Employment Application Sales Inquiries Contact sales@cementindustries.com Personal InformationName(Required) First Middle Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone(Required)Cell PhoneIf you are offered employment, can you provide verification of your legal right to work in the United States?(Required) Yes No Are you related to anyone employed here?(Required) Yes No If yes, who?(Required) Have you ever been employed here?(Required) Yes No If yes, when?(Required) Are you at least 18 years of age?(Required) Yes No Position Desired: If applying for a driver's position, do you hold a valid Florida license? Yes No Date Available for Work: MM slash DD slash YYYY Available for Overtime: Job Skills:Education InformationHigh School - Name High School - Location High School - Graduate Yes No High School - Years Completed College - Name College - Location College - Graduate Yes No College - Years Completed Technical, Trade, GED - Name Technical, Trade, GED - Location Technical, Trade, GED - Graduate Yes No Technical, Trade, GED - Years Completed Technical, Trade, GED and other Skills TrainingEmployment InformationJob 1 - From MM slash DD slash YYYY Job 1 - To MM slash DD slash YYYY Job 1 - Employer Information (Name, Address & Telephone)Job 1 - Position Job 1 - Reason for Leaving Job 2 - From MM slash DD slash YYYY Job 2 - To MM slash DD slash YYYY Job 2 - Employer Information (Name, Address & Telephone)Job 2 - Reason for Leaving Job 3 - From MM slash DD slash YYYY Job 3 - To MM slash DD slash YYYY Job 3 - Employer Information (Name, Address & Telephone)Job 3 - Reason for Leaving Job 4 - From MM slash DD slash YYYY Job 4 - To MM slash DD slash YYYY Job 4 - Employer Information (Name, Address & Telephone)Job 4 - Reason for Leaving Have you ever been discharged or suspended for any employment?(Required) Yes No If so, explain:(Required)Acknowledgement StatementThis application will remain active for six (6) months. Any applicant wishing to be considered for employment beyond six (6) months should reapply YesI understand that as a condition of being offered employment I will be required to take a pre-employment drug test. YesI understand that I will be required to provide satisfactory proof of my legal right to work in the United States YesI authorize the Company to perform an investigation to confirm my background and any information I have provided in this application process for the purpose and opinion that will be used in making a hiring decision. Further I release any and all parties from any liability for any damage that may result from furnishing this information to the company. YesIn consideration of employment, I agree to obey the rules and policies of the Company. I understand that nothing contained in this application or in the interview process is intended to create a contract between the Company and myself for either employment or for the providing of any benefits. I agree that my employment is at-will and the terms of the employment may be changed with or without cause, with or without notice, including but not limited to termination, demotion, promotion, transfer, compensation, benefits, duties and location of work, at any time, for any reason, at the option of myself or the Company YesI hereby acknowledge that I have read the above statements and understand them. I certify that I, the undersigned applicant, have personally completed this application. I declare the facts contained in the application (or any resume or other document(s) submitted are true and complete to the best of my knowledge. I understand that any misrepresentations or omissions will disqualify me from further consideration for employment, and will result in my termination from employment if discovered at a later date. YesApplicant Signature (Type Your Name)(Required) Date:(Required) MM slash DD slash YYYY The company of Cement Industries, Inc. is an Equal Opportunity Employer. We adhere to a policy of making decisions without regard to race, color, age, sex, religion, national origin, disability, veteran status, citizenship status or marital status. We assure you that your opportunity for employment with us relies solely on your qualifications.