Sysco Cincinnati, LLC

Name: __________________________________________ Date: ____________________

Contract Compliance Coordinator Screening Questions

Please circle: Yes or No

Do you have at least 1-2 years’ prior experience with customer pricing? Yes No Do you have experience reading contracts? Yes No Do have intermediate or higher level of proficiency In Microsoft Word and Excel? Yes No Do you have a high school diploma or equivalent? Yes No Do you experience working with vendors or suppliers? Yes No The position requires availability Monday through Friday 8:00 AM to 5:00 PM. Yes No Are you available to work those days and hours?

EMPLOYMENT APPLICATION An Equal Opportunity Employer

Sysco Cincinnati, LLC 10510 Evendale Drive Cincinnati, OH 45241 Date:

(Please complete the entire form. Incomplete applications will not be considered as legitimate employment inquiries.)

GENERAL INFORMATION

CRIMINAL HISTORY INQUIRY

Have you been convicted or pled guilty or no contest to a crime within the last seven (7) years? (Do not include convictions that were sealed or expunged pursuant to a court order.) � Yes � No

Please explain any “Yes” answer (Nature and Date of Offense). Use additional paper if necessary.

MILITARY SERVICE � Yes � No

Branch From (Date) To (Date) Rank at Entry Rank at Discharge Duties

Last Name

First Name

Middle

Other Names Used Present Address (Street & Number) City State/Prov. Zip Code

Previous Address (Street & Number)

City

State/Prov.

Zip Code

Home Phone

Cell/Mobile Phone E-mail Address

Desired Type of Employment � Full-Time � Part-Time � Temporary

Can you work weekends? � Yes � No

Can you work nights? � Yes � No

Can you work overtime? � Yes � No

Are you currently eligible to work in the United States? � Yes � No

Will you now or in the future require sponsorship for employment with Sysco? � Yes � No

Date Available Salary Requirements

Have you ever been employed at this or any Sysco affiliated com-pany? � Yes � No

If Yes, indicate where and when:

Have you ever applied at this or any of Sysco affiliated company? � Yes � No

If Yes, indicate where and when:

Who referred you to this company? Specific Source:

Have you ever been discharged or forced to resign from any position? � Yes � No If Yes, give details:

EDUCATION

SKILLS SUMMARY

List the qualities and skills you possess that will qualify you in performing the functions of this job:

Software:

Other:

GAPS - Any gap in employment must be fully explained

DATES ACTIVITY

Name of High School Attended City of High School H.S. State � GED � Graduate

Name and City of College, University or Trade School Course Of Study Graduated Degree

� Yes � No

� Yes � No

Are you a licensed or certified member of any profession or trade? � Yes � No

Kind of License/Certification Certificate Number State Year

APPLICANT AUTHORIZATION AND CONSENT FOR RELEASE OF INFORMATION

SYSCO Cincinnati, LLC requires, as a condition of employment, and/or continued employment, that all applicants consent to and authorize a pre-employment verification of the background information submitted on their applica-tion or resume. Please read this statement carefully. I, the undersigned applicant, do hereby certify that the information provided by me for the purpose of employment is true and complete to the best of my knowledge. I understand that if I am employed any false statements will be considered as cause for possible dismissal. This release and authorization acknowledges that this Company may now, or at any time while I am employed, con-duct a verification of my education, previous employment/work history, credit history, motor vehicle records, con-tact personal references, require that I provide a urine specimen to be tested for the presence of drugs or alcohol, and receive any criminal history record information pertaining to me which may be in the files of any Federal, State or Local criminal justice agency in any state, and/or other information as deemed necessary to fulfill the job re-quirements. The results of this verification process will be used to determine employment eligibility under this Company’s employment policies. I authorize SYSCO Cincinnati, LLC and any of its agents and/or employees to disclose orally and in writing the results of this verification process and/or interview to the designated authorized representatives of this Company. I have read and understand this release and consent, and I authorize the background verification. I authorize per-sons, schools, current and former employers, and other organizations and Agencies to provide all information that may be requested, and I hereby release all of the persons and Agencies providing such information from any and all claims and damages connected with their release of any requested information. I agree that any copy of this docu-ment is as valid as the original. I hereby acknowledge that the agent cannot vouch for or guarantee the accuracy of information provided by third parties. Accordingly, I agree to forever release and discharge SYSCO Cincinnati, LLC, its agent, and their associ-ates to the full extent permitted by law from any claims, damages, losses, liabilities, costs and expenses, or any oth-er charge or complaint filed with any agency arising out of any errors or omissions or the retrieving and reporting of information regarding my background information. According to the Federal Fair Credit Reporting Act, I am enti-tled to know if employment was denied based on information obtained by my prospective employer, and to receive, upon written request, a disclosure of the public record information and of the nature and scope of the investigative report. _______________________________________ __________________________________ Applicant’s Name, Printed Social Security Number _______________________________________ Street Address _______________________________________ ________________________________________ City State Zip Signature Date

