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2090 Wagner St., Vandalia, IL 62471 Email Iconsales@octochem.com
Phone Icon Tel: 618-283-9360

Employment Application

    Personal Information

    Your Full Legal Name (required)

    Street Address 1 (required)

    Street Address 2

    City (required)

    State (required)

    Zip/Postal Code (required)

    Phone (required)

    Your Email address (required)

    Position you are applying for: (required)

    Are you over 18 years of age? (required) YesNo

    Education

    Highest Grade Completed (required)

    Do you have a diploma or GED? (required) YesNo

    Number of Post High School Years:

    Most recent place of post high school education:

    Name of school

    Credit Hours:

    Degree:

    Major:

    Minor:

    Second most recent place of post high school education:

    Name of school

    Credit Hours:

    Degree:

    Major:

    Minor:

    Third most recent place of post high school education:

    Name of school

    Credit Hours:

    Degree:

    Major:

    Minor:

    If you expect to complete an educational program in the near future, please indicate what type of degree or program and expected completion date:

    Experience

    Starting with the most recent, describe ALL paid, military and applicable voluntary experience. Explain your knowledge, skills and abilities which best describe your qualifications for this position. You may list significantly different jobs within the same organization as separate items.

    May we contact your present supervisor? (required) YesNo

    Current or most recent employer

    Job Title:

    Employer:

    Employer Address:

    Employer Phone:

    Immediate Supervisor:

    Dates from:

    to:

    Reason for leaving:

    Equipment used:

    Duties:

    Second most recent employer

    Job Title:

    Employer:

    Employer Address:

    Employer Phone:

    Immediate Supervisor:

    Dates from:

    to:

    Reason for leaving:

    Equipment used:

    Duties:

    Third most recent employer

    Job Title:

    Employer:

    Employer Address:

    Employer Phone:

    Immediate Supervisor:

    Dates from:

    to:

    Reason for leaving:

    Equipment used:

    Duties:

    Any additional information you think would help us evaluate your application, including training, seminars, workshops, and special achievements or skills:

    Typing speed (words per minute):

    Licenses including Drivers license and any trade licenses or certificates:

    References

    Names, addresses and relationships of three persons not related to you who know your qualifications

    First reference

    Name:

    Address:

    Phone Number:

    Relationship:

    Second reference

    Name:

    Address:

    Phone Number:

    Relationship:

    Third reference

    Name:

    Address:

    Phone Number:

    Relationship:

    Availability

    Which shift you will accept?

    Are you available for overtime as needed?

    YesNo

    What job status you will accept?

    Full timePart time

    Are you willing to accept employment which requires you to travel?

    YesNo

    Are you legally eligible for employment in the United States? (required)

    YesNo

    List any known allergies:

    Date you can start:

    By checking yes I hereby certify that all entries on this application are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part of any employment with Octochem, Inc. I understand that all information on this application is subject to verification and I consent to criminal history background checks. I also consent that you may contact references, former employers and educational institutions listed regarding this application. I further authorize Octochem, Inc. to rely upon and use, as it sees fit, any information received from such contacts.(required)

    YesNo

    Todays date:(required)

    Attach a resume in pdf format: (Limit 5mb)

    How Did You Hear About Us?