Employment ApplicationThe following information is requested in order to help us make the possible placement within the company. All portions of this application pertaining to you must be completed. We appreciate the time you spend in filling in this application form. The company, in accordance with state and federal laws, does not discriminate on the basis of age, race, religion, color, sex. national origin, marital status, physical or mental handicap, height, weight or arrest record.Grand Haven Campus: 1125 Robbins Road, Grand Haven, MI 49417- (616) 842-1900Northcrest Campus: 2650 Rudiman Drive, North Muskegon, MI 49445 – (231) 744-2447Date(Required) MM slash DD slash YYYY Authorized Applicant Name(Required) First Middle Last Address(Required) Street City State ZIP Phone Number(Required)Email(Required) U.S. Citizen(Required)Are you either a U.S. Citizen or an alien authorized to work in the United States? Yes No18 Years or Older?(Required) Yes NoPosition applied for?(Required)Date you can start?(Required) MM slash DD slash YYYY Employment Status(Required)Are you currently employed? Yes NoCurrent Employer(Required)May we inquire of your present employer? Yes NoPrevious Employee(Required)Have you ever worked here? Yes NoIf yes, when? MM slash DD slash YYYY Know employee?(Required)Do you know anyone who works here? Yes NoIf yes, who?Overtime(Required)Can you work overtime? Yes NoShiftsFor which shifts are you available? Any Shift 1st 2nd 3rdGrammar School (Name and location)Did you graduate? Yes NoDegree / MajorHigh School (Name and location)Did you graduate? Yes NoDegree / MajorCollege (Name and location)Did you graduate? Yes NoDegree / MajorTrade, Business or Correspondence School (Name and location)Did you graduate? Yes NoDegree / MajorSpecial skills?Employment RecordPlease list the most recent position first.Employer 1Name of EmployerDate Start MM slash DD slash YYYY Date End MM slash DD slash YYYY Exact Reason for LeavingAddress Street City State ZIP PhoneSupervisorContact?May we contact them? Yes NoEmployer 2Name of EmployerDate Start MM slash DD slash YYYY Date End MM slash DD slash YYYY Exact Reason for LeavingAddress Street City State ZIP PhoneSupervisorContact?May we contact them? Yes NoEmployer 3Name of EmployerDate Start MM slash DD slash YYYY Date End MM slash DD slash YYYY Exact Reason for LeavingAddress Street City State ZIP PhoneSupervisorContact?May we contact them? Yes NoPersonal ReferencesReference 1NamePhoneContact?May we contact them? Yes NoAddress Street City State ZIP Reference 2NamePhoneContact?May we contact them? Yes NoAddress Street City State ZIP Emergency Contact – NamePhoneAddress Street City State ZIP Resume Drop files here or Select filesMax. file size: 256 MB, Max. files: 4. (Optional) Upload resumé, letter of recommendation, or cover letter.I certify that the facts 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 therein and the employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties in accordance with the employee right to know act, from all liability for any damage that may result from furnishing same to you.I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause.Approvals and SignatureI certify that the facts 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.(Required) I AgreeI authorize investigation of all statements contained therein and the employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties in accordance with the employee right to know act, from all liability for any damage that may result from furnishing same to you.(Required) I AgreeI understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause.(Required) I AgreeDigital SignatureBy typing my name I am providing my digital signature to certify that the information provided in this application is true and correct.Date of SignatureHiddenSignatureNameThis field is for validation purposes and should be left unchanged.
