Application Form

April 1, 20240

*First Name

*Middle Name

*Last Name

*Date of Birth

*Street Address

*City

*State

*Zip

*Country

*Phone

*Email

*Position applied for

*How did you hear about this opening?

*When can you start?

*Requested Starting Wage

*Do you have current and unrestricted authorization to work in the U.S.? You may be required to provide documentation I-9 form

*Have you ever been convicted of a crime?

Yes No

*Have you ever lived maintained a residence outside of Michigan?

Yes No

Education

*High School

*College

*Other Training

In addition to your work history, are there other skills, qualifications, or experience that we should consider?

Other Current Employment

*What other employment or “sideline” business do you have? Please describe.

*Would you want to continue it if employed by us?

Yes No

Personal ReferencesPlease include the name, email address, and phone number of the reference.

Reference 1

First Name

Last Name

Phone

Reference 2

First Name

Last Name

Phone

Reference 3

First Name

Last Name

Phone

Employment HistoryList below past and present employment, starting with most recent. Include employment with U.S. military service. Do not skip any employers.

Employer 1

Name and Address

Position

Starting Wage

Ending Wage

Description of Duties

Supervisor Name

Date Employed From

Date Employed To

Reasons for leaving:

Employer 2

Name and Address

Position

Starting Wage

Ending Wage

Description of Duties

Supervisor Name

Date Employed From

Date Employed To

Reasons for leaving:

Employer 3

Name and Address

Position

Starting Wage

Ending Wage

Description of Duties

Supervisor Name

Date Employed From

Date Employed To

Reasons for leaving:

APPLICANT ACKNOWLEDGEMENT AND CONSENT

*I authorize this company to investigate all statements contained in this application, including records of any former employers, police departments, and other references or sources concerning me. I authorize all such references and sources and the company to release this information without liability for damage incurred in giving it. I waive any written notice of the release of such records that may be required by state or federal law. I affirm that the information provided on this application and accompanying resume and notes, if any is true and complete. I also agree that any false information, misrepresentations, or omissions—oral or written—may disqualify me from further consideration for employment and may result in discipline or dismissal if discovered at a later date. Should I receive a conditional offer of employment, I agree to submit to any physical medical examination. I further authorize any physician or entity conducting such medical examination to release the results of such examination to NMCP, Inc. I also understand that if I have a protected disability that affects my ability to do the job I seek, I may ask NMCP, Inc. to attempt to make a reasonable accommodation for it. I must make my request in writing to the Personnel Department as soon as possible, and under the Michigan Persons With Disabilities Civil Rights Act, such notice must be given no later than 182 days after the date I know or reasonably should know that accommodation is needed. Should I receive a conditional offer of employment, I give my consent for NMCP, Inc., through an authorized testing service of its choice, to collect blood, urine, or saliva samples from me and to conduct any other necessary medical tests to determine the presence of alcohol, drugs, or controlled substances, and I release NMCP, Inc. from any liability arising out of such test or its results. Further, I give my consent for the release of the test results and other relevant medical information to authorized NMCP, Inc. management for appropriate review. If I am accepted for employment by NMCP, Inc., I consent to be tested in the above manner during my employment when, in the Company’s judgment, such testing is appropriate, and I acknowledge that remaining free of illegal drug use and complying with the Company’s substance abuse policy is a condition of my employment. I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.

Acknowledge

*Signature

*Date

*Resume

Cover Letter

Fields with (*) are compulsory.

Application Form

Application Form

J & M Construction

Pages

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