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RCS EMPLOYMENT APPLICATION

Robertson Crushed Stone, Inc.

6300 Hwy. 64 NW
Milltown, IN 47145

Robertson Crushed Stone, Inc. (the “Company”) is an equal opportunity employer and considers applicants without regard to race, sex, religion, color, national origin, pregnancy, genetic information, or any other characteristic protected by applicable law. If you are disabled and need a reasonable accommodation to complete this application, please let us know.

Carefully read and fully and accurately complete every portion of this application or you will not be considered for employment. We may disregard your application if we cannot read it.

This application is valid for sixty (60) consecutive calendar days. If you wish to be considered for employment after that time, you must complete and submit a new application.

Applicant's Information

Are you at least 18 Years of Age? *
Are you 21 Years of Age or Older? *
Have you been Convicted of any Felony that has not been Expunged? *
If you Served in the U.S. Military, were you Discharged on any Basis other than Honorable? *
Are you Legally Authorized to Work in the United States? *
If Offered Employment, will you Submit to a Drug Screening Test? *

RESIDENCY Information

Provide the following information regarding your current and past three (3) years’ residences (i.e., places where you actually live or have lived).

EDUCATION

EMPLOYMENT REFERENCES

EMPLOYMENT HISTORY

Please provide accurate and complete employment information, including all full-time, part-time, contract, self-employment, military service, and periods of unemployment, for the past 3 years. You must provide all the requested information, including full addresses, phone numbers, etc. Start with your current or most recent employer. Referencing or attaching a resume is not an acceptable alternative. You must complete this section.

Employer 1

Employer 2

Employer 3

Employer 4

Employer 5

BY SIGNING THIS APPLICATION, I:

(1) Certify that I personally completed this application and that all information provided in this application is true and complete to the best of my knowledge; agree that any omission, misrepresentation, falsification, or misleading information provided in this application or in any other communication to the Company justifies refusing to hire me or terminating my employment if discovered after I am hired; acknowledge that I understand that any conditional offer of employment may be revoked if I do not submit to and pass a pre-hire medical examination by a health care professional of the Company’s choosing, submit to and pass a pre-hire drug screening test, and cooperate fully with any such examinations and tests; and acknowledge that a background check may be required to verify my criminal, employment, education, and/or credit history, and I agree to cooperate fully to authorize such actions; and

(2) Acknowledge the information provided in this application, including information regarding my current and former employers, may be used, and those employers may be contacted, to investigate my work and safety performance history for the purpose of making employment decisions; authorize the Company to contact my current and former employers, educational institutions, references, and others for employment-related purposes; and understand I may be required to provide additional information; and

(3) Authorize my current and former employers, and others, to give the Company information concerning my employment, and release my current and former employers from any liability whatsoever for providing such information; and understand the Company will protect information provided by my current and previous employers from disclosure to other third parties and will use it only for employment decisions; and

(4) Acknowledge that if I am hired my employment with the Company will be “at-will” and both the Company and I will be free to terminate the employment relationship at any time without notice and without cause, and that this “at-will” employment relationship can be changed only by an express written employment agreement signed by the Company’s President.

I understand I will not be considered for employment with the Company unless I agree to the terms above. I, therefore, agree to those terms knowingly, voluntarily, and in exchange for the Company’s willingness to consider my application for employment.