Application for Employment

To the Applicant: We appreciate your interest in our company and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in seeking to place you in a position which, in our judgment, best meets your qualifications. *Please be advised, you will be required to undergo a background check and drug screening in order to obtain employment. By signing this application, you are giving consent for a background check to be performed.*
We are an equal opportunity employer and will not unlawfully discriminate on the basis of race, color, sex, religion, national origin, age, marital or veteran status, the presence of a medical condition or handicap, height, weight or any other protected status.

FIRST NAME *
LAST NAME *
Date *
Address - Street, City, State, and Zip *
EMAIL ADDRESS *
PHONE NUMBER
Are you 18 years or older? *
YesNo
Are you a U.S. Citizen? *
YesNo
Are you authorized to work in the United States? *
YesNo
Have you been previously employed here? *
YesNo
If yes, date(s) *
List any friends or relatives working here *
What method of transportation will you use to come to work? *



Employment Desired

Position(s) applied for *
Kind of work sought: *
Full TimePart Time
Other
Do you have any special training, skills, qualifications or other experiences that relate to the position(s) applied for?
Salary Desired
Date available to work



Employers must make accommodations to disabled applicants and employees where the accommodation does not impose an undue hardship on the employer.
Under Michigan law only, disabled employees and applicants may request an accommodation of their disability by notify the company in writing of the need for accommodation within 182 days of the date the disabled individual knows or should know that an accommodation is needed. This requirement does not apply to an individual’s right under the Americans with Disabilities Act. Failure to properly notify the company may preclude any claim that the employer failed to accommodate the disabled individual.

REFERENCES (Do not include relatives or former employers)

1 -Include Name, Address, Phone Number and Years Acquainted
2 - Include Name, Address, Phone Number and Years Acquainted
3 - Include Name, Address, Phone Number and Years Acquainted



Military Service Record

Have you had any experience in the Armed Forces of the United States or in a State National Guard?
YesNo
If yes, what branch?
Rank at Discharge
Date of Discharge
Are you in the reserves?
YesNo
If yes, date obligation ends
Special/Technical training



ADDITIONAL INFORMATION

Have you been convicted of a crime?
YesNo
If so, where, when and nature of offense
Do you have a valid driver’s license?
YesNo
List professional trade, business or civic activities and offices held (excluding groups in which the name or character of which indicate race, color, religion, sex, national origin, handicap, marital or veteran status, height, weight or age)
State any additional information that you feel may be helpful to us in considering your application.
Name, address, and telephone number of the person to be notified in the event of accident or emergency



AUTHORIZATION AND UNDERSTANDING:
Upon the signing of this application, I represent that all of the information now or hereafter given by me in support of my application is true and complete. I authorize you to verify any of the information concerning my background, including but not limited to, my employment, driving record, education, criminal history, or medical history (post-offer only)with the appropriate disciplinary employment record, without any obligation to give me written notice of such disclosure. I also authorize you to release any information requested by any of my prospective or subsequent employers without any obligation to give me written notice of such disclosure. I hereby release you and them from any liability whatsoever as a result of any such inquiries and disclosures and this EEOC. I agree that any false information in support of my application may subject me to discharge at any time during the period of my employment.

I agree that either party may terminate the employment relationship, with or without cause, at any time, and I further agree that this arrangement may only be altered in writing directed to me personally and signed by the president of the company. I agree that I shall be bound by the other rules, policies, regulations and terms and conditions of employment of the firm as they are in writing, by the president or his designated representatives.

I agree that any action or suit against the company, its agents or employees, arising out of my employment or termination of employment, including, but not limited to, claims arising under State and Federal law, but not Federal civil rights statutes containing a separate limitations period, must be brought within 180 days of the event giving rise to the claims or be forever barred unless the applicable statute of limitations period is shorter than 180 days in which case I will continue to be bound by that shorter limitations period. I waive any limitation periods to the contrary. I further agree that if I should bring any non-statutory action or claim arising out of my employment against the company, in which the company prevails, I will pay to the company any and all such costs incurred by the company in defense of said claims or actions, including attorney fees. I further agree that my employment is conditional until such time as the results of my post-offer physical (if such physical is required) are known.