Sysco Cincinnati, LLC

Voluntary Applicant Self-Identification Questionnaire

Instructions

Please read all instructions carefully before completing this form.

Sysco Cincinnati, LLC (Sysco) is subject to certain governmental recordkeeping and reporting requirements for the administra-tion of civil rights laws and regulations. In order to comply with these laws, Sysco invites applicants to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential, separate from the application and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be sum-marized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. Completion of this form is voluntary and not an employment requirement. Name: __________________________________ Position Applied For: _____________________________

Date: ____________________________ ____ What is your gender? Male □ Female □ What is your race/ethnicity? You may mark only one box.

□ Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

□ White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Mid-dle East, or North Africa.

□ Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.

□ Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

□ Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

□ American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the origi-nal peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

□ Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above races.

Sysco Cincinnati, LLC is an Equal Opportunity Employer. Anti-Discrimination Notice. It is an unlawful employment practice for an employer to fail or refuse to hire or discharge any individual, or otherwise to discriminate against any individual with respect to that individual’s terms and condi-tions of employment, because of such individual’s race, color, religion, sex, age, disability, veteran status or national origin.

Voluntary Veteran’s Invitation to Self-Identify Sysco Cincinnati, LLC is a federal contractor with veterans reporting requirements. Completion of this form is voluntary, but will be greatly appreciated to assist in complying with reporting requirements. Using the definitions below, please check the box or boxes below to identify yourself in as many covered categories as may apply to you. Today, ________________ (date), I __________________________________(print name) certify that I am a/an:

Special Disabled Veteran Disabled Veteran Veteran of the Vietnam Era Other Protected Veteran One-Year, Recently-Separated Veteran (Enter Discharge or Release Date: ___/____/_______) Three-Year, Recently Separated Veteran (Enter Discharge or Release Date: ___/____/_______) Armed Forces Service Medal Veteran

NONE OF THE ABOVE APPLY Please return this form to Human Resources. Disclosing your status as an individual with a disability or covered veteran is voluntary. Choosing not to provide this information will not subject you to any adverse treatment. Information you submit concerning your disability will be kept confidential except that (i) supervisors and managers may be informed regard-ing restrictions on the work duties of individuals with disabilities or special disabled veterans, and regarding necessary accommodations, (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if the condition might require emergency treatment, and (iii) government officials engaged in enforcing the Rehabilitation Act, VEVRAA, or the ADA, may be informed. The information provided will be used only in ways that are consistent with Section 503 of the Rehabilitation Act, VEVRAA, and the ADA. Definitions: Special Disabled Veteran means (i) a veteran who is entitled to compensation (or who but for the receipt of military retired pay would be enti-tled to compensation) under laws administered by the Department of Veterans’ Affairs for a disability (A) rated at 30 percent or more or: (B) rated at 10 or 20 percent in the case of a veteran who has been determined under 38 U.S.C. 3106 to have a serious employment handicap; or (ii) a person who was discharged or released from active duty because of a service-connected disability. Disabled Veteran means (i) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans’ Affairs, or (ii) a per-son who was discharged or released from active duty because of a service-connected disability. Veteran of the Vietnam-era means a person who (i) served on active duty for a period of 180 days, and was discharged or released there from with other than a dishonorable discharge, if any part of such active duty occurred: (A) in the Republic of Vietnam between February 28, 1961 and may 7, 1975; or (II) between August 5, 1964 and May 7, 1975 in all other cases; or (B) veteran who was discharged or released from ac-tive duty because of a service-connected disability if any part of such active duty was performed: (I) in the Republic of Vietnam between Feb-ruary 28, 1961 and May 7, 1975; or (II) between August 5, 1964 and May 7, 1975 in all other cases. Other Protected Veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a cam-paign or expedition for which a campaign badge has been authorized. One-Year Recently Separated Veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during the one-year period beginning on the date of such veteran’s discharge or release from active duty. Three-Year Recently Separated Veteran means a veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service. Armed Forces Service Medal means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 Fed. Reg. 1209).

