Application for Employment Viskase Companies, Inc. (the "Company"), is an equal opportunity employer and complies with all federal, state and local laws that Prohibit discrimination in employment because of race, color, creed, national origin, ancestry, religion, age, gender, sexual orientation, marital or veteran status, disability or any other basis prohibited by applicable law.

POSITION(S) FOR WHICH YOU ARE APPLYING APPLICATION DATE

PERSONAL INFORMATIONFULL NAME

LAST, FIRST, MIDDLE

PRESENT ADDRESS

STREET, CITY, STATE, ZIP HOW LONG  PRIMARY TELEPHONE NUMBER

PREVIOUS ADDRESS

STREET, CITY, STATE, ZIP HOW LONG PRIMARY E-MAIL ADDRESS

IF NO PHONE, HOW MAY WE CONTACT YOU?

Are any of your relatives presently employed with VISKASE? YES NOIf YES, provide name, relationship, and location of employee:

Have you previously applied, interviewed with, or been employed by VISKASE? YES NO If yes, provide date of application/interview/employment

How were you referred: ADVERTISMENT WALK-IN VISKASE EMPLOYEE OTHER:If VISKASE employee, state relationship:

GENERAL INFORMATIONAre you at least 18 years of age? YES NO If no, are you authorized to work, or, if necessary, can you obtain working papers?

Are you able to perform, with or without reasonable accommodation, the essential functions of the job for which you are applying? YES NO

The Company will work with an otherwise qualified individual to reasonably accommodate his or her disability. Job applicants should direct all requests for accommodations to Human Resources.

Do you have the legal right to work in the United States? YES NO

Will you now or in the future require immigration sponsorship to work in the United States? YES NO If yes, state work permit or visa type and expiration date:

Immigration Reform and Control Act (IRCA) The Immigration Reform and Control Act (IRCA) prohibits the employment of unauthorized aliens and further requires that if you are hired, Viskase must verify your identity and your authority to work in the United States, even if you are a U.S. citizen. You are responsible for obtaining and providing the documentation required to perform the verification. (Information concerning this verification procedure and requirements is available upon request.)

NO Have you ever been discharged from any employment or asked to resign? YES If YES, please explain:

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EMPLOYMENT HISTORYNote: Account for your entire employment history (most recent first including periods of self-employment). Attach additional pages, if necessary.

1EMPLOYER FROM TO JOB TITLE

MO. YR. MO.  YR.

ADDRESS PHONE NUMBER

REASON FOR LEAVING (Please Explain) STARTING SALARY

ENDING SALARY

NAME & TITLE SUPERVISOR

$ $

OTHER COMPENSATION (Bonus, Long Term Incentive)

DESCRIBE WORK PERFORMED AND SCOPE OF RESPONSIBILITIES

EXPLAIN ANY PERIOD BETWEEN JOBS:

2EMPLOYER FROM TO JOB TITLE

MO. YR. MO.   YR.

ADDRESS PHONE NUMBER

REASON FOR LEAVING (Please Explain) STARTING SALARY

ENDING SALARY

NAME & TITLE SUPERVISOR

$ $

OTHER COMPENSATION (Bonus, Long Term Incentive)

DESCRIBE WORK PERFORMED AND SCOPE OF RESPONSIBILITIES

EXPLAIN ANY PERIOD BETWEEN JOBS:

3EMPLOYER FROM TO JOB TITLE

MO. YR. MO.   YR.

ADDRESS PHONE NUMBER

REASON FOR LEAVING (Please Explain) STARTING SALARY

ENDING SALARY

NAME & TITLE SUPERVISOR

$ $

OTHER COMPENSATION (Bonus, Long Term Incentive)

DESCRIBE WORK PERFORMED AND SCOPE OF RESPONSIBILITIES

EXPLAIN ANY PERIOD BETWEEN JOBS:

3 

4EMPLOYER FROM TO JOB TITLE

MO. YR. MO.   YR.

ADDRESS PHONE NUMBER

REASON FOR LEAVING (Please Explain) STARTING SALARY

ENDING SALARY

NAME & TITLE SUPERVISOR

$ $

OTHER COMPENSATION (Bonus, Long Term Incentive)

DESCRIBE WORK PERFORMED AND SCOPE OF RESPONSIBILITIES

EXPLAIN ANY PERIOD BETWEEN JOBS:

EDUCATIONEDUCATION TYPE

OF SCHOOL NAME AND ADDRESS OF SCHOOLFIELD OF STUDY 

CIRCLE LAST YEAR ATTENDED GRADUATED DEGREE

HIGH SCHOOL 9 10 11 12 YES NO

COLLEGE 1 2 3 4 YES NO

COLLEGE 1 2 3 4 YES NO

GRADUATE SCHOOL 1 2 3 4 YES NO

PROFESSIONAL LICENSES (indicate license name, issuing state or jurisdiction, license number, year obtained and expiration date):

ADDITIONAL EXPERIENCE OR QUALIFICATIONSList any other experience, skills or other qualifications including hobbies, which you believe should be considered in evaluating your qualifications for employment. Please indicate any prior military service that you would like considered in connection with your application for employment.

