Employment Application

KibbeChem, Inc. is an equal opportunity employer. Applicants are considered for employment without regard to race, color, religion, sex, age, disability, citizenship status, national origin, veteran status, or any other basis prohibited by law. KibbeChem, Inc. will comply with its obligation to provide reasonable accommodation to qualified individuals with disabilities.

* Required Information

Personal Information

If you have resided at your present address less than three years, list your prior address:

Position(s) Desired

Verification of eligibility to work in the United States is required at the time of hire.

Available to work


List the name, address, and telephone number of three business/work references.

  Name Address Telephone No.
Reference #1
Reference #2
Reference #3
  School Name / Location Graduated Yes / No Years Attended Major Pursued / Degree Earned
High School or GED
College or University
Business, Trade or Technical School or College
Correspondence, Post Graduate or Special School or College
Employment Experience

Start with your most recent or present employer, and provide all employers leaving no gaps in your work history for the last 3 places of employment. Include any military service assignments that may cause a gap.

Employer #1

Employer #2

Employer #3

Applicant's Statement

Please indicate that you have read and understand each paragraph of the following Applicant’s Statement by placing your initials beside each paragraph.

Initial Here: You must enter your initials to submit.

1. I certify that this application was completed by me and that all entries and information in it are TRUE and COMPLETE to the best of my knowledge. I understand that false, misleading or omitted information in my application may result in no employment being offered or an offer being withdrawn and, in the event of employment, in discharge.

Initial Here: You must enter your initials to submit.

2. I hereby authorize investigation of all statements contained in this application. I understand that information may be obtained through interviews with references and past employers, from educational institutions, through a credit check, a criminal history check and/or a driver’s record check. This inquiry may include information about my work performance and workplace conduct. I hereby consent to consideration of any statements of references which former employers or others provide in response to the inquiry. If KibbeChem, Inc. decides to obtain a consumer credit report, I understand that it will provide, at my request, the name and address of the reporting agency so I may obtain from such reporting agency the nature and substance of information contained in such report.

Initial Here: You must enter your initials to submit.

3. I hereby release my references and my previous employers from liability for their furnishing information me and I also release KibbeChem, Inc. regarding/for any employment decision it makes on the basis of such information.

Initial Here: You must enter your initials to submit.

4. I understand that, if I am hired, I will be required to undergo a physical/medical examination and drug screen, as a condition of beginning my employment, and I hereby authorize any doctor, hospital, clinic, laboratory or other medical facility to furnish any medical information with reference to me as may be necessary in conjunction with that examination and related considerations. If employed, I understand and agree that as a condition of continued employment, I may be subject to periodic testing to detect the presence of illegal drugs or substances in my body. Such testing will be performed by an entity or individual designated by KibbChem, Inc.

Initial Here: You must enter your initials to submit.

5. I understand that, according to federal law, all individuals who are hired must, as a condition of employment, produce certain documentation to verify their identity and United States citizen status or, if aliens, their legal authorization to work in the United States. I understand that any offer of employment to me is contingent upon my ability to produce the required documentation within the time required by law.

Initial Here: You must enter your initials to submit.

6. I certify that I am not bound by any employment or non-competition agreement that would be breached by any employment that might be offered to me by KibbeChem, Inc., any proprietary or confidential information that is subject of any contract, non-disclosure agreement, or prior work relationship involving any other person, employer or entity.

Initial Here: You must enter your initials to submit.

7. I understand that this application is not, and is not intended to be, a contract of employment and if I am hired, my employment is for no fixed period of time and either I or KibbeChem, Inc. can end the relationship at any time and for any reason. I further agree, if employed, to follow all rules, policies and regulations of KibbeChem, Inc. I understand and agree that KibbeChem, Inc. officials may search my property while I am, or the property is, on KibbeChem, Inc.’s premises. I further understand that statements contained in rules, policies, handbooks or other material do not create any guarantee of employment and that KibbeChem, Inc. has the right to modify, amend or terminate rules, policies, handbooks or other programs within the limits and requirements imposed by law. I understand that no representative of KibbeChem, Inc. other than the President has the authority to enter into any employment agreement for any specific period of time or to make any agreement contrary to the foregoing and that any such agreement must be in writing to be binding.

NOTE: An Application not completed in its entirety will not be considered. Please look over the entire form to make sure you have responded to every item.