Recycled Aggregates LLC

	Employment Application


After you have completed this form, click SUBMIT FORM to have an electronic copy sent to us, or you may use our print version and fax it to (202) 507-4677. To process your application, all questions must be answered. If a question does not apply, write N/A.


GENERAL INFORMATION

Today's Date:		Social Security Number:

Applicant Full Name:		Aliases/Maiden/Other Names:

Address Line 1:		Home Phone Number:
Address Line 2:		Cell Phone Number:
City:		Email Address:
State:
ZIP Code:

Are you legally eligible to work in this country?		Yes No	This employer participates in the Federal E-Verify program. If you are hired, you must provide proof of authorization to work in the United States.

Position Applied for:
Salary Requirements:	per year per month per week per hour
Referred by:
Have you ever worked or applied here before?		Yes - if so, when: No
Please list the names of any relatives, close friends, or professional acquaintances currently employed by this company:
Have you ever been convicted of a felony, misdemeanor or any other offense besides a minor traffic violation?		Yes No	Criminal convictions will not necessarily disqualify you from employment, but will be considered only with respect to the specific requirements of the job for which you are applying.

EDUCATION AND TRAINING

High School or Prep Name:	Number of Years Attended:
Course of Study (Degree):	Graduated:	Yes No
	Grade Point Average (GPA):

Business/College/Grad Name:	Number of Years Attended:
Course of Study (Degree):	Graduated:	Yes No
	Grade Point Average (GPA):


WORK EXPERIENCE
Start with the PRESENT or most RECENT employer. Include self-employment, military service, summer and part‐time jobs. If you need more space, please use the COMMENTS section below. Resumes may be attached; however the information below must still be completed.

Company Name:	Position:
Address Line 1:	Start Date:
Address Line 2:	Starting Salary:
City:	End Date:
State:	Ending Salary:
ZIP Code:	Name of Supervisor:
Telephone Number:	Title of Supervisor:
	Reason for Leaving:
	May we contact this employer?	Yes No

Company Name:	Position:
Address Line 1:	Start Date:
Address Line 2:	Starting Salary:
City:	End Date:
State:	Ending Salary:
ZIP Code:	Name of Supervisor:
Telephone Number:	Title of Supervisor:
	Reason for Leaving:
	May we contact this employer?	Yes No


REFERENCES
Please list three (3) personal references not related to you. Providing this means you give this Company permission to contact those individuals listed.

Personal Reference (1):			Address:
Known for how long?			Telephone:

Personal Reference (2):			Address:
Known for how long?			Telephone:

Personal Reference (3):			Address:
Known for how long?			Telephone:

Please list three (3) professional references. These references can be from paid employment or volunteer work.

Professional Reference (1):			Address:
Known for how long?			Telephone:

Professional Reference (2):			Address:
Known for how long?			Telephone:

Professional Reference (3):			Address:
Known for how long?			Telephone:


ADDITIONAL INFORMATION

Use this space to describe skills and aptitudes that you feel qualify you for a position at this Company. You any wish to include civic and community activities, professional societies in which your participate, hobbies, sports, or other special training or skills such as accounting, bookkeeping, work processing, software applications, operation of equipment or other applicable skills. Please do not list organizations or activities which reveal, race, religion, age, sex, national origin or ancestry, sexual orientation, disability or political persuasion. List only organizations that you consider relevant to your ability to do the job for which your are applying.


Other Comments or Details:




CERTIFICATION AND SUBMISSION

TERMS AND CONDITIONS. Recycled Aggregates, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, amnesty or status as a Vietnam‐era or special disabled veteran in accordance with applicable federal, state and local laws. Recycled Aggregates, LLC complies with applicable state and local laws governing non‐discrimination in employment in every location in which the Company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation and training. Recycled Aggregates, LLC expressly prohibits any form of unlawful employee harassment based on race, color, religion, gender, sexual orientation, national origin, age, disability or veteran status. Interference with the ability of Recycled Aggregates, LLC employees to perform their expected job duties will not be tolerated. By signing your name below, you acknowledge and certify: • That all statements made by me on this application are true and complete to the best of my knowledge. • That I have withheld nothing that would affect this application unfavorably. • That any offer I may receive from the Company is contingent upon my successful completion of the Company’s total pre-employment screening process. • That I understand that misrepresentations or omissions may be cause for rejection or may be cause for subsequent dismissal if I am hired. I also understand that nothing contained in this application or in the interview process is intended to create an employment contract between the Company and myself. Should this application result in my employment, it will be an at-will relationship. I have a right to terminate my employment at any time and for any reason and the Company retains the same right. I agree to conform to the rules and regulations of the Company. I further understand that no representative of the Company other than a Senior Officer of the Company has any authority to enter into any agreement with me for any specified period of time or to guarantee some other personnel move or benefit. I also understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me, and a Senior Officer of the Company. I understand that past employers/educational institutions and/or the military may be contacted for references and I authorize any such organization to provide the requested information. I further release and forever discharge the Company, its agents, its employees, and the individuals, companies, and health care providers contacted by this Company as part of its inquiries and investigations, from any and all claims, demands, damages, actions, causes of action, or suits of any kind or nature whatsoever arising from the Company’s inquiries and investigation of my credentials and information in connection with my application. I understand screening tests for alcohol and illegal drug use is required before hiring and during my employment with this Company. I further understand this entire statement applies to the period before, or after, I may be employed. I hereby acknowledge that I have read and understand each of the above statements. I authorize release of information about me to this Company.

I agree to the TERMS AND CONDITIONS above and hereby certify that the information presented herein is correct to the best of my knowledge.

Full Applicant Name:			Date of Application:



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