CAREERS

PERSONAL INFORMATION

* Are you legally authorized to be employed in the United States? (Proof of identity and work authorization documentation will be required as a condition of employment.):

Yes   No

* Will you at any time require sponsorship for work authorization?:

Yes   No

* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):

Yes   No

* Have you ever worked for this Company before?:

Yes   No

If Yes, please provide details (Where/When/Job Title):

EMPLOYMENT DESIRED

* When would you be available to begin work?:

* Type of employment desired:

Full-Time Part Time Seasonal Internship

* Hourly rate/salary desired:

* Are you currently employed?:

Yes   No

If so may we inquire of your present employer?:

Yes   No

If presently employed, why are you considering leaving?:

EDUCATION

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location	Did you Graduate?	Degree Received	Subjects Studied/Major
	Yes   No
	Yes   No
	Yes   No

If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

REFERENCES

Please provide three references (not relatives).

Name	Relationship	Phone Number	Email
*	*	*
*	*	*
*	*	*

AUTHORIZATION

-I swear/affirm that the statements and information I have provided in this Application for Employment are true, correct, and complete to the best of my knowledge.
-I certify that I have answered all questions to the best of my ability and have not withheld any information that would unfavorably affect my application for employment. I acknowledge that misrepresentation or omissions may be the cause for my rejection for employment or may result in my subsequent dismissal if I am hired. I specifically, acknowledge that the employer will use my driver record abstract(s) required pursuant to Section 6-114 of the Pa Vehicle Code for the purposes identified and for no other purpose.
-I hereby consent to have GOH, Inc. contact anyone it deems appropriate to investigate or verify any information I have provided or to discuss my background, past performance, or suitability for employment. I expressly consent to any discussions regarding the foregoing by any person contacted. I knowingly and voluntarily waive all rights to bring any actions for defamation, invasion of privacy, or similar cause of action against anyone providing such information. This affidavit is filed in compliance with Section 607 of the Fair Credit Reporting Act.
-I understand that employment at GOH, Inc. is "at-will" which means that either I or GOH, Inc. can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no leader, supervisor, manager, or executive of GOH, Inc., other than the President, has the authority to create an employment contract other than an at will employment contract and the President may only do so in writing that is signed by both the President and the employee in question. I represent and warrant that I am not subject to any covenant or other restriction, including non-compete and/or non-solicitation agreements, that would preclude me from accepting employment at GOH and performing all duties associated with the position for which I am applying.

* Signature (type name):

* Date:

TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a condtional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in consideration with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of the company.

I understand that information I provide regarding current and / or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (o). I understand that I have the right to:

• Review information provided by current/previous employers
• Have errors in the information corrected by previous employers and for those employers to re-send the corrected information to the prospective employer; and
• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

* Signature (type name):

* Date:

PERSONAL INFORMATION

List previous addresses of residency for the past 3 years (if different from current).

Street	City	State	Zip Code	Number of Years

EMPLOYMENT INFORMATION

All applicants wishing to drive in interstate commerce must provide the following information on all employers during the preceeding three years. You must give the same information for all employers for whom you have drive a commercial vehicle seven years prior to the initial three years (total of ten employment records).

You are required to list the complete mailing address; street number and name city, state and zip code.

EMPLOYER 1 Dates Employed Employer Name & Address Employer Phone From: * To: * * * * Job Title Supervisor Name & Title May we Contact? * * * * Yes No Responsibilities Reason for Leaving Salary/Hourly Rate * * Start: * End: * WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? * Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? * Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 2 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 3 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 4 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 5 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 6 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 7 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 8 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 9 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 10 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 11 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 12 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 13 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 14 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 15 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 16 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 17 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 18 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 19 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason:

EMPLOYER 20 Dates Employed Employer Name & Address Employer Phone From: To: Job Title Supervisor Name & Title May we Contact? Yes No Responsibilities Reason for Leaving Salary/Hourly Rate Start: End: WERE YOU SUBJECT TO THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR, PART 40? Yes No

Add another Employer

*Any gaps in employment and/or unemployment must be explained

**The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more. (Refer to Section 390.5 of Federal Motor Carrier Safety Regulations for definition.)

