in no phos employment application

7/30/2019 In No Phos Employment Application

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An Equal Opportunity Employer. If you are disabled and require assistance in the application process, please let us know.

ApplicationFor

Employment

Date

GENERAL INFORMATION

Name Social Security No.

Address Home Telephone ( )

Work Telephone ( )

Have you been employed previously by any affiliated company of Innophos, Inc., including without limitationAMT Labs / Kelatron Corporation / Triarco Industries? (specify date and location)

Position(s) you are applyingfor:

Will you work overtime?Yes No

Will you travel?Yes No

Will you work shift assignments?Yes No

State any limitations on your working hours

How were you referred to us for employment? Walk-In Newspaper Ad College Recruitment

Employee Referral (Please specify)

Employment Agency (Please specify)

Other (Please specify)

Are you a US citizen or otherwise authorized to work in the United States? Yes NoProof of eligibility to work in the United States will be required upon employment.


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EMPLOYMENT HISTORYPlease account for all jobs held beginning with your present or most recent employer. (Include military service if applicable.)

Position Title Company Address Reason for Leaving

Dates of Employment:

Responsibilities / Achievements

From

To

Salary History:

Start

End


Dates of Employment:Responsibilities / Achievements

From

To

Salary History:

Start

End


Dates of Employment:Responsibilities / Achievements

From

To

Salary History:

Start

End


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EARLIER EMPLOYERS

Position Title Company Name / Address Dates of Employment

Are you licensed to practice any trade or profession? Yes No If yes, state nature of l icense issuingauthority and expiration date

List any skills or abilities which may be relevant to the position(s) you are seeking

EDUCATION AND TRAINING

NAME AND LOCATIONDEGREE

ACCUMULATEDCREDIT HOURS

MAJOR

High School

Technical /Business School

College

Graduate School

List any business or professional organizations to which you currently belong:


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REFERENCES

May we communicate with your present employer at this time? Yes No

If not, may we communicate in confidence with anyone else, such as clients or former employees? Yes No

Name Business Relationship Company Telephone

List additional business references below. Attempt to provide supervisors, peers and subordinates.

Name Business Relationship Company Telephone

Are you currently a party to a non-competition or similar agreement or restrictive covenant covering your futureemployment? Yes No

If yes, please provide a copy so that the Company can determine if the agreement or covenant applies to or otherwisecould affect your employment by the Company.

Have you ever been convicted of a criminal offense? Yes No Please explain:

(Disclosure of a criminal record does not automatically disqualify you for employment.)

APPLICANT CERTIFICATION

I certify that the information given by me in this application is true in all respects, and I authorize the Company tocontact my former employers, references and other sources in order to verify the facts furnished regarding mycharacter, qualifications, and previous employment record. I hereby release any such employer or person from

liability for furnishing such information, I understand that any misleading, incorrect or untruthful statements or actionsmay render this application void, and if I am employed, would be just cause for termination of my employment.

Further, I understand that nothing contained in this employment application or in the granting of an interview isintended to create an employment contract between the Company and myself for either employment or for theproviding of any benefit. No promises regarding employment have been made to me and I understand that no suchpromise or guarantee is binding upon the Company. If an employment relationship is established, I understand that Ihave the right to terminate my employment at any time and that the Company retains a similar right.

If I am offered employment, I understand and agree to review the Innophos Employee Booklet and Code of Ethics,which sets forth my obligations with regard to anti-trust law, patents, inventions and the company's proprietaryconfidential information, and my agreement to abide by them. In addition, if I am offered employment, I understandand agree to undergo a physical to include substance screening of my blood or urine or other medical substancescreening procedures for the purpose of assuming employment and acknowledge that refusal to submit to any part ofthis procedure will terminate the employment process. I hereby authorize any Company designated physician,laboratory, hospital or medical professional to conduct such substance screening and provide the results thereof tothe Company. I also understand that all medical examination results, including substance screening, will bemaintained in a confidential manner and that only information regarding the presence of illegal or unauthorizedsubstances or my ability to perform the essential functions of the job offered will be disclosed.

APPLICANTS SIGNATURE DATE

This application will be maintained in our current file for six months.

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