Employment Application

Name

Today's Date

Home Address

Email Address

Home Phone#

Mobile Phone#

Are you eligible to work in the United States? YesNo

Are you at least 18 years old or older? (If no, you may be required to provide authorization to work) YesNo

Have you ever been terminated from employment or asked to resign by an employer? YesNo
If yes, please provide company names and details

Have you ever worked for InChem before? YesNo
If yes, please provide details

Do you know anyone who currently works for our company? YesNo
If yes, who?

Position applying for

Hourly Rate/Salary Desired

Are you currently employed? YesNo
If yes, may we inquire of your present employer?

Can you work any shift? YesNo
If no, explain

Can you work overtime, including weekends? YesNo
If no, explain

Date you can start work

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? YesNo

Have you been convicted of an unlawful offense other than a minor traffic violation within the last 7 years? Conviction will not necessarily disqualify an applicant from employment. YesNo
If yes, explain

How did you hear about us? Walk In, Ads, Referral by Who?, Other

Education: Name & Location of School, #Yrs Completed, Diploma/Degree Received, Course of Study

EMPLOYMENT EXPERIENCE: Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

1.
Employer
Address
Telephone Number
Job Title
Immediate Supervisor
Reason for Leaving
Dates Employed (from, to)
Hourly Rate/Salary (starting, final)
Work Performed

2.
Employer
Address
Telephone Number
Job Title
Immediate Supervisor
Reason for Leaving
Dates Employed (from, to)
Hourly Rate/Salary (starting, final)
Work Performed

3.
Employer
Address
Telephone Number
Job Title
Immediate Supervisor
Reason for Leaving
Dates Employed (from, to)
Hourly Rate/Salary (starting, final)
Work Performed

4.
Employer
Address
Telephone Number
Job Title
Immediate Supervisor
Reason for Leaving
Dates Employed (from, to)
Hourly Rate/Salary (starting, final)
Work Performed

Additional Information

List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, national origin, age, ancestry, disability or other protected status.

Summarize special job-related skills and qualifications acquired from employment or other experience.

State any additional information you feel may be helpful to us in considering your application.

REFERENCES (Give the names of three persons not related to you, whom you have known at least three years.)

1.
Name
Address, Phone, Email
Company
Years Acquainted

2.
Name
Address, Phone, Email
Company
Years Acquainted

3.
Name
Address, Phone, Email
Company
Years Acquainted

Pleas Upload Resume:

Please read carefully before submitting.
InChem Rock Hill LLC is an equal opportunity employer. InChem Rock Hill LLC does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for InChem Rock Hill LLC to hire me. If I am hired, I understand that either InChem Rock Hill LLC or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of InChem Rock Hill LLC has the authority to make any assurance to the contrary.

I attest with my submission below that I have given to InChem Rock Hill LLC true and complete information on this application. No requested information has been concealed. I authorize InChem Rock Hill LLC to contact references provide for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Please leave this field empty.

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