Last Name *

Address *

City *

State *

ZIP Code *

Telephone Number *

Do you have a Driver's License? *

Yes No

If Yes:
Driver's License State

Driver's License Number

Drivers's License Expiration Date

Have you ever been convicted of a felony? *

Yes No

If Yes, explain why.

Type answer here.

Employment Information

Position(s) applied for:

Project Superintendent

Estimator

Installer

Are you willing to relocate? *

Yes No

Are you willing to temporarily work out-of-state? *

Yes No

Can you perform the position applied for with or without a reasonable accommodation? *

Yes No

Working overtime hours is expected for continued employment.  Are you able to meet this requirement? *

Yes No

Have you ever been employed by Nationwide before?  *

Yes No

If Yes, give dates employed, and indicate if employed under a different name

Type answer here.

Do you have the legal right to work in this country?  *

Yes No

Do you understand that the Immigration Reform and Control Act requires you to prove the legality of your residence or citizenship.  *

Yes No

Former Employment

1.

Employer *

Name *

Address *

Job Title/Duties *

Supervisor *

Reason for Leaving *

Dates Employed *

2.

Employer

Name

Address

Job Title/Duties

Supervisor

Reason for Leaving

Dates Employed

3.

Employer

Name

Address

Job Title/Duties

Supervisor

Reason for Leaving

Dates Employed

4.

Employer

Name

Address

Job Title/Duties

Supervisor

Reason for Leaving

Dates Employed

Education/Training/Licenses/Organizations

High School

College (Name, Major & Degree obtained)

(Name, Major & Degree obtained)

Vocational training or other

Membership in professional or civic organizations.  (Exclude those which may disclose your race, color, religion, or national origin.)

References

1.

Name *

Address *

Phone Number *

2.

Name*

Address*

Phone Number *

3.

Name

Address

Phone Number

If you have questions about the positions listed above or general questions about employment opportunities at Nationwide Construction Group, please e-mail your questions to info@nationwidecos.com, or call our Human Resources Department at (586) 749-6900, extention 949.

CERTIFICATION AND AGREEMENT

I certify that the information contained in this pre-employment application is correct to the best of my knowledge and understand that falsification of any information is grounds for Nationwide Construction Group refusing to offer employment, and if subsequently employed, grounds for termination. Nationwide Construction Group may contact my references and previous employers listed above who may give Nationwide Construction Group any and all information concerning any previous employment and any pertinent information that they may have, personal or otherwise.  I release all parties from all liability for any damage that may result.  I specifically waive any right to be notified under any act of the release of personnel file information by my prior employers. I understand and agree that if offered employment, my employment can be terminated, without cause, and with or without notice at any time.  I understand that no representative of Nationwide Construction Group has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.  Any agreement attempting to alter the terminable at-will nature of the employment relationship is void. Any offer of employment will be conditioned upon the successful completion of a medical examination with drug and alcohol screening.  My refusal to submit to a medical examination or drug and alcohol screening, or refusal to sign an authorization form will result in Nationwide Construction Group refusing to offer employment.  I also understand that positive test results will be the basis of a decision not to offer employment. I authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the duties of a job for which I am being considered. The medical examination and drug and alcohol screening will be conducted at a medical facility selected by Nationwide Construction Group and will be paid directly by Nationwide Construction Group. Any information gathered from this medical examination and drug and alcohol screening will be kept confidential and disclosed only as lawfully permitted and maintained separate from your personnel files. The medical examination will be related to the essential functions of the job which you have applied for.  You will be required to perform, with or without reasonable accommodations, the certain physical acts required by the job duties. I agree to disclose completely all information requested during such examination and testing as to my physical condition, medication and medical history. I hereby waive and release Nationwide Construction Group and any testing agency engaged by it, and their respective officers, employees, and agents from any and all claims or liability of any nature arising from any such testing or analysis; or from decisions made regarding my employment or termination of employment based upon the results of such testing or analysis; or with respect to any allegations that any State or Federal constitutional or other rights which I may have to privacy have been violated by virtue of such testing, disclosures of testing results, or decisions made with respect to same. I understand and agree that if after a review of my pre-employment application, Nationwide Construction Group is interested in considering me as a possible employee, I may be required to sign various authorizations, waivers and releases relating to the above Certification and Agreement and understand and agree that my refusal to do so will constitute grounds for Nationwide Construction Group refusing to offer employment.

An Equal Opportunity Employer