331 N Main Street Euless, TX 76039

(817)835-4100

APPLICATION FOR EMPLOYMENT

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status.

(PLEASE PRINT) Last Name First Name Middle Name

Address Number Street City State Zip Code

Telephone Number Social Security Number

E-mail Address:

Positions(s) Applied For Wage/Salary Expected

How did you learn about us? Advertisement Friend Walk In Employment Agency Relative Other

Are you at least 18 years of age? (21 for applicants seeking a driving position) Yes No Have you been employed by us before? Yes No

If yes, what dates: __________ Do we employ any of your relatives? Yes No If yes, Name_______________ Location_______________ Relationship_______________ Once employed, can you submit verification of your legal right to work in the U.S.? Yes No

(Such verification will be required upon employment) Are you currently employed? Yes No On what date will you be available for work? Date: _____/_____/_____ Can you travel if a job requires it? Yes No Are you available to work: Full Time Part Time Shift Work Temporary

Overtime Evening 24-Hour Call Nights Are you currently on lay-off status and subject to recall? Yes No Have you ever been convicted of a felony? Yes No (Conviction will not necessarily disqualify an applicant from employment)

If yes, please explain: ____________________________________________________________________________________________________ ___________________________________________________________________________________________________

EMPLOYMENT EXPERIENCE

List jobs chronologically starting with your present or last job and end with your first job. Your employment history should be complete. Applicants applying for commercial vehicle operator positions must list all employers for the previous 10 years.

May we contact your present employer? Yes No

Employer Date Employed Work Performed From – MO/YR To – MO/YR Address, City, State

Telephone Hourly Rate/Salary Starting Final

Job Title Supervisor

Reason for leaving:

Employer Date Employed Work Performed From – MO/YR To – MO/YR Address, City, State

Telephone Hourly Rate/Salary Starting Final

Job Title Supervisor

Reason for leaving:

Employer Date Employed Work Performed From – MO/YR To – MO/YR Address, City, State

Telephone Hourly Rate/Salary Starting Final

Job Title Supervisor

Reason for leaving:

Employer Date Employed Work Performed From – MO/YR To – MO/YR Address, City, State

Telephone Hourly Rate/Salary Starting Final

Job Title Supervisor

Reason for leaving:

If you need additional space, please continue on a separate sheet of paper.

EXTRA SHEET

Employer Date Employed Work Performed From – MO/YR To – MO/YR Address, City, State

Telephone Hourly Rate/Salary Starting Final

Job Title Supervisor

Reason for leaving:

Employer Date Employed Work Performed From – MO/YR To – MO/YR Address, City, State

Telephone Hourly Rate/Salary Starting Final

Job Title Supervisor

Reason for leaving:

Employer Date Employed Work Performed From – MO/YR To – MO/YR Address, City, State

Telephone Hourly Rate/Salary Starting Final

Job Title Supervisor

Reason for leaving:

Employer Date Employed Work Performed From – MO/YR To – MO/YR Address, City, State

Telephone Hourly Rate/Salary Starting Final

Job Title Supervisor

Reason for leaving:

EDUCATION

Schools Name Location Years Completed

Graduate Year Degree Major Subjects

Yes No High School

College

Graduate

Other

Certifications

List any scholastic honors you received and/or professional organizations in which you are active.

Summarize special job-related skills, qualifications, training, and apprenticeships. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

Specialized skills. Check all that apply. Word Excel Access Power Point Outlook CRM: ____________________

List Other Software: ________________________________________________________________________________

ADDITIONAL INFORMATION

State Additional information you feel may be helpful to us in considering your application. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

List references familiar with your employment history. Name Position

Address Phone #

Name Position

Address Phone #

Name Position

Address Phone #

DRIVER EXPERIENCE AND MECHANICAL QUALIFICATIONS

If applying for a position requiring the use of a company vehicle, complete the following:

Type of Driver’s License currently______________________________ Issuing State___________________

Driver’s License Number _____________________________________ Exp Date_______/_________/________

Have you ever had your driver’s license suspended, revoked, or been denied a driver’s license?

Yes __________ No___________

List any traffic citations, other than parking, that you have received during the previous three years. _______________ _______________________________________________________________________________________________

Equipment Operated, check all that apply.

