Employment Application We are always looking for talented people to join our team. Please fill out the employment application (or download here) and we will contact you if we require an interview. Applicant Name*Address*City/State/Zip*Number of years at this address*Email* Phone*DOB*Who should be contacted if you are involved in an emergency?*Emergency contact relationship to you?*Emergency contact day phone*Emergency contact evening phone*Job position applied for*Who referred you to our company?Have you applied to our company previously? If yes, when?Driver's license issuing state*In the past 3 years, are there any violations on your DL?*YesNoIf yes, please explainIf you are offered employment, when would you be able to work?*Are you legally eligible for employment in the U.S.?*YesNoAre you able to lift at least fifty pounds for a prolonged period of time?*YesNoEmployment HistoryEmployer nameAddressCity/State/ZipJob dutiesReason for leavingStart Date of Employment End Date of Employment Rate of payEmployer nameAddressCity/State/ZipJob dutiesReason for leavingStart Date of Employment End Date of Employment Rate of payEmployer nameAddressCity/State/ZipJob dutiesReason for leavingStart Date of Employment End Date of Employment Rate of payApplicant's education and trainingHigh school name and address*Last grade completed*9101112Diploma*YesNoCollege name and addressDid you receive a degree? (if yes, degree received)Other training (graduate, technical, vocational)References: List any two people who would be willing to provide a reference for you.NameAddressCity/State/ZipPhoneNameAddressCity/State/ZipPhonePlease provide any other information that you believe should be considered.CertificationI certify that the information provided on this Application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my Application, or if employment commences, immediate termination. I authorize ELKINS WHOLESALE, INC. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be entirely voluntary in nature. In other words, with appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer would have the same right. Moreover, no agent, representative, or employee of ELKINS WHOLESALE INC., except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship. I fully understand that I will be required to complete a drug screening as a condition of employment, and that a positive result will be sufficient reason for not hiring or termination. I understand that I may be required to submit to aptitude testing depending on the job requirements of the position being filled. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION, AND I UNDERSTAND AND AGREE TO ITS TERMS.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.