JASPER CENTER NACOGDOCHES WOODVILLE

Which location are you applying for employment? Please check location: Few Ready Mix Concrete Co.

P.O. Box 1870, Jasper, TX 75951

Phone:409-***-**** Fax:409-***-****

Application for Employment

In compliance with the Federal & State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, creed, gender, national origin, age, marital status, or non-job-related disability. Date of Application Who referred you?

Position applied for

Name

Last First Middle

Address Date of Birth

Street

City State

Social Security #

Zip Phone

Driver’s License #

Do you have the legal right to work in the U.S.? DL State and Expiration Date Previous addresses for the past three years:

Street City State Zip How long

Street City State Zip How long

Street City State Zip How long

Have you worked for Few Ready Mix Concrete Co. before? Dates: From To

Reason for leaving:

Which location(s)?

Rate of Pay Position

This job requires a person to lift and carry as much as 94 lbs. to the waist and 50 lbs. to the shoulder. Are you physically capable of completing this task? Yes No Is there any other reason you might be unable to perform the functions of the job for which you are applying? Yes No This position requires you to take both a federally mandated DOT physical and preemployment drug test. Will you be able to take both if asked to? Yes No

Are you currently employed? Yes No If not, how long since leaving last employment? Yes No

Yes No

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding seven (7) years. List complete mailing address, street number, city, state and zip code. List employers in reverse order, starting with the most recent. Add another sheet if necessary. EMPLOYER

Name

DATE

From To

Address Position

City, State, Zip Salary or

Wage/Hour

Contact Person Phone Reason for Leaving

EMPLOYER

Name

DATE

From To

Address Position

City, State, Zip Salary or

Wage/Hour

Contact Person Phone Reason for Leaving

EMPLOYER

Name

DATE

From To

Address Position

City, State, Zip Salary or

Wage/Hour

Contact Person Phone Reason for Leaving

EMPLOYER

Name

DATE

From To

Address Position

City, State, Zip Salary or

Wage/Hour

Contact Person Phone Reason for Leaving

EMPLOYER

Name

DATE

From To

Address Position

City, State, Zip Salary or

Wage/Hour

Contact Person Phone Reason for Leaving

EMPLOYER

Name

DATE

From To

Address Position

City, State, Zip Salary or

Wage/Hour

Contact Person Phone Reason for Leaving

EDUCATION MILITARY SERVICE

Grade completed: Graduation Year: Branch of Service: Last School attended: Rank: Discharge Date:

Any special training or courses that would be relevant: Any special training or courses: ACCIDENT RECORD (for past three (3) years) (Attach sheet if more space is needed) If none, write "none". DATES

NATURE OF ACCIDENT

(Head-on, rear-end, upset, etc.) FATALITIES INJURIES Last Accident

Next Previous

Next Previous

TRAFFIC CONVICTIONS & FORFEITURES (for past three (3) years, other than parking violations) LOCATION DATE CHARGE PENALTY

I certify that answers given herein are true and complete. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event of employment, I understand that false or misleading information given in my application may result in termination.

I agree to pre-employment drug screen and understand the Few Ready Mix Concrete Co. must follow federal drug testing standards and requires a drug and alcohol-free workplace. I authorize Few Ready Mix Concrete Co. to investigate my driving record during the employment initiation process, and at any point during my employment.

I hereby understand and acknowledge that any employment relationship with Few Ready Mix Concrete Co. is of an "at will" nature, which means the employee may resign at any time and Few Ready Mix may terminate at any time with, or without, cause. I understand that my initial 90 days of employment is strictly probationary. Applicant's Signature Date

If Yes, please give explanation:

Has any license, permit or privilege ever been suspended or revoked? Yes No Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No TO BE READ AND SIGNED BY APPLICANT

Contact this candidate