Forklift Tractor Trailer Straight Truck Dump Crane Bulk Van Tanker Mixer Pump Front-End Loader Sweeper

List Formal training and years of experience in the following areas:

Area Formal Training

Yrs Experience Area Formal

Training Yrs

Experience Drive Line Components Air Conditioning

Diesel Tune-up/Rebuild Frame and Wheel Alignment

Gasoline Tune-up/Rebuild Hydraulics

Brakes Trailer Repair

Electrical Repair Body Work

Cooling System Mechanical Inspections

List formal training and years of experience with the following equipment:

Area Formal Training

Yrs Experience Area Formal

Training Yrs

Experience Electrical Diagnostic Equipment Electric Welder

Frame/Axle Straightening Equipment Oxy/Acetylene Welder

Engine Rebuilding Equipment Wheel Balancing Equipment

Diesel Injection Equipment Air Conditioning Equipment

COMMERICIAL DRIVER EXPERIENCE AND QUALIFICATIONS

Answer these questions only if you are applying for a commercial driving position. (US Dept Transportation 49 CFR 391.21 requires questions contained in this section.)

Do you currently hold a valid commercial vehicle operator’s license? Yes No Class? A B C

List all unexpired driver’s licenses that you have been issued: License Number Issuing State Expiration Date License Class

Have you ever been denied a license, permit or privilege to operate a vehicle? Yes No

Has any license, permit or privilege ever been suspended, restricted or revoked? Yes No

Have you ever been disqualified for violations on the Federal Motor Carrier Safety Regulations? Yes No

If you answered “yes”, please explain:

List any violation of motor vehicle laws or ordinances (other than parking) for which you have been convicted or forfeited bond or collateral during the preceding 3 years.

Violation Date State

List all motor vehicle accidents in which you have been involved during the preceding 3 years. Nature of Accident Date Injuries Fatalities

Yes No Yes No

Yes No Yes No

Yes No Yes No

List the type of equipment (straight truck, truck tractors, semi-trailers, etc) and the dates operated. Type of Equipment Date

From ______/______ To _____ / ______

From ______/______ To _____ / ______

From ______/______ To _____ / ______

FORM A-2

Record retention guidelines: If “yes” to question 1, retain this form and documentation provided for 5 years. If “no” to question1, discard after employment terminates but not less than 2 years from

date of statement. H:\Desktop\Form_A2.doc

Previous Pre-employment Employee Alcohol and Drug Test Statement

Sec. 40.25(j) As the employer, you must also ask the employee whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past three years. If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety-sensitive functions for you, until and unless the employee documents successful completion of the return-to-duty process (see paragraphs (b)(5) and (e) of this section).

Prospective Employee Printed Name:

Prospective Employee SS or ID Number:

The prospective employee is required by Sec. 40.25(j) to respond to the following questions.

1. Have you tested positive, or refused to test, on any pre-employment drug oralcohol test administered by an employer to which you applied for, but did notobtain, safety-sensitive transportation work covered by DOT agency drug andalcohol testing rules during the past three years?

Check one: Yes No

2. If you answered yes, can you provide/obtain proof that you’ve successfullycompleted the DOT return to duty requirements?

Check one: Yes No

I certify that the information provided on this document is true and correct.

Prospective Employee Signature: Date:

Witness Signature: Date:

PRE-EMPLOYMENT URINALYSIS NOTIFICATION

The Federal Motor Carrier Safety Regulations, Section 391.103 – pre-employment testing requirements apply to driver-applicants of this company.

391.103 Pre-employment testing requirements

a. A motor carrier shall require a driver-applicant who the motor carrier intends to hire oruse be tested for the use of controlled substances as a pre-qualification condition.

b. A driver-applicant shall submit to controlled substance testing as a pre-qualificationcondition.

c. Prior to collection of a urine sample, under 391.107 of this subpart, a driver-applicantshall be notified that the sample will be tested for the presence of controlledsubstances.

As a condition of my employment, I agree to the urine sample collection and controlled substance testing.

I understand a positive test for controlled substances based on the Urinalysis Test will medically disqualify me from the operation of a commercial motor vehicle for this company.

The Medical Review Officer will maintain the results of the Urinalysis Test. Negative and positive results will be reported to the company.

My written authorization is required for the Urinalysis Test results to be given to the other parties.

I have read and understand the above conditions for the Pre-employment Urinalysis Notification.

