Application For Employment

Are you eighteen (18) years of age or older?*<br>

Yes

Are you eligible to work in the United States?*

Yes

Can you provide the necessary documentation to eshtablish that you are eligible to work in the United States prior to commencement of employment?* If No, employment is subjected to verification that you are of minimum age.

Yes

Federal law requires you to produce within 3 business days of hire specific documents establishing your identity and authorization to work in the United States.

Employment Desired:*

Full Time

Part Time

Temporary

Position you are applying for (check all that apply):

Distribution Center:

Finance:

Maintenance:

Purchasing:

Buying Agent

Purchasing Assistant

Pricing Clerk

Information Technology

Catalog

Data Processing

Programming

Supervision

Sales

Marketing/Advertising

Advertising/Design

Merchandising

Supervision

Transportation and Maintenance:

Driver

General Labor

Mechanic

Supervision

Management:

Administrative

Supervision

Other

Are you able to perform the essential functions of the position with or without reasonable accommodations?*

With

Without

Have you ever been convicted of any crime other than a minor traffic violation?*

Yes

A conviction will not necessarily automatically disqualify you for employment.Rather, such factors as age and date of conviction, seriousness and nature of the crime and rehabilitation will be considered.

Are you employed now?*

Yes

If Yes, may we contact your present employer?

Yes

Have you ever applied for a job with us before?*

Yes

Have you ever worked for us before?*

Yes

How did you come to apply?*

Have you ever held a position of trust (handling money or confidential material)?*

Yes

Education:

Last Year Completed:*

Did you Graduate?*

Yes

Last Year Completed:

Did you Graduate?

Yes

Prior Work Record (1)

Name and Address of the Employer: (start with the most recent or current employer and complete in full)

May we contact this Employer?

Yes

Prior Work Record (2)

Name and Address of the Employer: (start with the most recent or current employer and complete in full)

May we contact this Employer?

Yes

Prior Work Record (3)

Name and Address of the Employer: (start with the most recent or current employer and complete in full)

May we contact this Employer?

Yes

Pre-Employement Questions

Have you ever been discharged or requested to resign from a position?*

Yes

Will you work overtime whenever necessary?*

Yes

Are you able to work anytime during a 24 hour day?*

Yes

If hired, do you have a way to travel to and from work?*

Yes

Can you operate any shop or office machines and equipment?*

Yes

Please provide any additional information such as special skills, training, management experience, equipment or qualifications you feel will be helpful to us in considering your application:

Personal References

Please list at least two (2) personal references who have known you at least two (2) years. Do not list any relatives.

As part of our procedure for processing your employment application, your personal and employment information and references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job.

I agree and understand that if I am offered employment with Wallace Distribution, I will submit to a physical examination when requested to determine fitness for duty. I further authorize any physician who has examined me as a part of this process to release to Wallace Distribution a complete record of his findings and opinions.

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I hereby grant permission to Wallace Distribution to investigate any of the information included in this application, and I hereby release all such persons and organizations from any claims for damages or otherwise by reason of furnishing such information and records. I hereby release Wallace Distribution from any/all liability of whatever kind and nature which, at any time, could result in obtaining and having an employment decision based on such information.

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for discharge.

I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of Wallace Distribution However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is at will and for an indefinite duration, and that either I or Wallace Distribution may terminate my employment at any time with or without notice or cause.

PLEASE LOOK OVER YOUR APPLICATION AND MAKE SURE YOU HAVE GIVEN AN ANSWER TO EVERY ITEM

As part of its on-going program to select the best candidates for employment and maintain the best employees to provide a safe and healthy place for employment for all employees, Wallace Distribution may test applicants for employment and employees for drug and alcohol usage. Wallace Distribution’s includes the of applicants and the of employees randomly, upon reasonable cause, and upon an employee being involved in or contributing to an accident resulting in actual or potential injury or property damage. Reasonable cause will result when an employee appears to be unfit for duty or has given the company cause to suspect drug or alcohol abuse.

I hereby consent to the above-mentioned drug and alcohol screens, including, but not limited to, a urine test and/or blood test, and to a disclosure of the results of the test to Wallace Distribution for its use and internal communication. I hereby release and fully and forever discharge Wallace Distribution any laboratory or facility which performs analysis from any claim or liability arising from such tests including, but not limited to, the procedure, the analysis, the accuracy of the analysis or the disclosure of its results.

I understand that the results of any such drug screening tests will be considered in any employment decision, including the rejection of me as an applicant for employment or disciplinary action up to and including termination of me as an employee of Wallace Distribution.

I understand that the drug and alcohol screens may pick up on the presence of prescription drugs and that it is important for me to disclose any prescription drugs which I am using, or which I have recently used, prior to the screen test being conducted. I under- stand that as an applicant or employee of Wallace Distribution, that I must report all prescription drugs which have been prescribed for my use or which I am using at all times. I authorize Wallace Distribution to contact the physician who prescribed any medication reported by me and I hereby authorize the physician to provide information to Wallace Distribution regarding its effect or potential effect on my performance

If hired, as part of my continued employment with Wallace Distribution, I consent to tests for drug and alcohol usage and I further con- sent to searched of any areas on Wallace Distribution's premises including but not limited to lockers, furniture, containers, drawers, equipment or other facilities, lunch boxes, briefcases, personal bags, personal tool boxes or tool kits, parking lots, Wallace Distribution vehicles and personal vehicles parked on company premises.

I realize that the presence of drugs or alcohol in the workplace and the influence of these substances on me as an applicant / employee during work hours are inconsistent with company objectives.