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Core-Mark Families Foundation
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Employee Eligibility Certification
This page should be filled out by the parent/guardian Core-Mark employee.
Fields marked * are required.
Employee First Name *
Employee Last Name *
Phone # *
Core-Mark Employee Number *
Core-Mark Office or Division *
Core-Mark Office or Division
ADC #750
Albuquerque #048
AMI-Arctic East #066
AMI-Corona #092
Artic Cascade #068
AMI-Artic North East #070
Atlanta #178
Bakersfield #023
Carolina #280
Corona #035
Denver #256
Forrest City #160
Fort Worth #075
Hayward #007
Iowa #185
Kentucky #175
Las Vegas #065
Los Angeles #021
Minneapolis #170
Southern New England #081
Northern New England #150
New York
Ohio #077
Pennsylvania #281
Plano Data Center
Portland #044
RDC #520
Sacramento #016
Salt Lake #071
Spokane #053
Tampa #140
Westlake Corp Office
Calgary #172
Richmond IT
Richmond Data Center
Burnaby #020
Richmond Tax
Toronto #022
Winnipeg #079
Canadian Regional Corporate Office
Canadian Consolidation Centre #022
CM - Indianapolis
CM - Chicago
CM - Corporate
CM - Gibsonton
CM - Rockmart
CM - Detroit
CM - Columbus
CM - Louisville
CM - Eau Claire
CM - Aurora
CM - Raleigh
CM - Pittsburgh
Are You Currently Employed at Core-Mark in a Full-Time Capacity and Have You Been so Employed for Two Years? *
Yes
No
Job Title/Function *
Annual Household Income *
Name of Your Dependent Child That You Wish to Have Considered for Educational Funding by the Foundation
Applicant's First Name *
Applicant's Last Name *
Applicant's Age *
Applicant's Email *
Applicant's Address Line 1 *
Applicant's Address Line 2
Applicant's City *
Applicant's State/(add Province) *
Applicant's Zip-Code *
Applicant's Phone *
The applicant is my dependent child as defined:
biological or adopted; Includes the stepchild or grandchild of employee who is the legal guardian. The applicant also depends on me for his/her support.
*
Employee Signature *
The above information is true and correct to the best of my knowledge.
By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.