________________________________ Applicant’s Name (Print)

_________________________________ _____/_____/_____ Applicant’s Signature Date

Witnessed by:

__________________________________ _____/_____/_____ Company Representative’s Signature Date

FORMER EMPLOYER VERIFICATION

SECTION 1: PREVIOUS EMPLOYEE INFORMATION & RELEASE

NAME: SSN:

I hereby authorize to release the following requested information to for the purpose of investigation for qualifying me

to drive a commercial motor vehicle as required by the U.S. Department of Transportation & Federal Motor Carrier Safety Regulations Parts 382, 391, 392 & 49 CFR Part 40. You are hereby released from any and all liability that may result from furnishing such information. Your quick response to the re-quest will be greatly appreciated.

Signature: Date:

SECTION 2: PREVIOUS EMPLOYEE WORK HISTORY

Employed from to as a . Did previous employee drive a motor vehicle for you? Yes No If yes, please indicate the specific type of vehicle and time driven for you:

Tractor/Semi-Trailer years months; Straight Truck years months Other (Please specify) ; years months

What type trailer? Tanker Flat* Doubles Van Reefer *What type cargo if you checked flat?Was previous employee a safe and efficient driver? Yes No Was previous employee’s general conduct satisfactory? Yes No Reason for leaving your employ: Discharged Resigned Laid Off Other Is previous employee eligible for rehire? Yes No Upon Review Did employee have any accidents/incidents? Yes No If yes, # Preventable # Non-preventable

SECTION 3: NOTE REGULATIONS OF THE DEPT. OF TRANSPORTATION (49 CFR PART 40) requires your company to provide us with information concerning named driver’s past drug andalcohol test results, including refusals to be tested.

In the past two years has the previously named applicant ever: § Tested positive for a controlled substance? Yes No § Tested with an alcohol concentration of 0.04 or higher? Yes No § Refused to submit to a DOT drug or alcohol test, including a verified

adulterated or substituted result? Yes No § Had any other violations of DOT drug/alcohol testing requirements? Yes No § Had any other violations of drug/alcohol regulations from previous employers? Yes No

Your Name: (print) Title:

Your Signature: Date:

Your Telephone Number:

Please forward your response as soon as possible to the above address. (We prefer fax: )

Safety Director

CERTIFICATION OF COMPLIANCE WITHDRIVER LICENSE REQUIREMENTS

The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirementsthat you as a driver must comply with. These requirements are in effect as of July 1, 1987. They are as follows:

1. POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possess more than one motorvehicle operator's license.

If you have more than one license, keep the license from your state of residence and return the additional license to the states that issued them. DESTROYING a license does not close the record in the state that issued it; you must notify the state.If a multiple license has been lost, stolen, or destroyed, close your record by notifying the state of issuance that you nolonger want to be licensed by the state.

2. NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION:Sections 392.42 and 383.33 of theFederal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of anyrevocation or suspension of your driver's license.In addition, Section 383.31 requires that any time you violate a state or local traffic law (other than parking), you mustreport it within 30 days to : 1) your employing carrier, and 2) the state that issued your license (if the violation occurs in astate other than the one which issued your license). The notification to both the employer and state must be in writing.

The following license is the only one I will possess:

Driver's License No. State Expiration Date

DRIVER'S CERTIFICATION: I certify that I have read and understand the above requirements.

Driver's Name (Printed):

Driver's Signature: Date

Reviewed by:Carrier Official (printed) Date

Carrier Signature Title

Carrier

Comments:

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY

ALL ACCOUNT HOLDERS

1

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with _____________________________ (“Prospective Employer”), Prospective

Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history

from the Federal Motor Carrier Safety Administration (FMCSA).

When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from

FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer

will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair

Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving

history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part

or in whole on this report.

When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective

Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment

decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written

or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the

name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action

and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper

identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information

or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business

days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of

your report and a summary of your rights under the Fair Credit Reporting Act.

Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct

any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to

https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct

this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign,

or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those

crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report.

State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court

of law will also appear, and remain, on a PSP report.

The Prospective Employer cannot obtain background reports from FMCSA without your authorization.

AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

I authorize _______________________ (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP)

system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I

understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years

and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist

the Prospective Employer to make a determination regarding my suitability as an employee.

I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has

the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by

submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA

cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for

adjudication.

I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not

report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those

crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear

Redi-Mix Concrete

Redi-Mix Concrete

on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also

appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by

Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of

my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to

obtain the information authorized above.

Date: __________________________ _______________________________________

Signature

___________________________________________

Name (Please Print)

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety

Administration (FMCSA). Account holders are required by federal law to obtain an Applicant’s written or electronic consent prior to accessing the Applicant’s PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant’s consent. The

language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included

with other consent forms or any other language.

