Your Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Cell Phone *

(###)

###

####

Home Phone

(###)

###

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Proof of Legal Work Status *

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver's license, birth certificate, green card) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination. What will you be submitting to provide proof of legal work status?

US Driver's License

Birth Certificate

Green Card

Other

Have you been convicted of a felony in the USA or other country/countries? *

No

Yes

Name *

First Emergency Contact Name

First Name

Last Name

Phone *

First Emergency Contact Phone

(###)

###

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Name *

Second Emergency Contact Name

First Name

Last Name

Phone *

Second Emergency Contact Phone

(###)

###

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Siema Wines International Employee Handbook *

See button below for a PDF of the Handbook

You acknowledge that you have received the Siema Wines International Employee Handbook

Check each box below to acknowledge your agreement to each statement *

1. I have received and read a copy of the employee handbook. Iunderstand the policies and rules described in the handbook and realize that this handbook may be changed at any time;

2. I understand that my employment is at will, regardless of the length of my employment or the granting of benefits of any kind.

3. I understand that no contract of employment other than "at will" has been • expressed or implied, and that no circumstances arising out of my employment will alter my "at will" employment relationship unless expressed in writing.

4. I am aware that during the course of my employment confidential information will be made available to me. I understand that this information is critical to the success of the Company and must not be given out or used outside of Siema Wines International. In the event of termination of employment, whether voluntary or involuntary, I agree not to utilize or exploit this information with any other individual or company.

Tax & Payroll Information *

Each form is available below. You can upload the completed/signed forms here or email/bring them to the Siema Wines International office.

FORM W-4 EMPLOYEE'S WITHHOLDING CERTIFICATE Completed

FORM VA-4 PERSONAL EXEMPTION WORKSHEET VIRGINIA DEPARTMENT OF TAXATION Completed (if applicable)

FORM I-9 EMPLOYMENT ELIGIBILITY DEPARTMENT OF HOMELAND SECURITY Completed

AUTHORIZATION FOR DIRECT DEPOSIT FORM COMPLETED

MW 507 EMPLOYEE'S MARYLAND WITHOLDING CERTIFICATE (if applicable)