M

( ) M. Lipsitz-Waco, ( ) Brownwood Iron & Metal, ( ) Bryan Iron & Metal, ( )Terrell Iron & Metal, ( ) Tyler Iron & Metal,

( ) National Steel-San Antonio, ( ) OK Iron & Metal- Ardmore, ( ) Texas Commercial Waste-Bryan,

( ) Market Street Recycling-Houston, ( ) Recycle Midland

Select Location of Interest

Application for Employment

Page 1 of 4 (rev. 4/11)

We are an equal opportunity employment company. We are dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, sex, religion, ancestry, national origin, disability or veteran status. No question on this application is intended to secure information to be used for any such discrimination. We will reasonably accommodate all applicants and employees with disabilities, if we are informed of such disabilities. PLEASE PRINT

PERSONAL INFORMATION Date:

Name:

Current Address: City State Zip

Contact Telephone Numbers Social Security Number (Optional)

EMPLOYMENT DESIRED

Position Applying For:

Hours Available to Work:

Possible Start Date:

Salary Desired:

Have you worked for this company before? When?

Have you applied with this company before? When?

Education	Name and Location of School	Number of Years Attended	Graduated Yes/No	Subject Studied
High School
College
Trade, Business or Correspondence School
Special Study or Research Work

US Military or Naval Service? Yes No Rank___________________________________________

Activities other than Religious (Civic, Athletic, Fraternal, Etc.) __________________________________________________________________________________________

Exclude Organizations, the name or character of which indicates the race, creed, color or national origin of its members.

Employment History

Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer. Please list all employers for the previous 10 years. COMPLETE THIS SECTION, EVEN IF YOU ATTACH A RESUME.

Page 2 of 4

Company Name

Telephone ( )

Address/City/State/Zip

Employment Dates

From: To:

Supervisor Name

Pay Rate

Start: Last:

Job Duties

Reason for Leaving

Company Name

Telephone ( )

Address/City/State/Zip

Employment Dates

From: To:

Supervisor Name

Pay Rate

Start: Last:

Job Duties

Reason for Leaving

Company Name

Telephone ( )

Address/City/State/Zip

Employment Dates

From: To:

Supervisor Name

Pay Rate

Start: Last:

Job Duties

Reason for Leaving

Company Name

Telephone ( )

Address/City/State/Zip

Employment Dates

From: To:

Supervisor Name

Pay Rate

Start: Last:

Job Duties

Reason for Leaving

Company Name

Telephone ( )

Address/City/State/Zip

Employment Dates

From: To:

Supervisor Name

Pay Rate

Start: Last:

Job Duties

Reason for Leaving

Please list additional employers on a separate piece of paper. We may contact the employers listed above unless you indicate those you do not want us to contact.

Do Not Contact Employer #(s)________________Reason__________________________________________________

Page 3 of 4

Have you been convicted of a felony?___________ Have you been convicted of a crime involving violence?__________

Have you been convicted of theft of property within the last 5 years?__________________________________________

If yes, please explain?_______________________________________________________________________________

(Such a conviction is not an automatic bar to employment. Any information supplied regarding the circumstances, rehabilitation and age at the time, will be considered. You may attach additional information which you want considered. I understand that specific positions, such as cashier, scale operator, clerical, managerial and truck driver may require a criminal background check to substantiate the information I have given above regarding felony convictions. I agree to the criminal background check for this purpose and omissions may result in denial of employment.)

Substance Abuse Policy

I understand that the Company requires applicants for employment to be tested regarding their use of drugs or controlled substances. I understand the process of the testing is to determine if alcohol, drugs, and/or any controlled substances are present in my system. I understand that the testing is generally done by urinalysis. I also understand a laboratory selected by the Company will perform the testing and will provide the results to the Company. I hereby fully and freely consent to having such test(s) performed and to having the results provided to the Company, its’ employees and agents. If employed, I further consent to such testing during my employment by the Company. I further understand that the Company’s Drug and Alcohol Policy prohibits the possession of, use of or being under the influence of illegal drugs, controlled substances or alcohol while at work. I further understand that failure to submit to the testing or testing positive for alcohol, illegal drugs, or controlled substances, will disqualify me from consideration for employment, and if employed, may disqualify me from continued employment.

