Employment Application

It is the policy of VR Concrete, Inc. to provide equal employment opportunities to all applicants and employees with out regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status. Print & Fax

First Name: Last Name:

Address: City:

State: Zip: Phone Number:

Best time to contact you at this number:

Email:

Emergency Contact Information

First Name: Last Name:

Address: City: State: Zip:

Relation: Day Time Phone #: Evening Phone #:

Employment Information

Position Applying for: Salary Desired: Per:

Referred by:

Are you at least 18? Yes No If you are not 18, can you prove work eligibility? Yes No

Are you eligible for employment in the United States? Yes No

Have you applied here before? Yes No If yes, give date:

Have you been employed with us before? Yes No If yes, give date:

Do you have a family, relative or friend working with us?

Yes No If yes, provide name & relation:

Are you currently employed? Yes No May we contact your employer? Yes No

How will you get to work?

Are you willing to work any shifts including nights and weekends? Yes No

If no, please state limitations:

Education

School	School Address	Course of Study	Years Completed	Diploma or Degree
High School
Undergraduate College
Graduate / Professional
Other (Specify)

Additional Education Information

Please include information that may be helpful for the position you are applying for including any special vocational or technical training, awards, achievements, and honors.

Additional Skills

Please list any skills that me be useful for the position. Include the number of years of experience, and select your ability level (level one beginner, level 5 exceptional).

Employment Experience

List your current and most recent employment first.

Employer 1 May we contact? Yes No

Employer 1		Dates Worked
Address
Phone#		Pay Rates
Position
Supervisor		Work Duties
Reason for Leaving

Employer 2 May we contact? Yes No

Employer 2		Dates Worked
Address
Phone#		Pay Rates
Position
Supervisor		Work Duties
Reason for Leaving

Employer 3 May we contact? Yes No

Employer3		Dates Worked
Address
Phone#		Pay Rates
Position
Supervisor		Work Duties
Reason for Leaving

REFERENCE

Please provide at least 2 people who would be willing to provide a reference for you.

Name	Title	Phone	Best Time to Call

Please provide any other information that you believe should be considered.

I HAVE CAREFULLY READ THE BELOW CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

I Agree I Disagree

CERTIFICATION

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize VR Concrete, Inc. to contact former employers and educational organization regarding my employment and education organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If any employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be entirely voluntary in nature. In other words, with appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer would have the same right. Moreover, no agent, representative, or employee of VR Concrete, Inc, except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship.

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