ATTENDANCE AND PUNCTUALITY INFORMATIONConsistent attendance and punctuality are essential requirements of every job with this company. Is there anything that would interfere with your regular attendance and punctuality if you are offered a job with the company? YES NOIf YES, please explain:

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PERSONAL OR BUSINESS REFERENCESProvide the names and contact information for three professional or equivalent references whom you have known for at least three years and are familiar with your work performance. References should not include immediate or extended family. Equivalent references can include academic references, such as professors, mentors, counselors, or advisors. Two references must be or have been individuals to whom you reported directly or provide the reason you cannot provide two supervisory references. Be aware that we will be contacting the references you have chosen to list below.

Name Contact Information Relationship1

2

3

If not listed as a reference, may we also contact your present employer?    YES   NO. 

NOTIFICATION AND AGREEMENTPLEASE READ BEFORE SIGNING

I certify that all the information I have provided on this application is true and complete to the best of my knowledge. I understand that omitting requested information or giving false or misleading information on my application (even if I believed the information to be true), in my interview(s), or in the process of my pre-employment evaluation may result in rejection of my application or termination of employment. I authorize the Company to verify the information I have provided in this application and, if I am hired, I authorize continuing investigation of all statements contained in this application, consistent with applicable law.

I understand that employment and continued employment is subject to satisfactory completion of a background check and proof of my authorization to work in the United States, all conducted and/or required in accordance with applicable laws. Past conviction of a crime is not an automatic bar to employment. The nature, time since conviction, disposition of conviction and other factors deemed relevant by the Company for the position will be considered as it relates to the job you are seeking and consistent with applicable law.

To the maximum extent permitted by law, I hereby release and hold harmless all persons and entities, including my present employer, requesting or supplying information about my background and, to the maximum extent permitted by law, I also release the Company and any contractor or vendor retained by the Company from all liability in connection with the conduct of a background check in connection with my application for employment.

Notwithstanding the foregoing, I understand that this Application of Employment does not constitute an offer of employment by the Company. Employment with the Company is for an indefinite and unspecified duration. If I am hired, I may leave employment at will, and the Company may discharge me or any or all other employees at any time, without notice, and for any reason not prohibited by law.

I agree that any claim or lawsuit relating to my application for employment and, if applicable, employment or termination from employment with the Company must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitation to the contrary to the maximum extent permitted by law.

FOR ARIZONA APPLICANTS: PURSUANT TO ARIZ. REV. STAT § 36-601.01, THE COMPANY MAINTAINS A SMOKE-FREE WORKPLACE.

FOR RHODE ISLAND APPLICANTS: THE COMPANY IS SUBJECT TO CHAPTER 29-38 OF TITLE 28 OF THE GENERAL LAWS OF RHODE ISLAND AND IS THEREFORE COVERED BY THE STATE’S WORKERS’ COMPENSATION LAW.

FOR MARYLAND APPLICANTS: I ACKNOWLEDGE THAT, UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

_________________________________________________________________________________________________ Signature Date

FOR MASSACHUSETTS APPLICANTS: I ACKNOWLEDGE 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.

________________________________________________________________________________________________ Signature Date

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If hired, I agree to abide by all of the Company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without Notice, at any time, at the option of either the company or me or in accordance with any applicable collective bargaining agreement. I further understand that no representation, whether oral or written, by any representative or agent of the Company, at any time, constitutes a contract of employment. I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the Company has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by an officer of the Company, or to make any agreement contrary to the foregoing.

As a condition of my application being considered, I understand and agree to undergo substance abuse screening of my hair follicle. If employed and I ever appear to the employer to be impaired, am involved in an accident or safety incident, or hold a safety critical job, or I am recalled from layoff, I may be subject to further substance screening including screening of my hair follicle, blood, urine, breath, and saliva, or face disciplinary consequences, up to and including loss of employment. I hereby authorize any physician, laboratory, hospital, or medical professional retained by the Company for the Substance Abuse Program purposes to both conduct such screening and provide the results thereof to the Company, and I release Viskase Companies, Inc., its agents, employees and any such institution or person from liability therefore. I have read and understand the Program as described above and agree to be bound thereby for purposes of applying for and accepting employment at Viskase Companies, Inc. (“the Company”).

I agree that as a condition of employment and continued employment, I will sign Viskase Companies Inc.’s Confidentiality and Non-compete Agreement.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application. 

APPLICANT SIGNATURE:____________________________________________________ DATE:__________________________________

EEO VOLUNTARY SELF IDENTIFICATION FORM

Viskase Companies, Inc. is an equal opportunity employer. We do not discriminate in hiring or employment because of race, color, religion, creed, national origin, sex, sexual orientation, gender identity, age, disability veteran status, or any other legally protected status.

We are collecting the information below to comply with certain reporting obligations imposed by federal law on private employers. Your cooperation in completing this form is completely voluntary and any refusal to provide it will not subject you to any adverse treatment. Responses will remain confidential within the Human Resources Department and will be used only in connection with our reporting requirements to the government.

