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Tidewater Utility

Tidewater Utility

    Employment Application Form

    Present Address*





    EDUCATION & OTHER INFORMATION

    NAME OF SCHOOL LOCATION (Complete mailing address) NO. OF YEARS COMPLETED MAJOR or DEGREE
    High School
    College
    Bus. or Trade School
    Professional School


    Please list two references other than relatives or previous employers.

    Reference 1

    Reference 2

    Work Experience

    Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
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    PLEASE READ CAREFULLY

    APPLICATION FORM WAIVER

    In exchange for the consideration of my job application by TIDEWATER UTILITY CONSTRUCTION, INC. (hereinafter called "the Company"), I agree that:

    Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of TIDEWATER UTILITY CONSTRUCTION, INC., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by an officer of the Company. Both the undersigned and TIDEWATER UTILITY CONSTRUCTION, INC. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

    I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

    I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

    I further understand that my employment with the Company shall be probationary for a period of thirty (30) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

    This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

    VOLUNTARY APPLICANT AFFIRMATIVE ACTION INFORMATION SHEET

    As an Equal Opportunity Employer, we do not discriminate on the basis of race, color, religion, sex, age, national origin, disability, genetic information, veteran status, or any other classification protected by federal, state, or local law Asafederal contractor, we complywith government regulationsand affirmative action responsibilities where applicable.

    Completion of this data is voluntary and will not affect your opportunity for employment. This information is solely to help us comply with government record keeping, reporting, and other legal requirements and will be kept in a confidential file separate from the Application for Employment. Thank you for your cooperation.


    Address



    Tidewater Utility Construction, Inc
    200 Lummis Road, Suffolk, VA 23434
    Phone: (757) 935-5899
    Main Fax: (757) 935-5894
    Accounting/HR Fax: (757) 935-5893

    Voluntary Self-Identification of Disability

    Form CC-305

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    OMB Control Number 1250-0005

    Expires 04/30/2026


    Why are you being asked to complete this form?

    We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

    Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.


    How do you know if you have a disability?

    A disability is a condition that substantially limits one or more of your "major life activities." If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

    • Alcohol or other substance use disorder (not currently using drugs illegally)
    • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
    • Blind or low vision
    • Cancer (past or present)
    • Cardiovascular/heart disease
    • Celiac disease
    • Cerebral palsy
    • Deaf or serious difficulty hearing
    • Diabetes
    • Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
    • Epilepsy or other seizure disorder
    • Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
    • Intellectual or developmental disability
    • Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
    • Missing limbs or partially missing limbs
    • Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
    • Nervous system condition, for example, migraine headaches, Parkinson's disease, multiple sclerosis (MS)
    • Neurodivergence, for example, attention-deficit/hyperactivity disorder ADHD, autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
    • Partial or complete paralysis (any cause)
    • Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
    • Short stature (dwarfism)
    • Traumatic brain injury

    Please check one of the boxes below:


    PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid 0MB control number. This survey should take about 5 minutes to complete.

    For Employer Use Only

    Employers may modify this section of the form as needed for recordkeeping purposes.

    For example:

    VETS-4212 EMPLOYMENT SURVEY

    Our Company is a federal contractor subject to various federal laws, regulations, and Executive Orders, which require that federal contractors take affirmative action to employ and to advance in employment qualified individuals without discrimination based on a covered veteran status. To fulfill statistical reporting and affirmative action monitoring requirements, we invite you to voluntarily identify your veteran status by answering the questions below. Submission of this information is voluntary and no adverse consequences will result from either the disclosure or refusal to provide this information. The information that you submit will also be kept confidential as required under applicable federal and/or state laws. Should you decide not to self-identify at this time, you may do so at any time in the future.

    Please check all boxes that apply to you:

    Either (1) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administrated by the Secretary of Veterans Affairs, or (2) a person who was discharged or released from active duty because of a service-connected disability.

    Any veteran during the three year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval or air service.

    Discharge Date (mm/dd/yyyy)

    Any veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces Service Medal was awarded pursuant to Executive Order 12985. (For the current list of military operations for which an Armed Forces Service Medal was awarded, visit http://www.opm.gov/staffingporta1/vgmedal2.asp - Appendix A.

    A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. (For the current list of campaigns and expeditions for which a campaign badge was authorized, visit http://www.opm.gov/staffingportal/vgmedal2.asp - Appendix A.

    Tidewater Utility Construction, Inc
    200 Lummis Road, Suffolk, VA 23434
    Phone: (757) 935-5899
    Main Fax: (757) 935-5894
    Accounting/HR Fax: (757) 935-5893

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