English Application Application for Employment Custom Concrete Co., Inc. is an equal opportunity employer and considers all qualified applicants without discrimination in regard to race, color, religion, gender, national origin, age, marital or veteran status, or disability. Custom Concrete Co., Inc. will comply with its obligation to provide reasonable accommodation to qualified individuals with disabilities. Step 1 of 6 16% Name* First Last Phone*Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country If hired, can you furnish proof you are eligible to work in the U.S.?*YesNoAre you at least 18 years of age or older?*YesNoAre you at least 21 years of age or older?*YesNoHave you ever worked for us before?*YesNoIf yes, when & where?*Please tell us the dates you were previously employed with us, what department you worked in and your supervisor's name?If yes, when & where?*Please tell us the dates you were previously employed with us, what department you worked in and your supervisor's name? JOB INTERESTWhich department are you applying for?ResidentialCommercialEstimatingOffice/AdminCustom Truck & AutoOtherIf Other, please list the position you are applying forDo you have reliable transportation to get you to and from work?*YesNoConcrete/Construction Years of Experience*NoneLess than 1 year1 - 3 years3 - 5 years5 - 10 years10 or more yearsDo you have a valid Indiana driver’s license?*YesNoIf Yes, list driver’s license type, state of issuance and number:*How did you hear about us?*Current EmployeeCareer FairWorkOne OfficeIMPACT OfficeSchool/CollegeFacebookLinkedInInstagramOtherIf referred by a current employee, please fill in their name.If other, please list below.Salary required*Check each day you are available to work (please note that most positions require weekend availability)* Sunday Monday Tuesday Wednesday Thursday Friday Saturday Type of employment desired (check all that apply)* Full-Time Part-Time Temporary Summer Only Are you willing to work (check all that apply)* Days (7a-4p) Evenings (4p-11p) Nights (11p-7a) Overtime Holidays Is there any time that you cannot work? Employment History InformationWork History: Current and previous 2 employers (most current employer listed first)Most Recent Employer Name First City, StatePosition HeldStart Date Date Finished Employer PhoneSupervisor name First Last Describe your duties:Reason for leaving:NEXT EMPLOYEREmployer Name First City, StatePosition HeldStart Date Date Finished Employer PhoneSupervisor name First Last Describe your duties:Reason for leaving:NEXT EMPLOYEREmployer Name First City, StatePosition HeldStart Date Date Finished Employer PhoneSupervisor name First Last Describe your duties:Reason for leaving: Additional InformationHave you ever been employed under a name other than the name used on this application?*YesNoIf yes, please give date and explain* EDUCATION INFORMATIONHIGH SCHOOLName & City/State of High School*Course of Study/ Degree Earned*Did you graduate?*YesNoAttendingCOLLEGE OR UNIVERSITYName & City/State of College or UniversityCourse of Study/ Degree EarnedDid you graduate?YesNoAttendingOTHERName & City/State of OTHER (specify)Course of Study/ Degree EarnedDid you graduate?YesNoAttendingThree Reasons Why You Should Hire Me:*ResumeAccepted file types: pdf, doc, txt, docx. APPLICANT’S STATEMENTI certify that the answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment. I hereby authorize anyone of whom a request is made to supply to Custom Concrete Co., Inc. any information concerning my background in connection with my being considered for employment with the Company. I hereby release all parties, including but not limited to Custom Concrete Co., Inc., my personal references and my previous employers, from any and all liability for any injury or damage that may result from their furnishing information to Custom Concrete Co., Inc. concerning me or any action the Company takes on the basis of such information.I understand that this application is not and is not intended to be a contract of employment. I understand that this application expires 30 days from the date recorded below.In the event of employment, I understand that:(a) misrepresentation or omission of facts on this application is cause for immediate dismissal;(b) I am required to and agree to abide by all Company rules and regulations as a condition ofemployment; the use of profanity is strictly prohibited. The use of illegal drugs and alcohol is strictly prohibited on our property, job sites, operating any machine or equipment – ever.(c) this application is not a contract of employment; and(d) my employment is at-will and is for no definite period of time, and as such, either theCompany or I may terminate the employment relationship with or without cause at any time.Choose ONE:*I ACCEPTI DO NOT ACCEPTNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.