EMPLOYMENT APPLICATION Application for Employment PEOPLEASECORPORATION PLC Services, Inc APPLICATION FOR EMPLOYMENT QUESTIONS IN BURGUNDY INK MUST BE ANSWERED IN THEIR ENTIRETY. PLEASE PRINT ALL ANSWERS CLEARLY. Last Name First Name Middle Name Social Security Todays Date (please use Legal Name as it appears on your Social Security Card) Street Address City State Zip Home Phone Number Cell Phone Number Email Address Only U.S. citizens or aliens who have a lega! right to work in the U.S. are eligible for employment. Can you, upon employment, submit documentation verifying your identity and your legal right to work in the U.S.? Yes No Have you ever been convicted of a felony? Yes No Note: A conviction will not necessarily disqualify you from employment. If “yes” •. complete the “Felony Conviction” form which can be obtained from your potential On-Site Supervisor, If you responded “Yes”, the Felony Conviction explanation form must accompany this application for employment. Are you over 18 years of age? Yes No Position applying for: Are you able to perform the essential functions of the job? Yes No If “no”, are there reasonable accommodations that can be made to allow you to perform the essential functions of the job? Explain: IMPORTANT ~ IN CASE OF EMERGENCY NOTIFY: Name: Telephone Number: Relationship: Name: Telephone Number: Relationship: I have read and ‘understand the Notice to Applicants and the Applicant’s Statement on the inside page of this application packet. This application will remain active for thirty (30) days Any applicant wishing to be considered for employment beyond thirty (30) days should reapply. Signature: Please print, fill, and email to info@hollandtransferco.com Mission Statement Our reason for existence is to glorify Jesus Christ, to strive for excellent transportation, logistical, warehouse and distribution solutions for our customers, both domestic and global. To treat all people with respect, dignity and integrity and to provide meaningful employment for our employees. 704-873-4374 info@hollandtransferco.com © 2021 Holland Transfer Company.