Non-Driver Acknowledgement FM009

1 Non-Driver Acknowledgement As an employee of this Domino s Pizza franchise, I acknowledge that I do not meet driver requirements. Therefore, I am not currently eligible to drive, nor will I drive, in any capacity for this operation until such time that I am considered eligible to drive. The requirements that I do not meet may include, but are not limited to: (Circle all that apply) 1. I am under 18 years of age. 2. I do not have a 2-year driving history available for review. 3. My MVR indicates I do not meet driver requirements. 4. I choose not to drive in any capacity for the operation. If at any point in time I become eligible to drive while working for this Domino s Pizza franchise, I agree that prior to driving I will successfully complete the necessary driver s training course (supplied at company s expense), obtain an MVR showing I meet driver requirements, and will review and agree to abide by all driver regulations as stipulated by the Employer.

2 In addition, I have read and understand the following policies and standards of Domino s Pizza and will abide by them as an employee. By initialing each section, I confirm that I understand and agree to comply with these policies: _____ Company Safety Policy _____ Employment Eligibility and Background Checks _____ Weather Policy _____ Alcohol and Drug Policy _____ Weapon Policy _____ Security Policies and Procedures _____ Disciplinary Policies _____ Involuntary Termination of Employment _____ Occupational Safety and Health Act _____ Hazard Communication Policy and Test _____ Fire Prevention Plan _____ Emergency Action Plan _____ Accident Reporting I, the undersigned, acknowledge that I have received all safety and security policies by the Employer, and agree to comply with all procedures.

3 I further certify that all information provided to the Employer is true and accurate, to the best of my knowledge, and I consent to a work history check through any consumer investigative agency chosen by the employer. NAME (Printed): _____ SIGNATURE: _____ DATE SIGNED: _____ DATE OF HIRE: _____ Account #: _____ Company Name: _____ FM009 07/09