Pre-Employment Drug Testing Policy

Effective: October 1, 2012

Sysco Cincinnati, LLC (the “Company”) recognizes that drug and alcohol abuse among its employees,

both in the workplace and off the job, are subjects of immediate concern. It is well recognized that the

illicit use of drugs and the abuse of alcohol, whether on or off the job, may adversely affect an employ-

ee’s judgment and job performance, even after the individual believes the effects to have worn off; jeop-

ardize the safety of that employee, other employees, and the public; and undermine the Company’s op-

erations and public confidence in Company services.

Therefore, the Company has determined that it is necessary to maintain a workplace that is free from

the negative effects of drug and alcohol abuse. To ensure that these objectives are met, the Company is

implementing a Drug and Alcohol Free Workplace Program. It is the Company’s desire and goal that

through the implementation of the provisions of this Program, the employees will be provided with a saf-

er and more desirable place to work and that the Company’s customers receive superior and uncompro-

mised service.

This Pre-Employment Drug Testing Policy [“Policy”] is one of many elements contained within the Com-

pany’s overall Drug and Alcohol Free Workplace Program. Additional drug and alcohol related policies

may apply, and will be distributed separately.

This Policy applies to all applicants, including applicants who are also covered by and subject to U.S. De-

partment of Transportation and Federal Motor Carrier Safety Administration Regulations. Individuals

covered by both policies must comply with both policies.

All applicants will be provided with a copy of this Policy upon request at the time they receive a condi-

tional offer of hire.

PRE-EMPLOYMENT CONTINGENCY

All offers of employment will be made contingent upon satisfactory completion of a pre-employment drug

screen. A positive test result, or refusal to cooperate, will result in the denial of employment. Applicants

who have been denied employment through violation of this Policy will not be permitted to apply for po-

sitions within the Company for one year after being notified that the employment offer is revoked. The

ability to reapply in no way guarantees that an applicant will be offered a position.

Refusal to Cooperate

“Refusal to Cooperate” means to obstruct the collection or testing process; to submit an altered, adulter-

ated, or substitute sample; to fail to show up for a scheduled test; to refuse to complete the requested

drug testing forms; or fail to promptly provide specimen(s) for testing when directed to do so, without a

valid medical basis for the failure.

The Company will implement this Policy in a manner that complies with relevant federal, state, and local

law. If the terms of this policy differ from that of any applicable law, the Company will comply with that

law.

Confidentiality

All records relating to positive test results and medical information revealed to the Company and/or its

MRO shall be kept confidential, and disseminated within the Company only on a need-to-know basis.

Medical records will be kept in secure files separate from personnel files. Test results will not be re-

leased outside the Company without the written consent of the tested individual, except as may be re-

quired by law or legal process.

Illegal Drugs

“Drugs” under this Policy means any controlled substance as defined in Schedules I through V of Section

202 of the Controlled Substances Act, 21 U.S.C. § 812. The term "illegal drug" includes any drug the

possession or use of which is illegal under federal, state, or local law, including “medical marijuana” as

well as prescription medications not used by the person for whom prescribed or used in a manner other

than prescribed. The Company may test for the presence of some or all of the following classes of drugs:

amphetamines (including methamphetamine, MDMA (ecstasy), MDA, and MDMA), cocaine (including

“crack” cocaine), opiates (codeine, morphine, heroin, oxycodone), marijuana (THC, “weed,”) phencycli-

dine (PCP, “angel dust”)), benzodiazepines (Valium, Xanax, Klonopin), barbiturates (Darvon), methadone

and methaqualone (“Quaaludes”).

