Job Application Facebook Twitter Youtube Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstMiddleLastEmail *Date of ApplicationAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Social Security No.Are you 18 Years of older?YesNo Are You a U.S. CitizenYesNoAre you authorized to work in the United StatesYesNoHave you been previously employed hereYesNoWhat is the date you have been empolyedMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Supervisor NameHave you filed an application beforeYesNowhich date?MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920List any friend or relatives working hereWhat method of transportation will you use to come to work?Employment DésiredPosition(s) applied for *Kind of work soughtFull-TimePart-TimeOther Single Line TextHow did you hear about our company?List any of your special training, skills, qualifications, or other experiences that relate to the position(s) applied forSalary DesiredDate available to workEmployers 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 notifying the firm 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 firm may preclude any claim that the employer failed to accommodate the disabled individual.THIS APPLICATION WILL BE KEPT CURRENT FOR THREE MONTHS. YOU NEED TO COMPLETE ANOTHER ONE TO BE RECONSIDERED AFTER THIS DATE.uvrurucuts ur jurner en proyersFirstMiddleLastHave you had any experience in the Armed Forces of the United States or in a State National Guard? YesNowhat is the branchRank at DischargeDate of DischargeAre you in the reservesYesNoDate obligation endsSpecial/technical trainingAdditional InformationHave you been convicted of a crime?YesNoWhere, when and nature of offenseDo you have a valid driver's license?YesNoLicense NoStateList professional trade, business or civic activities and offices held excluding groups 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 applicationState any reoccurring or chronic medical condition that could interfere with your scheduled shift or the care and welfare of our residentsName, address, and telephone number of the person(s) to be notified in the event of accident or emergencyTAUTHORIZATION AND UNDERSTANDINGUpon the signing of this application, I represent all of the information now or hereafter given by me in support of my application us true and complete. I authorize you to verify any of the information concerning my employment, education, criminal history, medical history (post-offer only), or credit history with the appropriate individuals, companies, institutions or agencies, and I authorize them to release such information as you require, including my prior 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. 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 fim. I agree that I shall be bound by the other sules, policies, regulations, and terms and conditions of employment of the finn as they are from time to time changed, and no additional obligations can be imposed on the firm except those which have been acknowledged in writing, by the president or his designated representatives. I hereby authorize the fim to deduct from each and every period of my pay any amounts necessary to offset any damages caused by me or the value of property of money entrusted to me by, or owed by me to, the firm during the course of my employment I agree that any action or suit against the firm arises out of my employment or termination of employment, including, but not limited to, claims arising under State or Federal civil rights statutes, must be brought within 180 days of the event giving rise to the claims or be forever barred. I waive any fimitation periods to the contrary. Should the 180-day limitations period be found to be unreasonable and unenforceable, the period of limitations shall be the minimum reasonable time in excess of 180 days. I further agree that if I should bring any non-statutory action or claim arising out of my employment against the firm, in which the firm prevails, I will pay to the firm any and all such costs incurred by the firin in defense of said claims or actions, including attomey fees. I further agree that my employment is conditional until such time as the results of my post-offer pliysical (if such physical is required)Submit
