An Equal Opportunity Employer. If you are disabled and require assistance in the application process, please let us know.

Application For Employment

Date

GENERAL INFORMATION
Name Address Social Security No. Home Telephone Work Telephone ( ( ) )

Are you a US citizen or otherwise authorized to work in the United States? Yes Proof of eligibility to work in the United States will be required upon employment.

No

Have you been employed previously by any affiliated company of Innophos, Inc., including without limitation AMT Labs / Kelatron Corporation / Triarco Industries? (specify date and location)

Position(s) you are applying for: Will you work overtime? Yes No Will you travel? Yes No Will you work shift assignments? Yes No

State any limitations on your working hours How were you referred to us for employment? Employee Referral (Please specify) Employment Agency (Please specify) Other (Please specify) Walk-In Newspaper Ad College Recruitment

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EMPLOYMENT HISTORY
Please account for all jobs held beginning with your present or most recent employer. (Include military service if applicable.)

Position Title

Company Address

Reason for Leaving

Responsibilities / Achievements Dates of Employment: From To Salary History: Start End Position Title Company Address Reason for Leaving

Responsibilities / Achievements Dates of Employment: From To Salary History: Start End Position Title Company Address Reason for Leaving

Responsibilities / Achievements Dates of Employment: From To Salary History: Start End

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EARLIER EMPLOYERS Position Title

Company Name / Address

Dates of Employment

Are you licensed to practice any trade or profession? authority and expiration date

Yes

No If yes, state nature of license issuing

List any skills or abilities which may be relevant to the position(s) you are seeking

EDUCATION AND TRAINING NAME AND LOCATION DEGREE ACCUMULATED CREDIT HOURS MAJOR

High School

Technical / Business School

College

Graduate School

List any business or professional organizations to which you currently belong:

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REFERENCES May we communicate with your present employer at this time?

Yes

No Yes No

If not, may we communicate in confidence with anyone else, such as clients or former employees?

Name

Business Relationship

Company

Telephone

List additional business references below. Attempt to provide supervisors, peers and subordinates. Name Business Relationship Company

Telephone

Are you currently a party to a non-competition or similar agreement or restrictive covenant covering your future employment? Yes No If yes, please provide a copy so that the Company can determine if the agreement or covenant applies to or otherwise could affect your employment by the Company. Have you ever been convicted of a criminal offense? Yes No Please explain:

(Disclosure of a criminal record does not automatically disqualify you for employment.) APPLICANT CERTIFICATION I certify that the information given by me in this application is true in all respects, and I authorize the Company to contact my former employers, references and other sources in order to verify the facts furnished regarding my character, qualifications, and previous employment record. I hereby release any such employer or person from liability for furnishing such information, I understand that any misleading, incorrect or untruthful statements or actions may render this application void, and if I am employed, would be just cause for termination of my employment. Further, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between the Company and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the Company. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and that the Company retains a similar right. If I am offered employment, I understand and agree to review the Innophos Employee Booklet and Code of Ethics, which sets forth my obligations with regard to anti-trust law, patents, inventions and the company's proprietary confidential information, and my agreement to abide by them. In addition, if I am offered employment, I understand and agree to undergo a physical to include substance screening of my blood or urine or other medical substance screening procedures for the purpose of assuming employment and acknowledge that refusal to submit to any part of this procedure will terminate the employment process. I hereby authorize any Company designated physician, laboratory, hospital or medical professional to conduct such substance screening and provide the results thereof to the Company. I also understand that all medical examination results, including substance screening, will be maintained in a confidential manner and that only information regarding the presence of illegal or unauthorized substances or my ability to perform the essential functions of the job offered will be disclosed.

APPLICANTS SIGNATURE This application will be maintained in our current file for six months.

DATE

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