HIGHLAND PAVING - NON-DRIVER APPLICATION

Employment Application

General Labor & Administration
Apply to work in the Southeastern NC Region

Including Wilmington, Fayetteville, Lillington & surrounding areas.

Use this form if you are applying for a Non-Driver position
Today's Date

MonthDayYear
Date
Name

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Social Security Number
Your privacy is important to us. It is Highland Paving Co., LLC's policy to respect your privacy and comply with any applicable law and regulation regarding any personal information we may collect about you, including across our website and other sites we own and operate.
Position Applying For
YesNo
YesNo
YesNo
If Yes, When?
YesNo
If Yes, Please Explain
- Previous Address 01
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Previous Address 02
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code

References
Please list three professional references.
Reference 1

First NameLast Name
Relationship
Company Name
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2

First NameLast Name
Relationship
Company Name
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3

First NameLast Name
Relationship
Company Name
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Previous Employment (Last Three (3) Years)
Most Recent / Current Employer
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Supervisor
Position Held
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Reason For Leaving
YesNo
- Previous Employer 01
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Supervisor
- Position Held
- Date From
  
  MonthDayYear
  Date
- Date To
  
  MonthDayYear
  Date
- Reason For Leaving
- YesNo
- Previous Employer 02
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Supervisor
- Position Held
- Date From
  
  MonthDayYear
  Date
- Date To
  
  MonthDayYear
  Date
- Reason For Leaving
- YesNo

Military Service
Branch
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Transportation
YesNo
Driver's License #
State Issued
Expiration Date

MonthDayYear
Date
YesNo
Date Of Birth

MonthDayYear
Date
Employment AdSocial MediaInternetOther
Disclaimer & Signature

I certify that my answers are true and complete to the best of my knowledge.
Today's Date

MonthDayYear
Date
Signature

Employment History (Continued)

Please use this page to continue your employment history, if needed.
Employer Name
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Position Held
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Reason For Leaving
Please Explain Any Gaps In Employment
- Employer Name
- Address
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Position Held
- Date From
  
  MonthDayYear
  Date
- Date To
  
  MonthDayYear
  Date
- Reason For Leaving
- Please Explain Any Gaps In Employment
- Employer Name
- Address
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Position Held
- Date From
  
  MonthDayYear
  Date
- Date To
  
  MonthDayYear
  Date
- Reason For Leaving
- Please Explain Any Gaps In Employment

Voluntary Self Identification Form (Applicant)
Name
Date

MonthDayYear
Date
Signature
Voluntary Self-Identification of EEO Status

The Equal Employment Opportunity Commission (EEOC) requires organizations with 100 or more employees to complete an EEO-1 report each year. Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by Human Resources Department. Please return completed forms with your application of employment.
FemaleMale
Race/Ethnicity
Hispanic or LatinoWhite (Not Hispanic or Latino)Black or African American (Not Hispanic or Latino)Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)Asian (Not Hispanic or Latino)American Indian or Alaska Native (Not Hispanic or Latino)Two or More Races (Not Hispanic or Latino)

Voluntary Self Identification Form (Applicant)
APPLICANT VETS Self-ID:

We are a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of

1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires

Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows and are hereafter referred to all together as “protected veterans”:
- A “disabled veteran” is one of the following:
  - a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
  - a person who was discharged or released from active duty because of a service-connected disability.
- A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
- An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
- An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 .
If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.
I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERANS LISTED ABOVEI IDENTIFY AS A VETERAN, JUST NOT A PROTECTED VETERANI AM NOT A VETERANI DO NOT WISH TO SELF-IDENTIFY
Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended.

Voluntary Self Identification Form (Applicant)
Voluntary Self Identification Form (Applicant) We are an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, color, gender, national origin, ancestry, religion, physical or mental disability, age, veteran status, sexual orientation, gender identity or expression, marital status, pregnancy, citizenship, or any other factor protected by anti-discrimination laws.
Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity i to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such a collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
YES, I HAVE A DISABILITY (or previously had a disability)NO, I DON’T HAVE A DISABILITYI DON’T WISH TO ANSWER

North Carolina Division of Motor Vehicles

Driver Privacy Protection Act Authorization To Disclose Personal Information Form DPPA-2
I understand that personal information contained in my Motor Vehicle Record is protected by the federal Driver Privacy Protection Act and N.C. General Statue 20-43.1. I hereby authorize the release of my personal information to the person named below.
Your Full Name As It Appears On Your Drivers License:
Your NC Driver License #, SSN or ITIN
Today's Date

MonthDayYear
Date
Signature
Person to receive information: HIGHLAND PAVING CO., LLC

Mailing Address: PO BOX 64553, Fayetteville NC 28306

CONTRACTOR’S EEO/AA POLICY STATEMENT
Note: The EEO/AA Policy statement must be posted at company offices and all job sites.

