Full Time Employment Application

City of Grosse Pointe
17147 Maumee Avenue
Grosse Point, MI
48230
313-885-5800

It is the policy of the company to provide equal opportunity with regard to all terms and conditions of employment. The company complies with federal and state laws prohibiting discrimination on the basis of race, color, religion, creed, national origin, gender, disability, veteran status, age or any other protected characteristic.ccc

Name:

Phone:

Address:

City/State/Zip:

Position Applied For:

Shift Preferred:

Special training or skills (languages, machine operation, etc.) that would benefit you in the job for which you are applying:

Expected Pay:

Would you accept full-time work?:

Would you accept part-time work?:

On what date would you be available for work?:

Have you ever been employed here before?:   Dates: 
Do you have a legal right to be employed in the U.S.?

If you are under 18, can you provide a work permit if required?:

Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)?
This question os not designed to elicit information about the applicant's disability. Please do not provide information about the existance of a diability, particular accommodation, or whether accommodation is necassary. These issues may be addressed at a later stage to the extent permitted by law.

Explain any gaps in your employment, other than those due to personal illness, injury or disability:

Have you ever been fired or asked to resign for a job?

If Yes, please explain:


Educational Background

Grammar School
Name and Location:

Course of Study:

Did you graduate?:

Degree or Diploma:


High School
Name and Location:

Course of Study:

Did you graduate?:

Degree or Diploma:


College
Name and Location:

Course of Study:

Did you graduate?:

Degree or Diploma:


Graduate School
Name and Location:

Course of Study:

Did you graduate?:

Degree or Diploma:


Vocational or other training
Name and Location:

Course of Study:

Did you graduate?:

Degree or Diploma:


Continuing Education:

Previous Employers and Addresses
Check the box by the employer(s) you do not wish us to contact. List the most recent first.

 Company Name:

Contact name:

Address:

Dates of employment:

Position:

Reason for leaving:


 Company Name:

Contact name:

Address:

Dates of employment:

Position:

Reason for leaving:


 Company Name:

Contact name:

Address:

Dates of employment:

Position:

Reason for leaving:


 Company Name:

Contact name:

Address:

Dates of employment:

Position:

Reason for leaving:

 I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time.

 In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company’s option.

 I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.

 I understand that no company representative, other than its president, and then only when in writing and signed by the president, 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.

Applicant’s Signature:

Date: