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Name *

First Name

Last Name

Phone *

(###)

###

####

Birthday *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

When will you be available to work? *

MM

DD

YYYY

What work are you available for? *

Full-time

Part-time

Shift Work

Temporary

If under 18 years of age, can you provide proof of your eligibility to work? *

Yes

No

Are you authorized to work in the United States? *

Verification of employment authorization will be required of all applicants upon employment

Yes

No

Are you currently employed? *

Yes

No

May we contact your current employer? *

Yes

No

Have you ever filed an application with us before? *

Yes

No

Have you ever been employed with us before? *

Yes

No

Are you currently on "lay-off" status and subject to recall? *

Yes

No

Can you travel if a job requires it? *

Yes

No

Have you ever been convicted of any felony or misdemeanor involving theft, dishonesty, violence, or drugs? *

Conviction will not necessarily disqualify an applicant from employment

Yes

No

Application's Statment *

**You must sign and date this statement to submit your application.** I certify that my answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and policies of the Employer. I authorized investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, specifically a L.E.I.N. check (criminal history check), credit check, and employment reference check. I further understand that any offer of employment will be contingent on successfully passing these background checks as well as a drug/alcohol screening. I understand and acknowledge that any employment relationship with this organization is of an “at will” nature, which means that Employees may resign at any time and the Employer may discharge Employees at any time, with or without cause, for any or no reason, and without prior notice. It is further understood that this “at will” employment relationship may not be changed by any written document or agreement unless such change is specifically acknowledged in writing by an authorized executive of this organization. Michigan law requires employers to make reasonable accommodations to qualified handicapped applicants and employees where the employee makes their need known to the employer, request accommodation and such accommodation does not impose an undue hardship on the employer. With respect to State of Michigan Persons with Disability claims, persons with disabilities and applicants must request an accommodation of their handicap by notifying the Company in writing of the need for accommodation within 182 days of the date the person with a disability knows or reasonably should know that an accommodation is needed. Failure to properly notify the Company will preclude any claim that the employer failed to accommodate the person with a disability, however, this does not waive your rights under the Americans With Disabilities Act of 1990, as amended. I agree that any action (excluding governmental, statutory administrative proceedings) or suit against the Company arising out of or related to my application, employment, or termination of employment, including but not limited to claims arising under State or Federal civil rights statutes, must be brought, if at all, within the shorter of 180 days of the even giving rise to the claim or the applicable statute of limitations, or be forever barred. I waive any limitation periods to the contrary, with the exception being that this agreed to limitations period does not supersede the Federal Equal Employment Opportunity Commission or other applicable statutes or regulations that may extend this period as provided by law. I acknowledge that this 180-day limitation on actions forms and agreement between myself and the Company.

Agree

Disagree

Date *

MM

DD

YYYY