Please list all employment, beginning with present or most recent employer. All information must be completed. Please also upload a file of your resume, if you have one.

Please provide information for emergency contacts during work hours:

It is the policy of Robar Enterprises, Inc., Daily Transit Mix, LLC and AgCon, Inc. to afford equal opportunity for employment training, compensation and promotion to all individuals without regard to race, color, creed, religion, sex (including gender harassment and harassment based on pregnancy, childbirth or related medical condition), age, disability, sexual orientation, veteran status, or any other consideration made unlawful by federal, state or local laws.

PROOF OF EMPLOYMENT ELIGIBILITY WILL BE REQUIRED UPON EMPLOYMENT

PRE-EMPLOYMENT DRUG TESTING POLICY

As a component of the screening process, applicants shall be required to undergo drug and/or alcohol screening. Refusal or failure to submit to drug and/or alcohol screening at the time specified will disqualify applicants for further consideration for employment.

I voluntarily agree to submit to drug and/or alcohol screening as part of my application for employment.

I certify that the information I have given on this application is true and complete. I understand that omissions, misrepresentations, or falsifications of information will result in rejection of this application and/or will be sufficient grounds for immediate termination.

I authorize the release of all high school, college and other educational records pertaining to my attendance, course work and other school activities at any educational institute attended by me at any time.

I acknowledge by my signature that my former employer is released from any and all claims, demands or liabilities arising out of or in any way related to the disclosure of any and all information relating to my present and former employment, and I request all current and former employers to supply such information to Robar Enterprises, Inc., Daily Transit Mix, LLC and/or AgCon, Inc. upon its request. Additionally I waive and release Robar Enterprises, Inc., Daily Transit Mix, LLC and/or AgCon, Inc. and its agents from any liability for any action taken due to information provided by any current or former employer.

I agree that, if hired, I will conform to all rules, regulations and procedures of Robar Enterprises, Inc., Daily Transit Mix, LLC and/or AgCon, Inc. I further understand and agree that if I am hired, my employment with Robar Enterprises, Inc., Daily Transit Mix, LLC and or/AgCon, Inc. is for an indefinite period and may, regardless of the time and manner of payment of my wages and salary, be terminated at any time by Robar Enterprises, Inc., Daily Transit Mix, LLC and/or AgCon, Inc. or me, with or without prior notice or warning.

I further understand that this Application for Employment and any policies and procedures communicated or followed by Robar Enterprises, Inc., Daily Transit Mix, LLC and/or AgCon, Inc. during the term of my employment are not intended to be and are not a contract of employment, and that any such policies and procedures may be modified, disregarded or eliminated at any time, with or without notice to me, at the Company's sole discretion.

I understand that this application for employment shall be considered active for a period of time not to exceed 90 days from this date and that if I wish to be considered for employment, beyond that date, I must submit another employment application.

AUTHORIZATION

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

I authorize Robar Enterprises, Inc. (“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 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.

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.

NOTICE: The prospective employment concept referenced in this form contemplates the definition of “employee” contained at 49 C.F.R. 383.5.