APPLICATION FOR EMPLOYMENT Inteplast Group does not discriminate against any applicant or employee based on race, color, sex, religion, national origin, age, disability, or any other basis protected by applicable federal, state, or local laws. Inteplast Group, 9 Peach Tree Hill Road, Livingston NJ 07039 LoneStar Plastics, Inc., 2875 Market, Garland, TX 75041 Inteplast Group, 101 Inteplast Blvd., Lolita, TX 77971 LoneStar Plastics, Inc., 1107 Doster Road, Prattville, AL 36067 Inteplast Group, 455 Somerset Ave Bld 3, North Dighton, MA 02764 Salerno Packaging Inc., 14 Gus Lapham Lane, Plattsburgh, NY 12901 Hartman Plastics, 373 Poplar, Honey Brook, PA 19344 Vifan USA Inc., One Vifan Drive, Morristown, TN 37814 Niaflex Corporation, 7549 Brokerage Drive, Orlando, FL 32809 Pinnacle Films Corporation, 10701-A South Commerce, Charlotte, NC 28273 TODAY S DATE: Application retained for 12 months Position Desired How did you hear about us? PERSONAL Name: Last First Middle Address: Number & City State Zip Code Telephone No. ( ) Cell No. ( ) Business No. ( ) E-mail: EDUCATION AND TRAINING LEVEL High School College / Univ. Post Graduate Other (trade Schools, etc.) NAME & LOCATION OF SCHOOL DID YOU GRADUATE If hired, can you present evidence of your legal right to work in the United States? (Proof of employment eligibility will be required if hired.) Must be 18 years or older to apply. NUMBER OF YEARS COMPLETED DEGREE RECVD. COURSE OF STUDY OR MAJOR List any publications to your credit such as graduate thesis Have you ever served an apprenticeship? Yes No Trade Where When List machines you can operate (business or shop) Where trained? EMPLOYMENT INQUIRY Have you previously applied with or worked for any member of Inteplast Group? Yes No If yes, explain and include dates Type of work desired: Full-time Part-time Summer Internship Are you willing to work a rotating shift? Yes No Which of our locations are you interested in employment? Indicate the position you are applying for, and reason Inteplast Group Application for Employment (Rev. 6/1/12) pg. 1
EMPLOYMENT INQUIRY (Continued) Do you have any commitments or agreements with another employer that might affect your employment with this company? Yes No If yes, please explain Will you relocate? Yes No Will you travel? Yes No Limitations When will you be available for work? Wage / Salary Desired: EXPERIENCE To be prepared by all applicants. List all employment for the past ten (10) years (attach sheet if more space is needed). A resume may be attached as a supplement to this section; however, ALL blanks, dates, salaries, etc. must be completely filled in. List most recent position first. Name of Employer Title of Present or Last Position Title of First Position Starting Salary Present or Last Salary Reason for leaving or desiring a change May we communicate with present employer? Yes No Name of Employer Title of Last Position Title of First Position Starting Salary Last Salary Reason for leaving or desiring a change Inteplast Group Application for Employment (Rev. 6/1/12) pg. 2
EXPERIENCE (Continued) Name of Employer Title of Last Position Title of First Position Starting Salary Last Salary Reason for leaving or desiring a change OTHER PERIODS State what you did in other periods not already covered. Include periods of self-employment, part-time or temporary work during the 10 years preceding the date of this application. From To Employer, Address, Job Title and Reason for Leaving Month Year Month Year HAVE YOU EVER BEEN FIRED, ASKED TO RESIGN, OR LAID OFF FOR ANY POSITION? Yes No If yes, explain REFERENCES List individuals who can attest to your professional abilities/work accomplishments. (Do not include previously listed supervisors) NAME ADDRESS BUSINESS PHONE POSITION OR RELATIONSHIP TO YOU Inteplast Group Application for Employment (Rev. 6/1/12) pg. 3
DRIVER INFORMATION Complete this section ONLY if you are applying for a position regulated by the U.S. Department of Transportation. ALL BLANKS MUST BE FILLED IN COMPLETELY DATE OF BIRTH SOCIAL SECURITY NUMBER Please list your full address for three (3) years preceding the date of this application. Include street, city, state, zip code and # of years at the address. (Attach sheet if more space is needed) Please list information regarding all unexpired commercial motor vehicle operator s licenses or permits. Driver s License # State Type Exp. Date List all Current Endorsements Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No If yes, please explain Has any license, permit or privilege ever been suspended or revoked? Yes No If yes, please explain ACCIDENT REPORT List all motor vehicle accidents in which you were involved during the three (3) years preceding the date of this application. (Attach sheet if more space is needed) Date of Accident Nature of Accident Result in Fatality or Personal Injury? If you listed an accident above, did you receive a citation? Yes VIOLATION OF MOTOR VEHICLE LAWS - ORDINANCES List all violations of motor vehicle laws or ordinances (other than violations involving only parking) of which you were convicted or forfeited bond or collateral during the three (3) years preceding the date of this application. (Attach sheet if more space is needed) Date Convicted Nature of Violation State of Violation Location No Penalty (forfeited bond, collateral and/or points) EXPERIENCE Class of Equipment Products Hauled Type of Equipment (Van, Tank, Flatbed, etc.) Straight Truck # of Years Driven Tractor & Semi-Trailer Tractor Two Trailers Other List any driver training certificates or driver safety awards earned in the previous three (3) years Inteplast Group Application for Employment (Rev. 6/1/12) pg. 4
