Please fill out the application form below.
Please list the names of your present and/or previous employers in chronological order with present or most recent employer listed first. Provide information for at least the most recent ten (10) year period. Attach additional sheets if needed. If self‐employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships or military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment. Do not answer “see résumé.”
Please explain all periods of unemployment during the last ten (10) years.
Please list the names of additional work‐related references we may contact. Individuals with no prior work experience may list school or volunteer‐related references:
Please list the names of personal references (not previous employers or relatives) who know you well that we may contact.

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside.

I understand that the Company may now have, or may establish, a drug‐free workplace or drug and/or alcohol testing program consistent with applicable federal, state and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre‐employment (post‐offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug‐free workplace, consistent with applicable federal, state and local law, by be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company’s policies and applicable federal, state and local law.

If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to files, lockers, desks, vehicles and computers) and, in certain circumstances, my personal property.

I understand and agree that as a condition of employment and to the extent permitted by federal, state and local law, I may be required to sign a confidentiality, restrictive covenant and/or conflict of interest statement.

I certify that all the information on this application, my résumé or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation or omission of an information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

THIS COMPNAY IS AN AT‐WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THE APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT AY TIME, FOR ANY REASON, WITHOR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR IN ANY DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT‐WILL. NO OFFICE, EMPLOYEE OR REPRESENTATIVE OF THE COMPANY IS AUTHORIZED OT ENTER IN AN AGREEMENT – EXPRESS OR IMPLIED – WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY AN OFFICER OF THE COMPANY.

IF HIRED, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT‐WILL.

I authorize the Company or its agents to confirm all statements contained in this application and/or résumé as it relates to the position I am seeking to the extent permitted by federal, state or local law. I agree to complete any requisite authorization forms for background investigation which may be permitted by federal state and/or local law. If applicable and allowed by law, I will receive separate written notification regarding the Company’s intent to obtain “consumer reports”.

I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above‐mentioned information. I hereby release, discharge and hold harmless, to the extent permitted for federal, state and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization form any liability, claims, charges or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations or organizations furnishing such information. Further, if hired, I authorize the Company to provide truthful information concerning my employment to future employers and hold the Company and harmless for providing such information.

If hired by this Company, I understand that I will be required to provide genuine documentation establishing my identity and legibility to be legally employed in the United States by this Company. I also understand this Company employs only individuals who are legally eligible to work in the United States.

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS, IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.

I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE AND COMPLETE.

DO NOT SIGN UNTIL YOU HAVE READ ALL OF THE INFORMATION CONTAINED IN THE APPLICATION.

captcha

Powered by ChronoForms - ChronoEngine.com

horizontal rule

Tech Talk

Leaf-and-Water-World

Within the next decade, it is estimated that as many as 40 states will see water shortages in at least some areas. Water Recycling and Reuse helps protect this precious resouce as well as offer finanical savings.

 

What's New

Lab Test Tubes

International Chemtex enhances its Loop Protector Program with two new products. LoopGuard 265 and 266 provide the latest in corrosion inhibitor technology employing film forming amines for protection of multi-metal closed hot and chilled loops. They are designed for use where high pH issues are a problem. These filming amines provide protection on copper, mild steel, stainless steel and aluminum, as well as other metals. This email address is being protected from spambots. You need JavaScript enabled to view it. for more information.

The Trend

shutterstock 173604701--Chlorine-Dioxide

Chlorine dioxide (CLO2) is one of the most effective biocides on the market, yet there is a reluctance to utilize this biocide due to the strong chlorine odor of the product. The application recommendations in this Trend will provide you with thest latest information for applying Chemtex ACD-300 safely, effectively and odor free.

horizontal rule

Tutorial Videos