discharge at any time. I also affirm that I have a genuine intent and no other purpose in applying for a position with the Company. I also agree that having to work overtime hours is a condition of employment.

*****AUTHORIZATION TO OBTAIN CONSUMER REPORT*****

I certify that I have received a written notification that the Company may obtain a consumer report on me. This report may be used in connection with my application for employment and for other employment related purposes, including post-employment purposes. I authorize the Company to obtain this report.

If you have any questions regarding this statement, please ask a Company representative before signing

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT AND AGREEMENT ________________________________________________ __________________________________________________ ____________________ PRINT NAME SIGNATURE OF APPLICANT DATE

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TO BE COMPLETED BY APPLICANTS FOR POSITIONS REQUIRING A CERTIFIED DRIVERS LICENSE (CDL) ONLY

Under Federal DOT Regulations, you must answer all of the questions below. Additional paper is available if needed.

I. (PLEASE PRINT ALL RESPONSES) LAST NAME FIRST NAME MIDDLE CURRENT ADDRESS:

DATES OF RESIDENCE:

List all addresses you have resided at during the past three years, other than your current address: PREVIOUS ADDRESS:

DATES OF RESIDENCE:

PREVIOUS ADDRESS:

DATES OF RESIDENCE:

II. DO YOU HAVE A VALID MOTOR VEHICLE OPERATOR LICENSE OR PERMIT OR ANY OTHER UNEXPIRED

LICENSES? YES NO IF YES, PROVIDE THE FOLLOWING INFORMATION: LICENSE: ISSUING STATE:___________

CDL CLASS:_________

LICENSE #:___________________________

EXPIRATION DATE:___________

PERMIT: ISSUING STATE:___________ OTHER UNEXPIRED LICENSES: PERMIT: ISSUING STATE:___________

CDL CLASS:_________ CLASS:_________

LICENSE #:___________________________ LICENSE #:___________________________

EXPIRATION DATE:___________ EXPIRATION DATE:___________

III. HAVE YOU BEEN INVOLVED IN ANY MOTOR VEHICLE ACCIDENTS DURING THE PAST THREE YEARS? YES NO IF YES, PROVIDE THE FOLLOWING INFORMATION FOR EACH ACCIDENT: DATE OF ACCIDENT:

NATURE OF ACCIDENT

LIST INJURIES OR FATALITIES CAUSED BY ACCIDENT: DATE OF ACCIDENT:

NATURE OF ACCIDENT

LIST INJURIES OR FATALITIES CAUSED BY ACCIDENT: DURING THE PAST THREE YEARS, HAVE YOU BEEN CONVICTED OF, OR FORFEITED BOND OR COLLATERAL FOR, ANY VIOLATIONS OF MOTOR VEHICLE LAWS OR ORDINANCES (OTHER THAN THOSE INVOLVING ONLY PARKING)? YES NO IF YES, PROVIDE THE FOLLOWING INFORMATION FOR EACH SUCH VIOLATION. DATE: NATURE OF VIOLATION:

DATE: NATURE OF VIOLATION:

HAS YOUR LICENSE, PERMIT, AND/OR PRIVILEGES TO OPERATE A MOTOR VEHICLE EVER BEEN DENIED, REVOKED OR SUSPENDED? YES NO IF YES, EXPLAIN IN DETAIL REASONS FOR DENIAL, REVOCATION OR SUSPENSION. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

PLEASE COMPLETE REVERSE SIDE ALSO

IV. LIST EQUIPMENT OPERATED DURING PAST THREE YEARS: BUSES YES NO

FROM: TO:

TRUCKS OVER 10,000 LBS YES NO

FROM: TO:

TR TRAILER YES NO

FROM: TO:

OTHER TYPE YES NO

FROM: TO:

I UNDERSTAND THAT THE “APPLICANT’S STATEMENT AND AGREEMENT” ON PAGE FOUR OF MY APPLICATION FOR EMPLOYMENT ALSO APPLIES TO THE INFORMATION IN THIS SECTION. _________________________________ _________________________________ _________________________ PRINT NAME SIGNATURE DATE

Previous Employee Safety Performance History To: Company Name Regarding: Address: SS#: City/State: Position Held: Date:

The above party has listed you as an employment reference. We rely heavily on past performance in determining suitability of applicants for the job. Your help would be appreciated and held in confidence. Thank you for your assistance. Sincerely, _________________________________________________________ Your Company? Owner/Operator _____ Small Trucking Co. _____ Large Trucking Co. _____ Other ______ Applicant was employed as a : Driver ____ Mechanic ____ Other _____ Was it? Part-time ____ Full time _____ Was it? OTR ____ Local _____ Equipment type? Tractor-Semi _____ Straight Truck _____ Bus _____ Other ______ Was money or valuables handled? _________ Was applicant a safe, courteous & efficient driver? ____________________ Reason for leaving employment: Terminated ___ Laid Off ___ Resigned ____ Was general conduct satisfactory? ______________ Dates of employment: _______________ to _________________ # of accidents: _________________ (if any details below)

Accidents Type Preventable? Chargeable? Damages

I hear by authorize this company to release all information concerning records of employment. Including oral assessments of my job performance and ability to each and every company (or their authorized agents) which may request such information in connection with my application for employment with said company. I hereby release this company from any and all liability of any type as a result of providing the above-mentioned information to the above-mentioned company. Applicant’s Signature: _____________________________________________ Witness: _______________________________

