Applicant Information

Last Name / First / M.I. / Date
Street Address / Apartment/Unit #
City / State / ZIP
Phone / E-mail Address
Name of Institution attending:

Education (Must submit most RECENT transcipt of grades)

High School / Address
From / To / Did you graduate? / YES / NO / Degree
College / Address
From / To / Did you graduate? / YES / NO / Degree
Other / Address
From / To / Did you graduate? / YES / NO / Degree

References

Please provide 1-3 references of people who have been influential in your decision to pursue a career related to the construction industry.
Full Name / Relationship
Company / Phone / ( )
Address
Full Name / Relationship
Company / Phone / ( )
Address
Full Name / Relationship
Company / Phone / ( )
Address


Employment

Please list any work experience you have had in the construction field.
Company / Phone / ( )
Address / Supervisor
Job Title / From / To
Responsibilities
Company / Phone / ( )
Address / Supervisor
Job Title / From / To
Responsibilities

EXTRACURRICULAR ACTIVITIES

List any extracurricular activities (including school-related activities, hobbies and/or volunteer work). List most recent first.

ADDITIONAL INFORMATION

Please write a short response to the question below. Attach (no more than one page) if necessary.

What attracted you to the field of construction and what do you hope to accomplish in your career?

Signature

I certify that my answers are true and complete to the best of my knowledge.
Signature / Date
THE NAWIC TRI-CITIES CHAPTER #192 IS AN EQUAL OPPORTUNITY ORGANIZATION AND ENCOURAGES APPLICATIONS FROM ALL INDIVIDUALS PURSUING A CAREER IN THE CONSTRUCTION INDUSTRY.
Would you like to receive information on becoming a NAWIC Student Member? __Yes ___No
(This will not have an effect on awarding of scholarship)

TO BE CONSIDERED, APPLICATIONS AND ALL ATTACHMENTS MUST BE COMPLETE AND POSTMARKED

BY May 24, 2014

(THIS DEADLINE IS STRICTLY ENFORCED)