Job Listing

General information
Employment Experience

Application for Employment

Equal access to programs, services and employment is available to all persons. Those applicants requiring a reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department. We are an equal opportunity employer.

Position applied for

Application Date

First Name

Middle Name

Last Name

Agree to show contact information in public posting (optional)

ADDRESS:

Address Line 1

City

State

Zip Code

Cell/other Number

Home Phone

Email address

Shift preferred

Shift 1

Shift 2

Shift 3

Any

Expected Pay

Would you accept full-time work?

Yes

Would you accept part-time work?

Yes

On what date would you be available for work?

If necessary, best time to call you is

Where would you like us call?

Home

Cell other

How were you referred to our Company?

Have you submitted an application here before?

Yes

If yes, please give date(s) and position(s):

Have you ever been employed here?

Yes

If yes, please give dates:

Is this application a request for reemployment following an extended military leave of absence from our Company?

Yes

If yes, additional information may be requested.

If you are under 18 years old, can you provide a work permit if required?

Yes

Are you legally eligible for employment in the United States? (If yes, proof is required if hired.)

Yes

Are you able to perform the "essential functions” of the job for which you are applying (with or without reasonable accommodation)? NOTE: This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage, to the extent permitted by law.

Yes

Need more information about the job's "essential functions” to respond

Will you travel if required?

Yes

Will you work overtime if required?

Yes

If they have been explained to you, are you able to meet the attendance requirements of the position?

Yes

N/A

Have you ever been bonded?

Yes

Please provide your driver's license number, if driving is required for this job.

State

Do you have a class A or B driver's license?

List any endorsements you have.

Have you entered into an agreement with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our Company?

Yes

If yes, please explain:

NOTE: Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Have you ever pleaded guilty" or "no contest” to, or been convicted of, a crime?

Yes

If yes, please provide date(s) and details:

Employment Experience

Place a NO by the employer(s) you DO NOT want us to contact. List your most recent employer first.

Contact employer

Yes

Employer

Contact Name

ADDRESS:

Address Line 1

City

State

Zip Code

Phone Number

Job Title

Supervisor

Dates employed:

From

Hourly rate/salary:

starting salary

final salary

Work performed

Reason for leaving

What did you like most about your position?

What were the things you liked least about the position?

Employer 2

Contact employer

Yes

Employer

Contact Name

ADDRESS:

Address Line 1

City

State

Zip Code

Phone Number

Job Title

Supervisor

Dates employed:

From

Hourly rate/salary:

starting salary

final salary

Work performed

Reason for leaving

What did you like most about your position?

What were the things you liked least about the position?

Employer 3

Contact employer

Yes

Employer

Contact Name

ADDRESS:

Address Line 1

City

State

Zip Code

Phone Number

Job Title

Supervisor

Dates employed:

From

Hourly rate/salary:

starting salary

final salary

Work performed

Reason for leaving

What did you like most about your position?

What were the things you liked least about the position?

Explain any gaps in your employment, other than those due to personal illness, injury or disability.

Have you ever been fired or asked to resign from a job?

Yes

If yes, please explain:

Education Background

High School

Location

Course of study

Did you graduate?

Yes

Degree or diploma

College:

Location

Course of study

Did you graduate?

Yes

Degree or diploma

Graduate School:

Location

Course of study

Did you graduate?

Yes

Degree or diploma

Vocational Training/Other:

Location

Course of study

Did you graduate?

Yes

Degree or diploma

Other Continuing Education:

Special Training or Skills

Languages, machine operation, etc., that would be of benefit in the job for which you are applying.

Social Security Number

SS# The Company will make reasonable efforts to safeguard the privacy of this information and will use it only for employment purposes.

References

List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Name

Title

Relationship to You

Phone #

Years Known

Name

Title

Relationship to You

Phone #

Years Known

Name

Title

Relationship to You

Phone #

Years Known

Applicant Statement

I certify the below statement

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false or misleading information, omissions or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time. If hired, I agree to conform to the Company's rules and regulations, and I understand that these rules and/or the employee handbook do not form a contract of employment either express or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the Company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the Company. I understand that no Company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the forgoing. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, résumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives for seeking, gathering and using truthful and nondefamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. I also understand that, if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States as required by federal immigration laws. This Company does not tolerate unlawful discrimination or harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state or local law. No question on this application is used to limit or exclude an applicant from employment consideration on any basis prohibited by applicable federal, state or local law.

Signature

Sign Here

Date

AUTHORIZATION TO REQUEST MOTOR VEHICLE RECORD

Federal and state laws provide individuals with privacy rights with respect to personal information contained in their motor vehicle record. Disclosure of your motor vehicle record is permitted under specified circumstances. Two of those circumstances are (1) upon the written consent of the driver; and (2) for use by any insurer or insurance support organization or its agents, employees, or contractors, in connection with claim investigation activities, antifraud activities, insurance rating or underwriting.

In connection with your driving vehicles owned by Carolina Concrete Finishing and Materials, Inc. from time to time CCFM must obtain a copy of your motor vehicle record from the state Division of Motor Vehicles.

THE UNDERSIGNED DOES HEREBY ACKNOWLEDGE AND CERTIFY AS FOLLOWS:

That the undersigned gives his/her consent to the release of his/her driving record for use by Carolina Concrete Finishing and Materials, Inc.

Driver Name:

License # and State of Issuance:

Upload picture of the front of your driver's license

Choose File

Upload picture of the back of your driver's license

Choose File

Date of Birth

Social Security No.

Signature

Sign Here

Date