Acknowledgement:

For All Applicants: The information provided in this Application for Employment is true, correct and complete. I understand that any misstatement or omission of fact on this application and/or attachment may result in my being denied employment with the Company or if hired may result in termination of employment.

I understand and agree that if employed:

* My employment is for no definite period of time and may be terminated by the Company at any time without any prior notice and without cause.

* No officer or employee of the Company can guarantee me employment for any period of time or any specific salary or benefits, except by written employment agreement between me and the Company signed by the President of the Company.

* I will comply with the rules and regulations of the Company including the drug and alcohol policy. I understand the Company’s rules, regulations and policies are not a contract and may be changed or waived by the Company at any time.

Employment References:

I hereby authorize my prior employers to provide M. Lipsitz & Co., Ltd. and its’ affiliates with all information regarding my job performance, safety performance, and other information related to my previous employment. I hereby release my prior employers from any liability for providing such information.

_______________________________________________ Date:__________________________________

Applicant Signature

Applications are kept active only for sixty (60) days after the date of application. If you desire for your application to remain active beyond that period, please write the personnel office and request that your application be kept active for an additional sixty (60) day period.

To be completed by DRIVER APPLICANTS ONLY: Page 4 of 4

Driver License Information: (Please list your current driver license information. If you have had a driver’s license in another state in the past 5 years, please list that information also.)

STATE	LICENSE NO:	TYPE	EXPIRATION DATE	DATE OF BIRTH

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

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

3. Have you ever been convicted of a DWI or DUI? Yes No

If you answered “Yes” to any of the questions 1 through 3 above, please explain:________________________________

PREVIOUS DRIVING EXPERIENCE

About how many years, months of driving experience do you have:_____________________________________

Please list the types of equipment you have operated:______________________________________________________

ACCIDENT RECORD: Please list all accidents you were involved as a driver in the past 5 years:

Accident Date	Location	Nature – include fault/no fault	Injuries	Fatalities

TRAFFIC VIOLATION RECORD: Please list all violations of motor vehicle law or ordinances (other than violations involving only parking) of which you were convicted or forfeited bond or collateral during the three years preceding date of this application:

Violation Date	Type of Violation	Location

Authorization for Release of Information

Motor Vehicle Record and Criminal Background Check: I hereby authorize M. Lipsitz & Co., Ltd. and its’ affiliates to investigate my driving record, including obtaining a copy of my motor vehicle record and criminal background check, for the purpose of determining my eligibility to operate any company owned vehicles.

Alcohol and Drug Testing: I understand that the information in this application will be used to contact prior employers for purposes of investigation as required by 391.21 of the Federal Motor Carrier Safety Regulations. I hereby authorize M. Lipsitz & Co., Ltd. and its’ affiliates to obtain from my prior employers during the three(3) year period preceding the date of this application, information about me regarding alcohol tests with a concentration level of 0.04 or greater, positive drug test results, refusals to be tested (including verified adulterated or substituted drug test results), other violations of Federal Motor Carrier Safety Administration drug or alcohol regulations and, if applicable, completion of return to duty requirements , following violation of DOT drug and alcohol regulation. I hereby authorize and consent to release of such information by my prior employers to M. Lipsitz & Co., Ltd. and its’ affiliates, in person, by telephone, in writing or by any other method of transmission ensuring confidentiality. I hereby authorize M. Lipsitz & Co., Ltd. and it’s affiliates to release such information to any employee of M. Lipsitz & Co., Ltd. and its’ affiliates whose duties require them to assess this application or to make any recommendations or decisions with respect to it. This information is requested in compliance with subsection 40.25 and subsection 382.05 (f) and (h) of the Federal Motor Carriers Safety Regulations.

Applicant Signature___________________________________________ Date__________________________