Employment Application First Name Last Name AddressAddress Line 1 Address Line 2 City State Zip Code Email Phone Emergency Contact First Name Emergency Contact Last Name Emergency Contact Phone Position Applying For: Desired Salary Per Referred By Are you 18? Yes NoIf you are not 18, can you prove work eligibility? Yes No Are you eligible for employment in the United States? Yes No Have you ever applied here before? Yes NoWhen did you apply? Have you ever been employed with with us before? Yes No If you've applied before, when? Do you have a family, relative or friend working with us? Yes NoIf so, what are their names and your relation? Are you currently employed? Yes NoMay we contact your employer? Yes NoHow will you get to work? Are you willing to work any shifts including nights and weekends? Highest Level of Education Year or Years Gradudated 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. Please list additional skills with skill level. Level one being beginner, and level 5 being expert. Most Recent Employer First Name Most Recent Employer Last Name Name of Business Recent Employer AddressAddress Line 1 Address Line 2 City State Zip Code Recent Employer Phone & Email Employer 2 First Name Employer 2 Last Name Employer 2 Business Name Employer 2 Address Line 1 Address Line 2 City State Zip Code Employer 2 Phone Number & Email Employer 3 First Name Employer 3 Last Name Employer 3 Business Name Employer 3Address Line 1 Address Line 2 City State Zip Code Employer 3 Phone Number & Email Referrence 1 Referrence 2 Referrence 3 Please provide any other information that you believe should be considered. 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. Agree Disagree I consent to have this website store my submitted information so they can respond to my inquirySubmit
