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May 31, 2023

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Application for Employment

References:

List three individuals not related to you, whom you have known at least one year.

Reference #1
Reference #2
Reference #3

Current and former employers:

Most recent employer
Employer #2
Employer #3
Employer #4
Employer #5

Please read the following statement carefully before signing to indicate your understanding.

I understand that, prior to being offered employment, I may be requested to take an employment examination. In the event I have a disability that will affect my ability to take the test, I will so inform the Company prior to the test so that a reasonable accommodation can be made. The Company reserves the right to require medical documentation regarding the need for accommodation.

Calumet Electronics Corporation participates in pre-employment drug testing.

I understand and agree that, if hired, my employment is at-will, meaning it is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated with or without cause, at any time, with or without notice. This provision supersedes any oral or written representation to the contrary unless in writing and signed by both a Human Resources Representative and the person to whom the writing is directed. I authorize investigation of all statements contained in this application for any employment-related purpose. I release the listed references and all employers, except those specifically noted* to provide you with any applicable information they may have. I hereby release these references and former employers from all liability for any information they may give to the Company.

I certify that the facts contained in this application are true, accurate, and complete to the best of my knowledge, and understand that, if employed, falsified statements or omitted material facts on this application may result in my disqualification from consideration for employment, or termination from employment if I have been hired.

Calumet Electronics Corporation is an equal employment opportunity employer and will not discriminate against any applicant on the basis of any characteristic that is protected by State or Federal law.