IRVING MATERIALS, INC.

8032 N. State Rd 9

Greenfield, IN 46140

(317) 326-3101

 

EMPLOYMENT APPLICATION

This application is valid for 60 days. If you wish to be considered for employment beyond this 60-day period, a new application must be submitted. This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered. This Company is an equal opportunity employer*

PERSONAL

An address must be supplied for the last three years of residence. If none applies enter "same as above" or rewrite.

If you are applying for a driver/equipment operator position, are you over 21?    
Have you ever been convicted of a crime (including felonies, misdemeanors, guilty pleas, or pleas of nolo contendere), other than convictions that were ordered expunged or sealed by a court?     

If yes, state the offense, location, date and outcome:    

A prior conviction will not necessarily bar you from employment. The company will consider factors such as the nature and gravity of the offense or offenses committed, the time that has passed since the conviction and/or completion of the sentence, and the nature of the job sought by the applicant.

*Our Company is an equal opportunity employer and does not discriminate against applicants or employees on the basis of age, race, color, gender, religion, national origin, ancestry, physical or mental disability, genetic information, or any other classification protected by federal, state, or local law. Equal access to employment, services, and programs is available to all qualified persons. Applicants requesting reasonable accommodation for the application and/or interview process should notify a Company representative.

MILITARY

Have you ever served in military?    
    

EMPLOYMENT DESIRED

Are you seeking:
Have you ever applied to our company before ?    
Have you worked for our company before ?    

If your answer to either of the above questions is yes, state when and where you applied and/ or worked :  

How did you learn of our company and/or position ?     

Are you or do you expect to be engaged in any other business or employment ?    

If yes, specify those days or hours you would be unable or unwilling to work:     

GENERAL

Are you legally authorized to work in the United States?    

(Pursuant to the Immigration Reform and Control Act of 1986, if you are hired you must produce documents which are specified by the Federal Government, establishing your identity and authorization for employment in the United States)

Are you able to perform the essential functions of the position for the position for which you are applying ?    
Are you willing to take a drug screen ?    

REFERENCES:

Give three references, not relatives or employers:

EDUCATION:

Are you planning to pursue further studies ?    

If so, when, where and what courses ?    

List any scholastic honors, offices held and activities involved in during high school and college :     

List and describe any other schools or specialized training :     

SPECIAL SKILLS :

Do you have a current D.O.T Batch Card ?    

If Yes, enter Date Issued:

D.O.T. Technician's Card ?    

If Yes, enter Date Issued:

Have you had any computer or word processing experience or training ?    

If yes, please describe :     

What languages do you speak fluently ? :     

List any other skills and/or abilities that you feel qualify you for a position :    


WORK HISTORY :

ALL APPLICANTS - PLEASE COMPLETE THIS SECTION.

IF YOU ARE APPLYING FOR A DRIVING POSITION, A 10-YEAR DRIVING EMPLOYMENT HISTORY IS NEEDED. List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. The "Reason for Leaving" section should include whether the separation was voluntary, involuntary, or a resignation in lieu of termination.
NAME OF THE EMPLOYER:

NAME /TITLE OF LAST SUPERVISOR

ADDRESS:

EMPLOYED FROM (MONTH/YEAR)

CITY, STATE, ZIP CODE:

START PAY

PHONE:


TITLE:

DUTIES

NAME OF THE EMPLOYER:

NAME /TITLE OF LAST SUPERVISOR

ADDRESS:

EMPLOYED FROM (MONTH/YEAR)

CITY, STATE, ZIP CODE:

START PAY

PHONE:


TITLE:

DUTIES

NAME OF THE EMPLOYER:

NAME /TITLE OF LAST SUPERVISOR

ADDRESS:

EMPLOYED FROM (MONTH/YEAR)

CITY, STATE, ZIP CODE:

START PAY

PHONE:


TITLE:

DUTIES

NAME OF THE EMPLOYER:

NAME /TITLE OF LAST SUPERVISOR

ADDRESS:

EMPLOYED FROM (MONTH/YEAR)

CITY, STATE, ZIP CODE:

START PAY

PHONE:


TITLE:

DUTIES

NAME OF THE EMPLOYER:

NAME /TITLE OF LAST SUPERVISOR

ADDRESS:

EMPLOYED FROM (MONTH/YEAR)

CITY, STATE, ZIP CODE:

START PAY

PHONE:


TITLE:

DUTIES

Are you presently employed?     
If yes, may we contact your present or previous employer ?     

If you are applying for a driving position please complete the Driving History section below

DRIVING HISTORY :

Have you ever tested positive, or refused to test, on a pre-employment drug or alcohol test administered by an employer to which you have applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years ?     
If you answered yes, you have had a positive test or a refusal to test, do you have documentation of successful completion of the return-to-duty process?
Have you ever had circumstances of any denial, revocation or suspension of any license, permit or privilege to operate a motor vehicle?

If yes, please give an explanation setting forth the facts and circumstances of any denial, revocation or suspension of any license, permit or privilege to operate a motor vehicle.     

If you are applying for a driving position you must provide a 3-year accident history.
Provide an explanation of what happened and when (month and year):     

List all violations, other than for parking, of which you were convicted or forfeited bond or collateral for a 3-year period preceding the date of the application:     

List all unexpired commercial motor vehicle operator's license or permit that have been issued:

List the nature and extent of your driving experience in the operation of motor vehicles, including the type of equipment (such as buses, trucks, truck tractors, semi-trailers, full trailers and pole trailers) which you have operated.

AFFIDAVIT

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I certify that the answers given by me to the foregoing questions and statements are true and correct without any consequential omissions of any kind. I understand that any misleading or incorrect statements set forth in my application, resume, or any other materials submitted as part of the employment application process or given by me during any interviews will render this application void and will be just cause for refusal of employment and if employed would be cause for my termination, regardless of the date of discovery. I further agree to waive any and all claims I may have against Irving Materials, Inc., its parent corporations, successors, subsidiaries and affiliates, whether owned in whole or in part, and all of their present and former directors, officers, agents, employees, attorneys, partners, and representatives, now or in the future, in any respect if my employment is terminated because of false statements, answers or omissions made by me in this questionnaire. I also authorize the companies, persons or schools named on this application to give any information regarding my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment to Irving Materials, Inc.; I hereby release said companies, schools or persons from all liability for any damage resulting from issuing this information. I certify that all statements and answers to questions are true and were made without reservations. I further understand that the taking of drug screens is a condition of my employment and refusal to take such screens when asked will result in my termination. In consideration of my employment, I agree to comply with the policies, rules, regulations and procedures of the company and understand that my employment is terminable at will, that I am not being employed for any specified time and that this application is not and is not intended to be a contract for current or continued employment. Further, I understand that my employment, with its compensation, can be terminated with or without cause or notice, at any time, at the option of either the company or myself. I also understand that no manager or representative of the company, other than the CEO, General Counsel or VP of Human Resources has any authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from or contrary to the foregoing. I also understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me and one of the individuals designated above. The information provided by you herein may be used, and your prior employers may be contacted, for the purposes of investigating your background.

    

x