Application for Employment (Equal Opportunity Employer) 1 Personal2 Position3 Experience4 Acknowledgement First Name*Last Name*GenderMaleFemaleRaceAfrican AmAsianHispanicNative AmOtherWhiteMilitary VeteranYesNoAddressCityStateAKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYZip CodePrimary Phone*Secondary PhoneEmail Emergency ContactPhone For what position are you applying/what is your trade?CarpenterConcrete LaborerFinisherMasonMasonry LaborerMasonry and Concrete LaborerOperatorUnion StatusNon UnionApprenticeJourneymanI have read the job description and understand this job requires for me to repeatedly: climb stairs and ladders, kneel, squat, bend, twist, and carry loads of 65lbs. I am also expected to work in temperatures of extreme heat and cold. Can you perform the requirements of this job without reasonable accommodation?*YesNoDo you have any questions about what is required for this position?*YesNoWhat questions do you have about the position?Add your drivers license # if you will be required to drive a company vehicle for any reasonPlease Provide Details about your Conviction Have you worked for NCM before? Yes Previous EmploymentCompanyStart Date End Date DutiesSupervisorTitlePhoneCompanyStart Date End Date DutiesSupervisorTitlePhoneReferencesNameTitlePhoneNameTitlePhone I hereby state that the information given by me in this application is true in all respects. I understand that if I am employed and the information is found to be false in any respect, I will be subject to dismissal without notice at any time. I hereby authorize my former employers to release information pertaining to my work record, my work habits, and my work performance while in their employ and I hereby release all former employers and references from any liability for what they say about me or my job performance. I hereby authorize the individuals listed as personal references to release any personal information that may pertain to my work habits or work performance including my prior personnel records. I understand and agree that the employee safety handbook which I receive will not constitute an employment contract, but will be merely a general statement of Northland Concrete & Masonry’s current policies. I understand that I am responsible for knowing and following this information. In the event I claim a workman’s compensation injury, I release Northland Concrete & Masonry Co. to medical records that may be related to my employment. NCM will not share this information with any 3rd parties outside our workman’s compensation insurance carrier. I understand and agree that if I am offered employment by Northland Concrete & Masonry Co. My employment will be for no definite term and that either I or Northland Concrete & Masonry Co. will have the right to terminate the employment relationship at any time with or without cause, and with or without notice. If Hired: I will be available each night via telephone for my work assignments Application paperwork will be in within 3 work days of hire I will show up to work when asked and on time I will call my Supt the night before or by 6:00 am if I will be late or absent so they can find someone to fill in. I will bring my tools home with me every night in case I am called to go to a different jobsite. I will write legibly on my timecard. I will make sure each day is initialed by my foreman. I will use correct job numbers. If I don’t know the job number I will find out before turning in my timecard which is due the Monday of each week. I have read, understand and agree to terms above NameThis field is for validation purposes and should be left unchanged.