229 East Front Street Traverse City, MI, 49684

(231)941-8888

Job Application

Personal Information

Name

First Name

Last Name

Present Address

street, city, state, zip code

Permanent Address (if different from present address)

street, city, state, zip code

Phone

(###)

###

####

Preferred method of contact

Referred by

Employment Desired

Position desired

Date you can start

Currently Employed?

Yes

If you are currently employed, may we inquire of your present employer?

Yes

Have you applied to this company before?

Yes

When did you apply before?

Educational History

High School

Name & Location of School. Years Attended. Did you Graduate? Subjects Studied.

College

Name & Location of School. Years Attended. Did you Graduate? Subjects Studied.

Trade/Business/Correspondence School

Name & Location of School. Years Attended. Did you Graduate? Subjects Studied.

General Information

Subjects of Special Study/Research Work

Special Training

Special Skills

U.S. Military or Naval Service

Include Rank

Former Employers

Last 4 employers. Most recent listed first.

Most Recent Employer

Include first & last dates of employment, Name and Address of Employer, Position, and Reason for leaving.

Former Employer 2

Include first & last dates of employment, Name and Address of Employer, Position, and Reason for leaving.

Former Employer 3

Include first & last dates of employment, Name and Address of Employer, Position, and Reason for leaving.

Former Employer 4

Include first & last dates of employment, Name and Address of Employer, Position, and Reason for leaving.

References

Three person, not related to you, whom you have known at least one year

Reference 1

Name, Address, Business, and Years Known

Reference 2

Name, Address, Business, and Years Known

Reference 3

Name, Address, Business, and Years Known

Authorization

Please read the following statement

"I certify that the fact contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in a disqualification from employment." In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

Agree

Disagree