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We are an equal opportunity employer. We treat all applicants and employees equally without regard to any legally-protected status, such as race, color, national origin, disability, age, gender, sex, religion, sexual orientation, height, weight, familial status, marital status, genetic information, status as a protected veteran, or any other classification protected under applicable law. If you are a qualified individual with a covered disability in need of an accommodation in order to apply, please contact our main office.
Position applied for
Approximate salary/rate desired
Approximate salary/rate desired
Referral source
Referral source
Monster.com
Friend
Relative
Michigan Talent Bank
CareerBuilder.com
Other
Other
First name
*
Middle name
Last name
*
Address
*
City
*
State
*
State *
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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Hawaii
Idaho
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip
*
Phone
*
Email
*
Have you filed an application here before?
Yes
No
If yes, give date
Have you ever been employed here before?
Yes
No
If yes, give date
Are you employed now?
Yes
No
May we contact your past/present employers?
Yes
No
Are you legally eligible to work in the United States?
Yes
No
On what date would you be available for work?
Are you available to work?
Full time
Part time
Summer
Temporary
Which shifts could you work?
Morning
Afternoon
Midnights
Are you on layoff and subject to recall?
Yes
No
Are you physically and mentally able to perform the essential duties of the job for which you are applying, either with or without reasonable accommodation?
Yes
No
For driving jobs, do you have a valid driver's license?
Yes
No
Have you been convicted of a felony at any time, or have any pending felony charges?
Note: A criminal record will not necessarily be a bar to employment. The company will take into account factors such as your age at the time of the offense, the nature and severity of the offense, rehabilitation efforts, the amount of time since the offense occurred, and the offense’s relationship to the essential duties of the position sought. You are not required to, no should you, disclose any conviction that is “sealed,” “expunged,” “set aside,” or “erased” under applicable law (i.e., a conviction record that is non-public and unreportable).
Yes
No
If yes, explain
Educational experience
Level
High school
College/undergraduate
Graduate/professional
School name
Years completed
1
2
3
4
5
Did you graduate?
Yes
No
Diploma/degree earned
Major/courses of study
Honors received
GPA
Please describe any other education, training, apprenticeships, skills, or relevant extracurricular activities you would like us to consider, without disclosing any information that indicates race, sex, religion, or any other protected status
Employment experience
Please list all jobs you have previously held or currently hold, in reverse chronological order, starting with your present or last job. Do not write “see resume.” You should include any military service and volunteer activities in which you received relevant experience. If possible, do not disclose any organization names or other information that indicates race, sex, religion, or other protected status.
Job 1 – Employer
Job 1 – Phone
Job 1 – Address
Job 1 – Job title
Job 1 – Supervisor
Job 1 – Reason for leaving
Job 1 – Dates employed (from/to)
Job 1 – Hourly rate/salary (starting/final)
Job 1 – Job duties/achievements
List 2nd job?
Yes
Job 2 – Employer
Job 2 – Phone
Job 2 – Address
Job 2 – Job title
Job 2 – Supervisor
Job 2 – Reason for leaving
Job 2 – Dates employed (from/to)
Job 2 – Hourly rate/salary (starting/final)
Job 2 – Job duties/achievements
List 3rd job?
Yes
Job 3 – Employer
Job 3 – Phone
Job 3 – Address
Job 3 – Job title
Job 3 – Supervisor
Job 3 – Reason for leaving
Job 3 – Dates employed (from/to)
Job 3 – Hourly rate/salary (starting/final)
Job 3 – Job duties/achievements
List 4th job?
Yes
Job 4 – Employer
Job 4 – Phone
Job 4 – Address
Job 4 – Job title
Job 4 – Supervisor
Job 4 – Reason for leaving
Job 4 – Dates employed (from/to)
Job 4 – Hourly rate/salary (starting/final)
Job 4 – Job duties/achievements
References
Please exclude family members and supervisors listed above under your employment experience.
Reference 1 – Name
Reference 1 – Phone
Reference 1 – How
List 2nd reference?
Yes
Reference 2 – Name
Reference 2 – Phone
Reference 2 – How
List 3rd reference?
Yes
Reference 3 – Name
Reference 3 – Phone
Reference 3 – How
Additional information
Please state any additional information that you feel may be helpful to us in considering your application and suitability for the position you are seeking
Additional information
Read before signing
1. I have provided complete, truthful, and accurate information in this application. I will inform the Company immediately if any information I have provided changes while my application is being considered. I understand that if any information in this application is found to be misrepresented, omitted, or otherwise incorrect, it may result in rejection of my application or termination of employment.
2. I understand and agree that if I am employed, my employment with the Company will be “at-will,” which means that either I or the Company may terminate my employment relationship at any time, with or without cause, and with or without advance notice. I understand that no one can modify the Company’s “at-will” policy, except for the President of the Company in a specific contract.
3. I understand that any offer of employment I may receive may be conditioned upon me satisfactorily passing a pre-employment background check, physical examination, references check, drug test, and similar screening and also being able to verify my identity and authorization to work in the United States.
4. I authorize the Company, its affiliates, and their agents to make whatever inquiries deemed necessary in connection with my application and suitability for the position that I am seeking. As part of such inquiries, the Company, its affiliates, and their agents have my permission to contact persons and entities who may have information relating to my qualifications for employment. I agree to release and hold harmless the Company and all other persons and entities from any liability from any damages that may result from requesting or furnishing such information. I also waive written notice from my current employer and former employers regarding the disclosure of disciplinary reports, letters of reprimand, and other notices of disciplinary action contained in my personnel records.
5. I agree to file any claim or lawsuit in any way related to my application, my employment, or the cessation of my employment within 180 days after the claim arises, or within the applicable statutory limitations period, whichever is shorter. I acknowledge that the failure to do so will bar any claim I may have, and I waive any longer statutory limitations period to the contrary.
6. By signing below, I fully agree to the foregoing statements, which are contractual and agreed to in consideration of my employment candidacy. In the event that one or more of the foregoing statements contained in this application are declared unenforceable or void, the balance of the statements shall remain in full force and effect.
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Date
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