Please fill out the application in its entirety. Step 1 of 9 - Applicant Information 11% Applicant InformationPlease provide us with your personal information including the date you are available to start. All forms are required.Full Name:*LastFirstM.I.Date: Date Format: MM slash DD slash YYYY Address:*Street AddressApt./Unit#*City*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificState*ZIP CodePhone:*Email:* Date Available to Start:* Date Format: MM slash DD slash YYYY Social Security No.:*Desired Salary:*Position Applying for:*Are you a citizen of the United States?*YesNoIf no, are you authorized to work in the U.S.?*YesNoHave you ever worked for this company?*YesNoIf yes, when?*Have you ever been convicted of a felony?*YesNoIf yes, explain:* EducationPlease provide us with your education background. If not applicable, enter "N/A".High School:*From:* Date Format: MM slash DD slash YYYY To:* Date Format: MM slash DD slash YYYY Did you graduate?*YesNoDiploma:*College:From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Did you graduate?YesNoDegree:Other:From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Did you graduate?YesNoDegree: Add other Other:From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Did you graduate?YesNoDegree: ReferencesPlease provide us with three professional references. All forms are required.Full Name:*Relationship:*Company:*Phone:*Address:Full Name:*Relationship:*Company:*Phone:*Address:Full Name:*Relationship:*Company:*Phone:*Address: Previous EmploymentPlease provide us with your employment history in chronological order. If not applicable, enter "N/A".Company:*Phone:*Address:*Supervisor:*Job Title:*Starting Salary:*Ending Salary:*Responsibilities:*From:* Date Format: MM slash DD slash YYYY To:* Date Format: MM slash DD slash YYYY Reason for Leaving:*May we contact your previous supervisor for a reference?*YesNoAdd Employment History Add Company:Phone:Address:Supervisor:Job Title:Starting Salary:Ending Salary:Responsibilities:From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Reason for Leaving:May we contact your previous supervisor for a reference?YesNoAdd Other Employment History Add Company:Phone:Address:Supervisor:Job Title:Starting Salary:Ending Salary:Responsibilities:From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Reason for Leaving:May we contact your previous supervisor for a reference?YesNo Military ServicePlease provide us with your military service background. If not applicable, enter "N/A".Branch:From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Rank at Discharge:Type of Discharge:If other than honorable, explain: Upload Resume*Accepted file types: doc, docx, pdf. Disclaimer and signaturePlease provide your signature if you certify that your answers are true and complete to the best of your knowledge.NOTICE ABOUT INFORMATION LAWS AND PRACTICES With few exceptions, you are entitled upon your request to be informed about the information Clear Lake Specialties (CLS) collects about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to have CLS correct information about you that is held by us (CLS) and is incorrect. The information that CLS collects will be retained and maintained as required by Texas Records Retention Laws (Section 441.180 et seq. of the Texas Government Code) and Rules. Falsification of any information on this form will void your Application for Employment and any actions based on it. The information on the Application for Employment, together with any attachments, is the property of Clear Lake Specialties.Name:* First Middle Last *SSN*List any former names used:Driver License Number and Issuing State:*Date of Birth:* Date Format: MM slash DD slash YYYY Maiden Name:Current and Previous Addresses:*Race:Gender:SelectMaleFemalePrefer Not to AnswerHeightWeight:I hereby authorize any law enforcement agency to furnish Clear Lake Specialties or its agent information related to my criminal history. I hereby release Clear Lake Specialties, all its agents and employees, the law enforcement agency and all employees of law enforcement agencies furnishing information, from all liability resulting from the furnishing of this information to Clear Lake Specialties. In addition, I authorize Clear Lake Specialties or its agent to verify information related to education. I certify that statements made by me on this form are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that any false statements made herein will void my Application for Employment and any actions based on it.Signature:*Date:* Date Format: MM slash DD slash YYYY Background CheckFALSIFICATION OF ANY INFORMATION ON THIS FORM WILL VOID YOUR APPLICATION FOR EMPLOYMENT AND ANY ACTIONS BASED ON IT. THE INFORMATION ON THE APPLICATION FOR EMPLOYMENT, TOGETHER WITH ANY ATTACHMENTS, IS THE PROPERTY OF CLEAR LAKE SPECIALTIES.I certify that my statements are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.Signature:*Date:* Date Format: MM slash DD slash YYYY