Date: Position applied for:

Name:

Referral Source: Advertisement (print) Employee Referral Walk-in

Employment Agency Internet (specify site)

Other

EEO Survey

Government agencies require periodic reports on the sex and ethnicity of applicants and employees. This data will be used for analysis and reporting only. Choose one race/ethnic group. Submission of information is voluntary.

Sex: Male Female

Race/Ethnic Group Hispanic or Latino White Black or African American

Native Hawaiian or Other Pacific Islander Asian

American Indian or Alaska Native Two or more races

Definitions

Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.

:

__________________________ __________________

Voluntary Self-Identification of Disability Form CC-305

OMB Control Number 1250-0005 Expires 1/31/2017

Page 1 of 2

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to

qualified people with disabilities i To help us measure how well we are doing, we are asking you to tell us if you

have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will

choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used

against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may

become disabled at any time, we are required to ask all of our employees to update their information every five

years. You may voluntarily self-identify as having a disability on this form without fear of any punishment

because you did not identify as having a disability earlier.

.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that

substantially limits a major life activity, or if you have a history or record of such an impairment or medical

condition.

Disabilities include, but are not limited to:

Blindness

Deafness Cancer Diabetes

Epilepsy

Autism

Cerebral palsy

HIV/AIDS

Schizophrenia

Muscular dystrophy

Bipolar disorder

Major depression

Multiple sclerosis (MS)

Missing limbs or partially missing limbs

Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair

Intellectual disability (previously called mental retardation)

Please check one of the boxes below:

YES, I HAVE A DISABILITY (or previously had a disability)

NO, I DON’T HAVE A DISABILITY

I DON’T WISH TO ANSWER

Your Name Today’s Date

i

Voluntary Self-Identification of Disability Form CC-305

OMB Control Number 1250-0005 Expires 1/31/2017

Page 2 of 2

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.

Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples

of reasonable accommodation include making a change to the application process or work procedures,

providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal

employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract

Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required

to respond to a collection of information unless such collection displays a valid OMB control number. This

survey should take about 5 minutes to complete.

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Invitation for Voluntary Inclusion in the Affirmative Action Program for Protected Veterans

It is the policy of Viskase Companies, Inc. to recruit, select and employ qualified recently separated veterans, Armed Forces service medal veterans, active duty wartime or campaign badge veterans, disabled veterans, and any other protected veterans. Viskase Companies, Inc. complies with Section 4212 of the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002.

In accordance with these laws, Viskase Companies, Inc. has developed affirmative action programs to employ and advance in employment qualified recently separated veterans, Armed Forces service medal veterans, active duty wartime or campaign badge veterans, disabled veterans, and other protected veterans. Viskase Companies, Inc. will, where appropriate, consider reasonable accommodations for qualified disabled veterans. If you are a recently separated veteran, Armed Forces service medal veteran, active duty wartime or campaign badge veteran, disabled veteran, and/or any other protected veteran and would like to be considered under our affirmative action programs, please complete the sections below. Appropriate definitions of these terms are provided for your convenience.

Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.

If you are a disabled veteran it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability.

Providing this information is voluntary and refusal to provide this information will not subject any individual to adverse treatment by Viskase Companies, Inc. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended.

The information provided will be kept in strict confidence, except that (a) necessary management and supervisory personnel may be informed regarding restrictions on the work or duties of disabled veterans and regarding necessary accommodations, (b) first aid and safety personnel may be informed, to the extent appropriate, that you have a condition that might require emergency treatment, and (c) government officials investigating affirmative action program compliance may be informed pursuant to the above cited laws and the Americans with Disabilities Act.

We request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we make pursuant to the above cited laws. If you believe you belong to any of the categories of protected veterans listed below, please indicate by checking the appropriate box below.

For post-offer applicants: if you choose not to self-identify at this time, you may do so at any time during your employment.

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INVITATION TO SELF-IDENTIFY PLEASE ANSWER THE FOLLOWING QUESTIONS

Do you identify as one (or more) of the following protected veteran categories? Please check the appropriate box below.

Disabled Veteran: (i) a veteran of the U.S. military, ground, naval, or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veteran Affairs; or (ii) a person who was discharged or released from active duty because of a serviceconnected disability.

Recently Separated Veteran: any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.

Armed Forces Service Medal Veteran: a veteran who, while serving on active duty in the U.S. military, ground, naval, or air service, participated in a United States military operation for which an Armed Forces medal was awarded pursuant to Executive Order 12985.

Active Duty Wartime or Campaign Badge Veteran: a veteran who served in the U.S. military, ground, naval, or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

I am a protected veteran. I am not a protected veteran. I prefer not to answer.

In addition to our affirmative action obligations, we value all forms of military service. If you are not a protected veteran as described above but would like to disclose your status as a member of the military, you may do so below. Are you currently serving, or have you served, in the Armed Forces of the United States of America (including the Reserves and National Guard)?

Yes. No. I prefer not to answer.

Name: 

Position(s) applied/hired for: 

Date: