Employment Application

The Authority is an equal opportunity employer and will not discriminate against any applicant on the basis of any characteristic that is protected by state or federal law. Michigan law requires a person with a disability or handicap requiring accommodation to perform the essential duties of the job must notify the employer in writing within 182 days of the date that the need is known or should have been known.

Please note that this application will only remain active for 6 months from the date of application ({{Today}}), after which the applicant would need to re-apply.

Thank you for your submission.

Position applied for:

Required

Date you can start:

Required

Name

First:

Required

Middle:

Last:

Required

Present Address

Street:

Required

City:

Required

State:

Required

Zip:

Required

Permanent Address

Same as Present Address

Street:

Required

City:

Required

State:

Required

Zip:

Required

Contact Info

Primary Phone:

Required

Work Phone:

Required

Email:

Required

Invalid Email

Are you 18 years or older?

Yes No

Required

Are there any hours or days of the week you cannot work?

Yes No

Required

If so, When?

Required

Salary Desired:

Required

Type of Employment:

Full-Time Part-Time

Required

Are you currently employed?

Yes No

Required

If so, may we conntact your present employer?

Yes No

Required

Have you ever been discharged from employement or asked to resign?

Yes No

Required

If so, please explain:

Required

Have you ever applied to the Authority before?

Yes No

Required

If so, when?

Required

Have you ever worked for the Authority before?

Yes No

Required

If so, under what name?

Required

Do you have any relatives employed by the Authority?

Yes No

Required

If so, please list name(s) and relationships:

Required

Education

Elementary School

Name and Address

Years Attended:

Did you graduate?

Yes No

High School

Name and Address:

Years Attended:

Did you graduate?

Yes No

College

Name and Address:

Years Attended:

Did you graduate?

Yes No

Subject/Major:

Specialized Training

Name and Address:

Years Attended:

Did you graduate?

Yes No

Subject/Major:

Do you have US Military experience?

Yes No

Date entered:

Required

Branch:

Required

Rank:

Required

Date discharged:

Required

Were you honorably discharged?

Yes No

Required

Are you lawfully entitiled to be employed in the United States?

Yes No

Have you ever been convicted of a crime expect a minor traffic violation?

Yes No

If so, please state citation, date and place where offense occured: This will be considered in conjunction with the nature and gravity of the offense, when it occured, and successful efforts at rehabilitation since conviction, and how it relates to the nature of the job sought.

Required

Other Skills

Please provide any additional information such as special skills, training, managment experience, equipment operation or qualifications you feel will be helpful to us in considering your application.

References

Three individuals NOT related to you, whom you have known for at least one year.

Name:

Address and Phone Number:

Relationship:

Years Known:

Availability

Please enter the times you are available to work.

Monday

From:

To:

Tuesday

From:

To:

Wednesday

From:

To:

Thursday

From:

To:

Friday

From:

To:

Saturday

From:

To:

Sunday

From:

To:

Please provide any other information about your availability.

Current & Former Employers:

List current and former employers (most recent first).

Date (From/To):

Name, Address & Phone Number:

Salary (Starting/Ending):

Last Position Held/Responsibilities:

Reason For Leaving:

May we contact the employers listed?

Yes No

Required

If not, which one(s) are specifically excepted?

Required

How did you hear about this position?

Please read the following statement carefully before signing to indicate your understanding:

I certify that the facts contained in this employment application are true and complete to the best of my knowledge and understand that falsified statements or a material omission of information from this application may result in termination of the hiring process and/or the employment relationship.

I authorize investigation of all statements contained in this application for any employment related purpose. I release the listed references and all employers, except those specifically excepted, to provide you with any and all applicable information they may have. I hereby release these references and former employers from all liability for information they may give to you.

I agree not to begin any claim, complaint, action or suit relating to this hiring process or my employment with LEPFA more than one hundred and eighty-two (182) calendar days after the event giving rising to the claim, complaint, action, or suit; or later than the applicable limitations period established by statute, whichever is less. This is not intended to modify any timeline that is set forth in an applicable collective bargaining agreement.

I have read and understand the above.

Required

Signature

Required

Date

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