It is the policy of Highland Paving Co, LLC to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age, or disability. Such action shall include employment, upgrading, demotion, or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship, pre-apprenticeship, and/or on-the-Job training.

Highland Paving Co, LLC will take affirmative action to ensure that the EEO/AA Policy is implemented regarding advertising, application procedures, compensation, demotion, employment, fringe benefits, job assignment, job classification, layoff, leave, promotion, recruitment, rehire, social activities, termination, transfer, upgrade, working conditions and selection for training to include apprenticeship, pre- apprenticeship, and on-the-job training.

Highland Paving Co, LLC will continue to make it understood to the employment sources/agencies with which it deals, and in employment opportunity announcements/ads, the above mentioned EEO/AA Policy and that all the company's employment decisions are based on individual merit only.

All current employees of Highland Paving Co, LLC are requested to encourage qualified disabled persons, minorities, females, special disabled veterans, and Vietnam Era veterans to apply for employment, on-the-job training or for union apprenticeship. It is the policy of Highland Paving Co, LLC to satisfy reasonable special accommodations for qualified disabled individuals.

It is the policy of Highland Paving Co, LLC that all company activities, facilities, and job sites are non- segregated. Separate or single-user toilet and changing facilities are provided for privacy between genders. Disabled parking spaces may be assigned to accommodate accessibility needs.

It is the policy of Highland Paving Co, LLC to ensure and maintain a working environment free of coercion, harassment, and intimidation at all job sites, and in all facilities at which employees are assigned to work. Any violation of the policy should be immediately reported to your supervisor or the Company EEO Officer identified below:
John W. McCauley
910-824-0996
2031 Middle Rd, Eastover NC 28312
Applicant Initials

DISCRIMINATION COMPLAINT PROCEDURE
Individuals desiring to submit a discrimination complaint are requested to follow the procedure below. If the employee feels for any reason that they do not want to contact their supervisor or if that person is· not available to register the complaint with, the employee should then feel free to contact the EEO Officer. Discrimination complaints may be submitted verbally or in writing.
Step 1:

Contact your immediate supervisor. If you are uncomfortable contacting your immediate supervisor or you do not get satisfactory results at this level within ten working days, or desire to take the complaint further then,

Step 2:

Contact the EEO Officer, John W. McCauley, at: (910) 485-5790 (910)824-0996 2031 Highland Paving Co., LLC. Middle Rd Eastover, NC 28312

Step 3:

If you do not get satisfactory results with the company within ten working days, or desire to take the complaint further then, contact one of the following agencies:

U. S. Department of Labor Equal Employment Opportunity Commission

Charlotte District Office
129 West Trade Street Suite 400
Charlotte, NC 28202

Phone: 800-669-4000
Fax: 704-954-6410 and 704-344-6734
TTY: 800-669-6820

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U.S. Department of Labor Equal Employment Opportunity Commision

Raleigh Area Office
1309 Annapolis Drive
Raleigh, NC 27608-2129

Phone: 800-669-4000
Fax: 919-856-4151
TTY: 800-689-6820

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U.S. Department of Labor Equal Employment Opportunity Commission

Greensboro Local Office
2303 W. Meadowview Road, Suite 201
Greensboro, NC 27407

Phone: 800-669-4000
Fax: 336-547-4032
TTY: 800- 669-6820

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Federal Highway Administration Division Office

310 New Bern Avenue, Suite 410
Raleigh, NC 27601- 1418

Phone: 919-856-4336 ext 126
Fax: 919-856-4353

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North Carolina Department of Transportation Office of Civil Rights

1511 Mail Service Center
Raleigh, NC 27699-1511

Phone: 919-508-1830
Toll Free: 800-522-0453
Fax: 919-508-1814
Applicant Initials
Should be Empty:

Employment Application

References

Previous Employment (Last Three (3) Years)

Military Service

Transportation

Employment History (Continued)

Voluntary Self Identification Form (Applicant)

Voluntary Self Identification Form (Applicant)

Voluntary Self Identification Form (Applicant)

North Carolina Division of Motor Vehicles

CONTRACTOR’S EEO/AA POLICY STATEMENT

DISCRIMINATION COMPLAINT PROCEDURE