Application For Employment Position For Which You Are Applying:* First Name* Last Name* Middle Initial * Home Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code Contact Phone Number* Email Address* Have you ever been discharged or forced to resign from any position? If yes, please give employer, date and reason.* Yes No Please Explain:Are you legally authorized to work in the United States?* Yes No Will you now or in the future require sponsorship for employment visa status (e.g. H-B status)?* Yes No Educational Background:Name and Location of School(s)* Did you graduate?* Yes No Major/Minor Degree Earned (e.g. GED/BA/BS) Related Licenses:Professional License Issued By: Field/Trade Specialization License Number Issue Date Expiration Date Professional License Issued By: Field/Trade Specialization License Number Issue Date Expiration Date Professional License Issued By: Field/Trade Specialization License Number Issue Date Expiration Date Last 3 Employers:1. Employer/Company Name and Address Dates of Employment Position Name and Title of Immediate Supervisor Phone Number May We Contact? Yes No Reason for Leaving Starting/Ending Salary Were you terminated or asked to resign? Yes No Describe job responsibilities in order of importance:2. Employer/Company Name and Address Dates of Employment Position Name and Title of Immediate Supervisor Phone Number May We Contact? Yes No Reason for Leaving Starting/Ending Salary Were you terminated or asked to resign? Yes No Describe job responsibilities in order of importance:3. Employer/Company Name and Address Dates of Employment Position Name and Title of Immediate Supervisor Phone Number May We Contact? Yes No Reason for Leaving Starting/Ending Salary Were you terminated or asked to resign? Yes No Describe job responsibilities in order of importance: ReferencesName/Title Phone Number Relationship Name/Title Phone Number Relationship Name/Title Phone Number Relationship CONDITIONS OF EMPLOYMENTI hereby certify that the facts set forth in the above employment application are true and complete. I understand that any misrepresentation or material omission made by me on this application shall be considered sufficient basis for non-selection or termination of employment whenever it is discovered. I understand that, if employed, I will abide by Manner Polymer’s policies, rules, procedures and regulations as they now exist and may be modified from time to time in the sole discretion of Manner Polymers. I also understand that I may be asked to take a medical examination and consent to a personal background screen, which may also include a drug screen. I understand that all new employees must comply with the employment verification requirements of the Immigration Reform and Control Act. I understand that, if I am hired, I will be required, within three days of starting work, to provide documents proving my identity and authorization to work in the United States. I further understand that I will be required to sign form I-9 (issued by the Federal Government) verifying, under oath, my employment authorization. I give the employer the right to contact and obtain information from all references, employers, educational institutes, other reporting agencies and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information. Manner Polymers is an at-will employer. If I am hired, I understand that I am free to resign at any time, with or without cause or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer. Manner Polymers provides equal opportunity to all employees and applicants for employment without regard to race, color, sex, religion, national origin, age, disability, genetic information, military status or any other prohibited characteristic. Any applicant who, because of disability, needs accommodation or assistance in completing this application or at any time during the application process should contact the Human Resources Department. Manner also provides reasonable accommodation to employees with disabilities consistent with its obligations under the law. This application is current for only sixty (60) days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application. I understand that this application, exam documents and attachments become a part of Manner Polymers records and will not be returned, reused or copied for me once submitted. I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions. Consent* I agree.By checking the box and typing your name below you are digitally agreeing to the conditions of employment statement.First Name* Last Name* Date* MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.