Prescription Medications

The use of any prescription medication for which the applicant does not hold a valid prescription or used

in a manner other than as prescribed is illegal, and will not invalidate or excuse a positive drug test re-

sult. Even in states that have decriminalized the use of marijuana for individuals with qualifying medical

conditions as a matter of state law, the use of marijuana remains illegal as a matter of federal law. In

accordance with the Federal Drug-Free Workplace Act of 1988, the Company has adopted and advanced

a policy prohibiting illegal drug use by its employees. The Company will not, therefore, accept a pre-

scription for ‘medical marijuana’ as a legitimate medical excuse for a positive test result. DOT drivers

should not use any drug, even by prescription, unless the drivers’ physician has affirmatively assured the

driver that it will not affect the ability to drive safely, in accordance with DOT regulations.

PRE-EMPLOYMENT DRUG TESTING AND COLLECTION PROCEDURES

Consent to Testing; Right to Refuse to Be Tested and Consequences

Testing will not be conducted under this Policy without the consent of the person being tested. Appli-

cants have the right to refuse to submit to drug testing under this Policy. However, the Company will

withdraw a conditional offer of employment extended to any applicant who refuses to submit to a lawful

pre-employment drug test.

Specimen Collection

When an applicant is directed to undergo drug testing, the applicant shall report to a certified collection

facility for specimen collection, as designated by the Company. The collection staff collecting samples and

the Company’s laboratory will follow chain-of-custody procedures. Specimen collection and chain-of-

custody procedures involving specimen transportation will ensure that specimen security, proper identifi-

cation, and integrity are not compromised.

Specimen collection will be performed under reasonable and sanitary conditions. Specimens will be col-

lected and tested with regard to the privacy of the applicant being tested. However, collection will be

conducted in a manner reasonably calculated to prevent substitutions or interference with the collection

and the testing of reliable samples.

Laboratory Testing

Drug testing will be conducted by a laboratory selected by the Company that is certified, licensed or ac-

credited in accordance with applicable law. All testing performed by the Company or at the Company's

direction will conform to scientifically accepted analytical methods and procedures. Testing will include

confirmation of any positive test result by gas chromatography-mass spectroscopy or an equivalent sci-

entifically accepted method of equal or greater accuracy before the result of any test will be used as a

basis for refusing to hire an applicant.

The Company will maintain a record of the chain of custody of the sample.

Medical Review Officer Review

A Medical Review Officer (MRO) is a licensed physician hired by the Company who is responsible for re-

ceiving and reviewing laboratory results generated by the Company’s testing program and evaluating

medical explanations for certain drug test results. The Company’s MRO will review all confirmed positive

specimens and offer the applicant the opportunity to demonstrate that the positive result cannot be at-

tributed to the legitimate use of prescription medication or to some other valid explanation. In the event

the MRO determines that the circumstances leading to a positive test result were other than conduct pro-

hibited by this policy, the test will be verified and reported to the Company as negative.

Following a “negative dilute” result, the applicant will be required to undergo another test. Should this

second test result in a negative dilute result, the test will be considered a negative and no additional

testing will be required unless directed to do so by the MRO.

Applicant Rights Following A Confirmed Positive Test Result

If a confirmation test yields a positive result, the test result will be a "confirmed positive" and the Com-

pany’s MRO will provide notice of the confirmed positive test result to the applicant. Within 3 working

days following notice of a positive test result, the applicant may explain the test result by disclosing any

over-the-counter or prescription medications taken or other medical information to the Medical Review

Officer. The applicant may also, within 5 days after receiving notice of a confirmed positive test result,

have a second confirmatory test (a “confirmatory retest”) conducted on the same sample. Any confirma-

tory re-test requested by the applicant (and costs associated with such re-test) will be conducted or in-

curred at the sole expense of the applicant.

Compliance with All Applicable Laws

The Company will implement this Policy in a manner that complies with relevant federal, state, and local

law. If the terms of this policy differ from that of any applicable law, the Company will comply with that

law.

Confidentiality

All records relating to positive test results and medical information revealed to the Company and/or its

MRO shall be kept confidential, and disseminated within the Company only on a need-to-know basis.

Medical records will be kept in secure files separate from personnel files. Test results will not be released

outside the Company without the written consent of the tested individual, except as may be required by

law or legal process.