Safety Manager at Estron Chemical

First Name *

Last Name

Street Address *

City, State, Zip *

Email *

Phone *

Resume *

How did you learn about this position? *

When are you available to start? *

Are you at least 18 years old and legally eligible to work in the United States? *

Are you able to perform the essential job functions of the position applied for, with or without reasonable accommodations? *

Describe any necessary accommodations:

Have you ever been employed with us before? *

If yes, please specify when and for what position:

Are you related to anyone who is currently employed at Estron Chemical? *

Have you ever been convicted of a crime or any traffic-related offenses? If yes, please explain. (Conviction will not necessarily disqualify an applicant from employment.) Arrests or charges that have been expunged need not be disclosed. *

If yes, please specify the date, place, and nature of each conviction.

Are you presently charged with any violation of the law? *

If yes, please specify the date, place, and nature of each charge.

Have you ever been involuntarily terminated from a job? *

If yes, please explain the involuntary termination:

What is the highest level of education you have completed? Please attach a resume containing additional information about your education. *

Where are you currently working? Please include your current position and rate of pay. *

May we contact your present employer? *

Where have you worked previously and why did you leave those positions? *

Are you willing to take a pre‐employment drug test and physical examination? *

Do you authorize Estron Chemical to conduct a criminal background check on you? *

Were you referred for a position here by a current Estron Chemical employee? *

If yes, who referred you?

Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.

Please list any special skills you may have that relate to the position applied for:

Please provide the name, job title, company, and phone number of three (3) individuals who can provide a professional and/or character reference for you. References must not be related to you and must be individuals who you have known for at least a year. *

Please type your initials below to indicate that you understand that by submitting your information you are indicating your interest in being considered for this position and certify that all information contained above is accurate. You understand that any information withheld or falsely provided by you on this form may be cause for disciplinary action up to and including termination. *

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Application Form