Application for Employment (Equal Opportunity Employer) 1Personal2Position3Experience4Acknowledgement Which state(s) are you applying to?* Minnesota South Dakota North Dakota First Name* Last Name* GenderMaleFemaleRaceAfrican AmAsianHispanicNative AmOtherWhiteMilitary VeteranYesNoAddress City StateAKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYZip Code Primary Phone* Secondary Phone Email Emergency Contact Phone 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?* Yes No Do you have any questions about what is required for this position?* Yes No HiddenWhat questions do you have about the position?Add your drivers license # if you will be required to drive a company vehicle for any reason HiddenPlease Provide Details about your Conviction Have you worked for NCM before? Yes Previous EmploymentCompany Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY DutiesSupervisor Title Phone Company Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY DutiesSupervisor Title Phone ReferencesName Title Phone Name Title Phone 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 PhoneThis field is for validation purposes and should be left unchanged.