DECLARATIONS AND ACKNOWLEDGEMENTS Please read these statements carefully before affixing your signature. In accordance with 606 of Title VI of the Consumer Credit Protection Act, you are hereby advised that Inteplast Group and members of this Group may procure or cause to be prepared an investigative consumer report, including information as to your character, general reputation, and personal characteristics, whichever are applicable; and you are further advised of your right, within a reasonable time of this notice, to make written requests of Inteplast for a complete and accurate disclosure of the nature and scope of the investigation requested. I declare that I have a genuine interest in being hired and employed with Inteplast Group, or a member of this Group, and understand that the receipt of this application does not imply I will be employed. I certify that all of the statements on my application, resume and those made during any job interview are true and correct. I agree to assume a continuing responsibility to disclose any additional or new information called for by this application, my resume, or job interviews but that became known to me only after completing my application, resume, or job interviews. I understand that any false or misleading statements or failure to make such disclosures are grounds for immediate termination, regardless of when such a falsification or failure to disclose may be discovered. I hereby request and authorize any school I have attended or any current or former employer to release all information contained in their records as requested by Inteplast or a member of Inteplast Group. I do hereby release any such school or employer from any liability or cause of action that may arise from compliance with this request. Employment in the position for which you have applied may be contingent upon completion of a company-paid pre-employment physical examination. Your offer of employment may be rescinded if the physical examination shows that you are unable, with or without accommodation, to meet the physical requirements necessary to perform the essential functions of the job. I also understand that Inteplast and any member of this Group strictly prohibit employee involvement with illegal drugs or the abuse of prescription drugs and/or alcohol. If employed, any such involvement on my part will result in disciplinary action up to and including termination. I understand that the organization may require me to pass a drug and/or alcohol test as permitted by law. Refusal to take a drug and/or alcohol screen is grounds for immediate termination. I acknowledge that access to company premises is conditioned upon the organization s right to search the person, vehicle, or personal effects of any employee or visitor. If employed, I agree that upon termination of my employment, I will return all company property and records in my possession. I agree that the cost of any company property not returned at the end of my employment shall be deducted from any wages or monies due me to the extent permitted by law. I further understand and agree that nothing in this application is intended to imply or create an employment relationship or contract for employment. Further, I understand and agree that if there were to be an offer of employment; employment would be offered at will. Hence, I would have the right to resign my employment with the company with or without cause or notice, and the company would have the right to terminate my employment at will, with or without cause or notice. I understand that only the Director of Corporate Human Resources & Communications of Inteplast has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the at-will employment relationship, and any such agreements must be in writing. I also understand that any handbooks, manuals, policies, and procedures maintained by the company are not contractual in nature and may be amended or abolished at the sole discretion of the company at any time. Massachusetts Applicants: I understand that it is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. I understand that if I am applying for a position regulated by the U.S. Department of Transportation, the information I provided regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e). I understand that if I held a position regulated by the U.S. Department of Transportation during the preceding three years, I have the right to: -Review information provided by current/previous employers. -Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to Inteplast Group; and -Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information. I certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. Applicant Signature Date / / Inteplast Group Application for Employment (Rev. 6/1/12) pg. 5