Employment Application ICT Caliber Concrete

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Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Home Phone*

Cell Phone

In the past 10 years, have you been convicted of a misdemeanor or felony?*

No
Yes

Conviction is not necessarily a bar to employment.

If yes, please explain*

Have you worked for ICT Caliber Concrete in the past?*

No
Yes

If yes, please provide dates and position held*

Can you, after employment, submit verification of your legal right to work in the U.S.?*

Yes
No

Only U.S. citizens or aliens who have a legal right to work in the U.S. are eligible for employment.

Employment Interests/Skills

Position for which you are applying*

Salary Requirement*

Date available for work*

Referral Source*

Referred By

Concrete Knowledge/Experience

Education

High School (Name & Location)*

Last Grade / Level Completed*

Diploma*

Yes
No

College, Business, Vocational

Course/Major

Last Level Completed

Diploma/Degree

Other Training (use as much space as needed)

Motor Vehicle Driver Applicants–Complete

Do you have or can you obtain a valid driver's license?*

Yes
No

Only if required by position.

Employment History

Please provide employment information beginning with current or most recent employer. Account for all time periods including unemployment, self-employment and U.S. Military Service. Please provide all the requested information for each job as space permits.

Employer Name, City, State, and Phone Number*

Job Title*

Start Date of Employment

End Date of Employment

Starting Salary

Ending Salary

Duties and Responsibilities

Reason for Leaving

May we contact this employer?*

Yes
No

Employer Phone*

Employer Name, City, State, and Phone Number

Job Title

Start Date of Employment

End Date of Employment

Starting Salary

Ending Salary

Duties and Responsibilities

Reason for Leaving

May we contact this employer?

Yes
No

Employer Phone*

Employer Name, City, State, and Phone Number

Job Title

Start Date of Employment

End Date of Employment

Starting Salary

Ending Salary

Duties and Responsibilities

Reason for Leaving

May we contact this employer?

Yes
No

Employer Phone*

References

Please provide Professional references only.

Name

Company

Phone

Years Known

Name

Company

Phone

Years Known

Name

Company

Phone

Years Known

Resume Document(s)

Allowed file types: PDF, TXT, DOC, DOCX, RTF. Maximum file size: 2MB each.

1. Click "Browse" to select your first file.

Accepted file types: txt, doc, docx, rtf, pdf, Max. file size: 2 MB.

2. Click "Browse" to select your second file.

Accepted file types: txt, doc, docx, rtf, pdf, Max. file size: 2 MB.

3. Click "Browse" to select your third file.

Accepted file types: txt, doc, docx, rtf, pdf, Max. file size: 2 MB.

Statement Certification

I certify that the statements made in this application are true and correct and understand that falsification of such statements and information is grounds for immediate dismissal in accordance with ICT Caliber Concrete policy. In consideration of my employment, I agree to conform to the rules and regulations of ICT Caliber Concrete and realize that my employment and compensation can be terminated at any time, with or without notice, by the Company or myself. I understand that no ICT Caliber Concrete representative has the authority to enter into any other agreement with me for employment for any specified period of time or to make any agreement contrary to the foregoing statement. I understand that employment may be contingent upon passing a motor vehicle records check and a security background check if included in the position requirements. I agree to authorize ICT Caliber Concrete to verify statements made in this application, and authorize all previous employers or other persons having knowledge of myself or my record to release such information to ICT Caliber Concrete. I hereby release those companies and persons and ICT Caliber Concrete from all claims and liabilities that may arise by such disclosures or such investigation.

Statement Certification*

I agree with this statement.

Notice to Applicants - Drug Free Workplace

ICT Caliber Concrete has a Drug Free Workplace Policy which strictly prohibits the use, purchase, sale or distribution of illegal drugs (meaning those drugs for which there is no generally accepted medical use, e.g., marijuana, cocaine, opiates, phencyclidine (PCP), amphetamines, or a metabolite of those drugs), drug paraphernalia, or use of alcohol by an employee in a company vehicle, at a job site, on company property, without company approval, or during work hours. A requirement for consideration of employment with ICT Caliber Concrete is the passing of a pre-employment test for the presence of illegal drugs. Any prospective employee who tests positive for the presence of illegal drugs will not be offered employment with the company. Applicants who become employees of ICT Caliber Concrete will be required to comply with the company’s Drug Free Workplace Policy which also includes random, reasonable cause, reasonable suspicion and post-accident testing.

Notice to Applicants - Drug Free Workplace*

I understand this policy.

Voluntary Affirmative Action Information

ICT Caliber Concrete is an Equal Opportunity Employer. We consider applicants for all positions without regard to sex, race, color, religion, national origin, age, veteran’s status, disability, or any other legally protected status.We request your cooperation in providing the following information which will be used in accordance with federal and state statutes and regulations regarding Equal Employment Opportunity and Affirmative Action. Providing this information is voluntary. All information received remains separate from your employment application and is not used in any way during the interviewing and hiring process.If you choose not to provide this information, check the box below indicating your decision. The absence of this data will, however, limit our effectiveness in auditing our employment practices and meeting fair employment reporting requirements.

Gender*

Male
Female
Do Not Wish to Identify

Veteran*

Protected Veteran
Not a Protected Veteran
Do Not Wish to Identify

Race and Ethnic Identification*

Please indicate your ethnicity or race by selecting an option below. If you are Hispanic/Latino, please select the Hispanic category. If you are not Hispanic/Latino, please select one of the other categories.

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture of 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 Alaskan Native (not Hispanic or Latino): A person having origins in any of the original peoples of North America and South American (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino): A person who identifies with more than one of the above five races.
Do Not Wish to Identify

Voluntary Self-Identification of Disability

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. 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 select one of the options below*

Yes, I have a disability
No, I don't have a disability
I don't wish to answer

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.

Reasonable Accommodation Notice*

I understand this policy.

EMPLOYMENT APPLICATION

Personal Information

Employment Interests/Skills

Education

Motor Vehicle Driver Applicants–Complete

Employment History

References

Resume Document(s)

Statement Certification

Notice to Applicants - Drug Free Workplace

Voluntary Affirmative Action Information

Voluntary Self-Identification of Disability

Reasonable Accommodation Notice