Record of Past Driver Drug and/or Alcohol Test Results 1. Has this person ever tested positive for a controlled substance in the last 3 years? Yes ___ No ___ 2. Has this person ever had an alcohol test with a BAC greater than0.04 in the last 3 years? Yes ___ No ___ 3. Has this person ever refused a required test for drugs/alcohol in the last 3 years? Yes ___ No ___ 4. Has this person had any other violations of DOT Agency Drug and Alcohol Testing regulations within the past three years? Yes ___ No ___ If yes to any of the above, who was the Substance Abuse Professional? Name: ____________________________________________ Address: _______________________________________________ City/State: _________________________________________ Phone Number: __________________________________________

(CONTINUED ON BACK)

Pursuant to a request for Previous Employee Safety Performance History, Dated ___________________________________, this response is being provided to the Prospective employer noted below in compliance with the Department of Transportation regulations, 391.23(g) (1) and 40.321(b).

I hereby authorize and agree to the release of the results, including refusals to test, of DOT required drug and alcohol test. I’m authorizing the release of my test results. I consent and agree to waive any physician-patient privileges that may otherwise exist with respect to the confidentiality of my drug and alcohol test results. I further release the Company and it’s medical review officer, and any officer, employee or agent of the Company or medical review officer whose disclosures of the results is in accordance with this release from any and all claims or causes of actions which may result from the disclosure of such test results to the person identified on this release form. Applicant Signature: __________________________________________________ Date: ___________________________

PROSPECTIVE EMPLOYER INFORMATION Ben Arnold Beverage Company ٱ Mailed, Dated: ___________________________ Attn: Stephanie Floyd ٱ Faxed, Dated: ___________________________ 101 Beverage Blvd. P.O. Box 480 ٱ Emailed, Date: ___________________________ Ridgeway, SC 29130 ٱ Phone Interview __________________________ 803-337-5301 (Please check the appropriate box) Attn: Stephanie Campbell Post Office Box 480 City, State, Zip: _________________________________________ _ Phone Number: _________________________________________

Declaration of Employment Status I declare that all information given by me is true and correct to the best of my knowledge. I understand that any misrepresentation or omission of the facts will be sufficient cause for cancellation of the consideration for employment, or dismissal from the Company’s services if am employed. My employment record, as listed on my Application for Employment includes “breaks” or “gaps” in my employment record. During the past three years, I certify that I was unemployed for more than two weeks during the following periods: ______________________ to ______________________ _______________________ to ______________________ _______________________ to ______________________ _______________________ to ______________________ _______________________________________ (Signature) _______________________________________ (Date)

Dear Applicant: Ben Arnold Beverage Company is an Equal Opportunity/Affirmative Action employer and subject to certain reporting and affirmative action requirements by the federal government. The information required on this insert is requested only so that we may meet our Equal Opportunity/Affirmative Action obligations. Your completion of this form is purely voluntary and will not, in any way, affect your consideration for employment. This insert will be separated from your resume/application and will be maintained separately. How were you referred to our Company? Ad (Specify)_______________________________________________ Walk-in__________________________________________________ Agency (Specify)__________________________________________ Employee (Who?)__________________________________________ State Employment Service (Job Service)________________________ Other____________________________________________________ Please Select the Appropriate Information for Each of the Three Categories: Sex: _______ Male _______ Female Ethnicity: _______ Hispanic or Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race). _______ Not Hispanic or Latino Race: Select one or more of the following five race categories:

_______ White _______ Black or African American _______ Asian _______ American Indian or Alaskan Native _______ Native Hawaiian or Other Pacific Islander

_______ Two or more races _______________________________________ __________________________________ Applicant’s Name (print) Date _______________________________________ Position Applying For

Please return to: Michele Boulware Ben Arnold Beverage Company, 101 Beverage Blvd, Ridgeway, SC 29130 or Fax to (803) 337-5308 or Email to micheleb@bas-co.com

VETS-100 EMPLOYMENT SURVEY The Federal Contractor Veterans’ Employment Report (VETS-100) Program is intended to assist the U.S. Department of Labor in determining whether special disabled and Vietnam-era Veterans benefit from affirmative action in obtaining and advancing in employment. Disclosure or refusal to provide the following information will not subject the employee to any adverse treatment and the information will be only in support of Veterans programs in accordance with the regulations implementing 38 U.S.C 4212. Please check the following categories that apply to you, and write your name below: □ Special Disabled Veteran: a) A Veteran who is entitled to compensation (or who, but for the receipt of military retired pay, would be entitled to compensation) under laws administrated by the Department of Veteran Affairs for a disability.

• Rated at 30 percent or more, or • Rated at 10 or 20 percent in the case of a Veteran who has been determined under

Section 1506 of Title 38, U.S.C., to have a serious employment handicap; or b) A person who was discharged or from active duty because of a service-connected

disability. □ Vietnam Era Veteran: A person who served more than 180 days of active military, naval, or air service, any part of which was during the period of August 5, 1964 through May 7, 1975, and

a) was discharged or released therefrom with other than a dishonorable discharge, or b) was discharged or released from active duty because of service-connected

disability.

□ Other Veteran: A person who served in a “war” and those who served in a campaign or on an expedition for which a campaign badge has been awarded. The Office of Personnel Management considers to be “wars” only those armed conflicts for which a declaration of was issued by congress. (See attached list of qualified wars, declarations and expeditions.)

□ Not Applicable. Name: _____________________________________ Date of Hire: ________________________________ Social Security Number: _______________________