Personal Information
First Name :
Last Name :
Address :
City :
State :
Select State/Province
Alaska
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Zip Code :
Phone :
Email Address :
Referred by :
Are you 18 years or older? :
yes
no
Employment Desired
Position Desired :
Date you can start :
Salary desired :
Are you employed now? :
yes
no
If so, may we unqire of your present employer? :
yes
no
Ever applied to this company before? :
yes
no
Where? When? :
Education
Grammar School (name & address) :
Years Completed :
1
2
3
4
Did you Graduate? :
yes
no
Subject Studied/Degree(s) Received :
High School (name and address) :
Years Completed :
1
2
3
4
Did you graduate? :
yes
no
College (name and address) :
Years Completed :
1
2
3
4
Did you graduate? :
yes
no
Subject studied/Degree(s) received :
College (name and address) :
Years Completed :
1
2
3
4
Did you graduate? :
yes
no
Subjects studied/Degree(s) received :
Trade, Business, or Correspondence School :
Years Completed :
1
2
3
4
Did you graduate? :
yes
no
Subject studied/Degree(s) received :
General Information
Subjects of special study or research work :
Job related skills (typing, drivers license, etc.) :
Activites other than Religious (civic, athletic, etc.) :
Former Employers
Date (Month & Year) :
Name & Address of Employer :
Salary (upon leaving) :
Positon :
Reason for leaving :
Date (month & year) :
Name & Address of Employer :
Salary (upon leaving) :
Position :
Reason for leaving :
Date (month & year) :
Name & Address of Employer :
Salary (upon leaving) :
Position :
Reason for leaving :
Date (month & year) :
Name & Address of Empoyer :
Salary (upon leaving) :
Position :
Reason for leaving :
References
Name & Address :
Phone Number :
Postion :
Years Known :
Name & Address :
Phone Number :
Position :
Years Known :
Name & Address :
Phone Number :
Postion :
Years Known :
"UNDER Michigan LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT OR PROSCPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT, ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANER AND SUBJECT TO A FINE NOT TO EXCEED $100.00"
"It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employemnt or continued employment. An employer who vilotes this law shall be subject to criminal penelties and civil liability."
If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.
Authorization
I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the company.
I understand that any employment is conditioned on a background check. I authorize the Company to thouroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding to my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.
I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be 'at will' and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Compnay unless made in writing.
If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical exmination or drug test at any time deemed appropriate by the Company and as permitted by law. I consent to such exminations and tests, and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the Company's Drug and Alcohol Policy
I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains all right to revise its policies and procedures, in whole or in part, at any time.
Signature :
Date Applied :
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