Online Application Form

Personal Information

First Name *

Middle Name *

Last Name *

Present Address

Street *

City *

State *

Zip *

Permanent Address

Street *

City *

State *

Zip *

Telephone Number *

Enter your telephone number (xxx) xxx-xxxx

Mobile Number *

Email Address *

	Yes	No
Are you 18 Years or Older?	Yes	No
Are you a citizen of the United States?	Yes	No
If NO, are you legally eligible for employment in the United States?	Yes	No

If not US Citizen - Under what VISA or work permit are you currently employed.

Have you ever been convicted of a crime? *

Yes

If YES, describe when, where and nature of the offense:

Employment Desired

Position Applied For: *

Which Location? *

Date You Can Start *

Month

Day

Year

Salary Desired: * $

	Yes	No
Do you agree to work any shift to which you are assigned?	Yes	No
Will you work on Saturday and/or Sunday when your work schedule requires it?	Yes	No
Are you employed Now?	Yes	No
If YES may we inquire of your present employer?	Yes	No

Have you ever applied to Summit Polymers before? *

Yes

If YES, when?(month/year)

Have you ever worked for any Summit Polymers facility before? *

Yes

If YES, when?(month/year)

Which Location?

How did you hear about employment opportunities at Summit? *

Education

School Information

	School Name	Years Attended	Graduated?	Subject(s) Studied
High School			Yes No
College			Yes No
Trade, Business or Correspondence			Yes No

Any other subjects of special study?

Employment History

List below your last four employers(including military services) starting with the last one first.

Job History

	Date Started (Month/Year)	Date Left (Month/Year)	Name & Location of Employer	Phone	Salary ($/Yr) or ($/Hr)	Position	Reason for Leaving
					$
					$
					$
					$

References

Give the names of three references that are familiar with your work performance. (Preferably Supervisors)

Reference List

	Name	Telephone Number	How do you know this person?

Emergency Contact

In case of emergency, notify:

Contact Info

	Name	Street Address	Telephone

Disclaimer/Signature

I UNDERSTAND THAT, IF I AM HIRED BY SUMMIT POLYMERS, I WILL BE EMPLOYED ON AN INDEFINITE BASIS AND MY EMPLOYMENT WILL BE SUBJECT TO TERMINATION WITH OR WITHOUT PRIOR DISCIPLINE, NOTICE OR WARNING, AND WITH OR WITHOUT CAUSE.

I HEREBY AFFIRM THAT THE INFORMATION PROVIDED ON THIS APPLICATION (AND ACCOMPANIED RESUME, IF ANY) IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I ALSO AGREE THAT ANY FALSE INFORMATION OR SIGNIFICANT OMISSIONS MAY DISQUALIFY ME FROM FURTHER CONSIDERATION FOR EMPLOYMENT AND MAY RESULT IN DISCIPLINE OR DISMISSAL IF DISCOVERED AT A LATER DATE.

I AUTHORIZE THOROUGH INVESTIGATION OF MY PAST EMPLOYMENT AND EDUCATION, AGREE TO COOPERATE IN SUCH INVESTIGATION, AND RELEASE FROM ALL LIABILITY AND RESPONSIBILITY ALL PERSONS AND CORPORATIONS REQUESTING OR SUPPLYING SUCH INFORMATION.

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 U.S. CITIZEN STATUS OR, IF ALIENS, THEIR LEGAL AUTHORIZATION TO WORK IN THE U.S. AS A CONSEQUENCE, I UNDERSTAND THAT ANY OFFER OF EMPLOYMENT WOULD BE CONTINGENT ON MY ABILITY TO PRODUCE REQUIRED DOCUMENTATION WITHIN THE TIME PERIOD REQUIRED BY LAW.

Signature of applicant (type your name): *

Upload Resume

Resume (.txt, .rtf, .doc, .docx, .pdf)

Contact Information

Technical Center:
6715 South Sprinkle Road
Portage MI 49002
(269) 324-9330

Dearborn Sales and Design:
15101 North Commerce Drive
Dearborn, MI 48120
(313) 583-6000

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