LAST UPDATED 12/22/2015

License #: ___________________

State: ________

Date of Birth: ________________

VOLUNTARY SELF-IDENTIFICATION FORM

U.S. Concrete is an Equal Opportunity Employer and does not discriminate on the basis of race,

color, religion, sex, age, national origin, disability, veteran status, sexual orientation, or any other

classification protected by federal, state or local law. Providing this information is voluntary,

kept confidential, and used only in accordance with applicable laws and regulations.

Name: Male Female

Position Applied For: Date of Birth:

Ethnic Group

American Indian or Alaskan Native A person having origins in any of the original peoples

of North America and South America (including

Central America), and who maintains tribal affiliation

or community attachment

Asian A person having origins in any of the original peoples

of the Far East, Southeast Asia, or the Indian

subcontinent.

Black or African-American A person having origins in any of the Black racial

groups of Africa. Does not include Hispanics or Latinos

Native Hawaiian or Other Pacific

Islander

A person having origins in any of the original peoples

of Hawaii, Guam, Samoa, or other Pacific Islands

White A person having origins in any of the original peoples

of Europe, North Africa, or the Middle East

Hispanic or Latino (all races) A person of Mexican, Puerto Rican, Cuban, Central or

South American, or other Spanish culture or origin

Other Some other race or two or more race/ethnicities

Veteran Status

Retired Other Protected Veteran/Active Wartime

Veteran

Disabled Veteran Armed Forces Service Medal Veteran

Active Reserve No Military Service

____________________________________________

Applicant’s Signature

I do not wish to Self-Identify

BACKGROUND INVESTIGATION CONSENT

I, ______________________________ hereby authorize U.S. Concrete, Inc. and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications for employment now and, if applicable, during the tenure of my employment with Company.

I release U.S. Concrete, Inc. and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from and all of the above referenced sources used.

The following is my true and complete legal name and all information is true and correct to the best of my knowledge.

First, Middle, Last Name (Printed)

Maiden Name or Other Names Used

Present Address

City/ State Zip Code Move-In Date

Former Address (If less than 3 years at current) Move-In Date

City/ State Zip Code

__________ ___________________ ____________________ _______________ Date of Birth Social Security Number Driver’s License Number State of License

Signature Date

*NOTE: The above information is required for identification purposes only, and is in no manner used asqualifications for employment. U.S. Concrete, Inc is an Equal Opportunity Employer, and does not discriminateon the basis of Sex, Race, Religion, Age (40 and over), Handicap or National Origin.

APPLICANT STATEMENT

I hereby certify that answers given herein are true and complete to the best of my knowledge. I understand and agree that any falsified answer or omission may disqualify me from consideration of employment.

I hereby authorize investigation of all answers, statements, or other information contained in this application as may be deemed necessary in arriving at an employment decision. I also authorize each and every person named in this applicant to provide any information deemed relevant by The Company and its subsidiaries in arriving at an employment decision. Furthermore, I hereby release The Company and its subsidiaries and such other persons and organizations named in this application from all liability and for any damage whatsoever incurred in providing, receiving, or investigating such information. I further agree that The Company may obtain my credit report in accordance with 1681(b)(2) of Title 15 of the United States Code, commonly known as the Fair Credit.

I understand that this application shall be considered active for a period of time not to exceed 60 days from the date indicated below. I understand that if I wish to be considered for employment beyond this time period, I must inquire whether applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with The Company and/or its subsidiaries is of an “at will” nature, which means the employee may resign at any time and the employer may discharge employee at any time with or without cause or reason. I further understand that this “at will” employment relationship may not be changed by any written document or conduct unless such change is specifically acknowledged in writing by the President and Chief Executive Officer of The Company.

I agree that before being employed, I am to submit to and must pass a controlled substance test to be conducted in accordance to The Company’s policy. I agree that any offer of employment is contingent upon successful completion of a post offer medical examination by a physician designated by The Company. I further agree to take physical exams and controlled substance and alcohol testing when required during my employment.

In the event of employment, I fully understand that this application will become part of my personnel record and that false and misleading information given in my application or interview(s) may result in discharge. I agree to abide by all policies, rules, and regulations of The Company and or its subsidiaries and, if requested, to sign The Company’s agreements relating to discoveries, inventions, and confidential information.

I have read the paragraphs above and fully understand their importance and effect upon my employment. I also acknowledge the same as a condition of my employment with The Company and/or its subsidiaries.

________________________________________________ _______________________________ Signature of Applicant Date