APPLICANT’S STATEMENT

I certify that any and all information which I have provided on this Employment Application is true and correct. In the event any information which I have provided is or proves at a later date to be false or incomplete, I understand that Central States Beverage Company may discontinue consideration of my application for employment or, if I am hired, may immediately terminate my employment. I authorize CENTRAL STATES BEVERAGE COMPANY and its employees or agents to verify any and all information which I have provided on this Employment Application unless I specifically state to the contrary. I authorize any school or previous employer named in this application to provide CENTRAL STATES BEVERAGE COMPANY with any relevant information that may be required to arrive at any employment decision unless I specifically state to the contrary.

I understand that if I am offered employment or employed by Central States Beverage Company, I must provide proof of eligibility to work in the United States in conformity with applicable law and failure to provide such proof of eligibility to work in the United States will result in immediate withdrawal of any offer of employment or, if already hired, immediate termination.

I understand that if offered employment, Central States Beverage Company may require a background check including a criminal background check, credit report and motor vehicle driving record check. I authorize Central States Beverage Company, its agents, employees and representatives, to conduct a background check including a criminal background check, credit report and motor vehicle driving record check. I understand that if the background check is not satisfactory to Central States Beverage Company, Central States Beverage Company may discontinue consideration of my application for employment or, if hired, may immediately terminate my employment.

I understand that Central States Beverage Company may require a drug and alcohol screening after an offer of employment and before I am hired and if hired, as provided by High Sales Company policy, and I agree to a drug and alcohol screening. I understand and agree that if the results of the drug and alcohol screening are not satisfactory to Central States Beverage Company, Central States Beverage Company may discontinue consideration of my application for employment or, if hired, may immediately terminate my employment.

I agree to have any and all disputes, claims, questions or controversies arising out of my application for employment and, if hired, my employment with and separation of employment from Central States Beverage Company (“Dispute”) resolved decided through final and binding arbitration presided over by a single arbitrator pursuant to the Federal Arbitration Act, 9 U.S.C. §§ 1 et seq. For purposes of arbitration, the term Dispute includes any and all employment discrimination claims under any federal, state or local law, and excludes any claims under applicable workers’ compensation and employment security (unemployment) laws. By way of example and not limitation, the term Dispute includes any and all claims or causes of action available to me under any of the following federal or state laws: Title VII of the Civil Rights Act of 1991, 42 U.S.C. §§ 2000e et seq.; the Americans with Disabilities Act, 42 U.S.C. §§ 12101 et seq.; the Age Discrimination in Employment Act, 29 U.S.C. §§ 621 et seq.; the Fair Labor Standards Act, 29 U.S.C. §§ 201 et seq.; the Family and Medical Leave Act of 1994, 29 U.S.C. §§ 2601 et seq.; 42 U.S.C. § 1981 and § 1983; the Kansas Act Against Discrimination, K.S.A. Chapter 44 Article 10; the Kansas Discrimination in Employment Act, K.S.A. Chapter 44 Article 11; the Missouri Human Rights Act, R.S.Mo. Chapter 213; any other federal, state or municipal fair employment practices law or laws regulating employment or human resources; the law of contracts; and the law of torts. A request for arbitration should be made in writing to the President of CENTRAL STATES BEVERAGE COMPANY at any time within one year of the Dispute. Any arbitration will proceed under the American Arbitration Association (AAA) National Rules for the Resolution of Employment Disputes, applicable at the time of the arbitration although the AAA will not administer the arbitration, with the following exceptions: (1) unless otherwise agreed by the parties, the arbitrator will be mutually agreed to by the employee and Central States Beverage Company and (2) unless otherwise ordered by the arbitrator, both the employee and Central States Beverage Company each will be limited to one (1) deposition of six (6) hours each. Unless otherwise agreed, venue of any arbitration will be within Jackson County in Missouri or Johnson County in Kansas. In any arbitration, Central States Beverage Company shall bear the cost of the arbitration and each party shall bear its own cost and expense. I waive any and all rights to file any action based on any Dispute in a court of competent jurisdiction, whether the action filed would be tried to a jury or tried to a court, arising out of my application for employment and, if hired, my employment with and separation of employment from CENTRAL STATES BEVERAGE COMPANY. Notwithstanding the foregoing, any arbitration award may be filed for enforcement in a court of competent jurisdiction. If any provision of this arbitration agreement is deemed unenforceable, that provision only shall be deemed of no force and effect and all other remaining provisions of the this arbitration agreement shall remain in full force and effect.

I understand and agree that if employed, I will be employed at will and either I or Central States Beverage Company may terminate the employment relationship at any time, with or without cause and with or without notice. I further understand and agree that this Employment Application is not a contract of employment or part of a contract of employment with Central States Beverage Company .

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.