EXPERIENCE AND QUALIFICATION

Accident History

If no accidents within the last 5 years

Check here

Date	Nature of Accident (Head-on, Rear-End, Upset, Etc.)	Injuries	Fatalities	Haz Mat Spill

Traffic Convictions and Forfeitures (5 years)

If no Traffic Convictions and/or Forfeitures within the last 5 years

Check here

Date (Month/year)	Violation (Other than violations involving parking only)	State of Violation	Penalty (Forfeited bond, collateral and/or points)

Section 383.21 FMOSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.

State	License No.	Expiration Date	Class	Endorsements
*	*	*	*	H    N    T    P    S    X

* Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes   No

If yes, give details.

* Has any license, permit or privilege ever been suspended or revoked?

Yes   No

If yes, give details.

APPLICANT CERTIFICATION

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

* Applicant's Signature (type name):

* Date:

Glenn O. Hawbaker, Inc. (the "company") intends to obtain and use a consumer report and/or an investigative consumer report from an external consumer reporting agency for employment purposes. These reports may be obtained at any time after the company receives authorization from you, including any time during the period of your employment if the company hires you. These purposes may include but are not limited to:

• considering your application for employment;
• making a decision whether to offer you employment with the company;
• deciding whether to continue your employment (if you are hired by the company);
• doing periodic rescreening of current employees, and/or;
• making any other employment decisions affecting you, including promotion, retention, and/or reassignment.;

A consumer reporting agency is a person or business that regularly assembles or evaluates consumer credit information or other information on consumers. As an applicant or an employee, you are considered a "consumer" under the Fair Credit Reporting Act.

A consumer report may include, but is not limited to, information about your character; general reputation; personal characteristics that may be used for employment purposes; mode of living, including credit history and reports; verification of social security number; previous and current residences; employment history; motor vehicle records; criminal history, including reports from any criminal justice agency in any or all federal, state, or county jurisdictions; and, any other public records. An investigative consumer report includes similar information as consumer reports, which are obtained through personal interviews with those who are acquainted with you or who may have knowledge of any relevant information about you.

You have a right to request disclosures of the nature and scope of any investigative consumer report that the company obtains about you. A summary of your rights under the Fair Credit Reporting Act (“FCRA”) is being provided to you along with this Disclosure. This information is also available at: www.consumer.ftc.gov/articles/pdf-0096-fair-credit-reporting-act.pdf



I acknowledge that I have received and read the Fair Credit Reporting Act Disclosure, a Summary of Consumer Rights under the Fair Credit Reporting Act, and this authorization. I hereby authorize Glenn O. Hawbaker, Inc. and any authorized agents or third party agents pursuant to the Fair Credit Reporting Act to obtain consumer reports and/or investigative consumer reports about me from a consumer reporting agency and that they may consider information in consumer reports and investigative consumer reports as part of their decision making process regarding any aspect of my application for employment and/or employment related matters, including periodic rescreening of current employees. I agree and understand that these reports may be obtained at any time after giving this authorization, including at any time during my employment if I am hired, without additional authorization, including authorization to run periodic checks of my Motor Vehicle Record. I authorize any individual or entity having personal knowledge of me to furnish Glenn O. Hawbaker, Inc, or its designated agents with any and all information regarding me in connection with this authorization and which will be used for employment related matters by Glenn O. Hawbaker, Inc. I further authorize and acknowledge that a copy of this authorization shall be accepted with the same authority as an original. I also acknowledge that I have received a copy of the Summary of Rights under the Fair Credit Reporting Act. I certify that the information provided on this form is true and correct. I understand that any information that I provide in an employment application or that I otherwise disclose during my employment may be used to obtain consumer reports and/ or investigative consumer reports.

* Signature (type name):

* Date: