Fillable Application For Employment (Charter Township of Waterford)

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Application For Employment (Charter Township of Waterford)

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U.S.A. forms for Charter Township of Waterford

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AN EQUAL OPPORTUNITY EMPLOYER
1
Application For Employment
C HARTER TOWNSHIP OF WATERFORD
Fiscal & Human Resources - 5200 Civic Center Drive, Waterford, Michigan 48329
www.waterfordmi.gov
Applicants are considered for all positions without regard to race, color, religion, sex, national origin,
age, marital status and in compliance with state and federal regulations on handicappers civil rights.
Under the Michigan handicappers’ Civil Rights Act, a handicapper may allege a violation of the Act
regarding the failure to accommodate only if the handicapper notifies the employer in writing of the need
for accommodation with 182 days after the date the handicapper knew or reasonably should have known
that an accommodation was needed.
PLEASE PRINT OR TYPE
Position(s) Applied For: ___________________________________________________________________
Name:___________________________________________________________________________________
(Last) (First) (Middle)
Address: _________________________________________________________________________________
(Street & Number) (City) (State) (Zip)
Telephone: ( ) EMAIL Address
Have you filed an application with the Charter Township of Waterford previously? _____ Yes ____ No
Are you under 18 years of age? _____ Yes ____ No
Are you currently working? _____ Yes ____ No
Are you on lay-off? _____ Yes ____ No
If yes, are you subject to recall? _____ Yes ____ No
Will you submit to a drug screening test? _____ Yes ____ No
Were you ever employed by the Charter Township of Waterford previously? _____ Yes ____ No
If yes: _______________________ _________________________ ____________________
Position Department Dates
Are you prevented from lawfully becoming employed in this country
because of Visa or immigration status? _____ Yes _____ No
Have you ever been fired? _____ Yes _____ No
If yes, give date, where you worked and explanation: ____________________________________________
_________________________________________________________________________________________
Have you ever been convicted of a Felony? ______Yes _____No
If yes, completely describe including location and date:___________________________________________
__________________________________________________________________________________________
Note: A conviction record will not necessarily be a bar to employment. Factors such as age, time of offense,
seriousness and nature of violation, and rehabilitation will be considered.
Are you capable of performing with or without reasonable accommodation (special assistance, equipment
or other help), the activities involved in the job or occupation for which you have applied? ___Yes ___No
AN EQUAL OPPORTUNITY EMPLOYER
2
EDUCATION & TRAINING
High School or
Equivalent
Vocational/
Technical
College
Graduate
Name of School,
Address/City/State
Did you graduate?
____ Yes _____ No
_____ Yes ____ No
_____Yes_____ No
____ Yes ____ No
Credits earned?
Degree or certificate
Received:
NA
Describe
Course of
Study:
Describe any specialized training, apprenticeships, internships, skills, licenses, certificates, and extra-
curricular activities that pertain to the position(s) for which you are applying.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
List professional, trade, business group memberships and offices held, and volunteer work (excluding
groups the name and character of which indicate race, color, gender, religion, national origin, age, height,
weight, marital status, veteran status, handicap, or any other protected class):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Driving Information & History:
Driver’s License No. ______________________ Chauffeur License No. __________________________
Commercial Driver’ License (CDL) No. ______________________________________
Types of CDL Endorsements: _______________________________________________
List Traffic Citations for Last Five Years: _____________________________________________________
AN EQUAL OPPORTUNITY EMPLOYER
3
Training & Experience:
Typing Speed __________________W.P.M.
Computer Skills (include software packages) __________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_______________________________________________________________________________________
Equipment or Machines: ____________________________________________________________________
Hand Tools:______________________________________________________________________________
Other:___________________________________________________________________________________
References (Do not include relatives or former employers)
Name
Address
Telephone
Military Service Record
Have you had any experience in the Armed Forces of the United States of America
or in a state national guard? ____ Yes ____ No
If yes, which branch? __________________ Rank at discharge _____________________
Date of discharge ______________________ Were you honorably discharged? ____ Yes ____ No
Note: A dishonorable discharge from the military will not necessarily be a bar to employment.
Employment Experience
List each job held, beginning with your present or last job first.
(1) Employer:
Dates Employed:
From: _______________
To: _______________
Job Duties
Address:
Telephone:
Hourly Rate/Salary
Starting: _____________
Final: _____________
Supervisor:
Reason for Leaving:
AN EQUAL OPPORTUNITY EMPLOYER
4
(2)Employer:
Dates Employed:
From: _______________
To: _______________
Job Duties
Address:
Telephone:
Hourly Rate/Salary
Starting: _____________
Final: _____________
Supervisor:
Reason for Leaving:
(3)Employer:
Dates Employed:
From: _______________
To: _______________
Job Duties
Address:
Telephone:
Hourly Rate/Salary
Starting: _____________
Final: _____________
Supervisor:
Reason for Leaving:
(4)Employer:
Dates Employed:
From: _______________
To: _______________
Job Duties
Address:
Telephone:
Hourly Rate/Salary
Starting: _____________
Final: _____________
Supervisor:
Reason for Leaving:
AN EQUAL OPPORTUNITY EMPLOYER
5
Agreement & Understanding
1. I certify that the information in this application is true, complete and correct to the best of my
knowledge and understand that falsification, misleading, misrepresentation or omission of any
information submitted in connection with my application or interview, whether in this document
or not, may result in rejection of my application or, if hired, in dismissal.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
2. I waive written notice from my current employer and from any of my former employers regarding
the disclosure of disciplinary reports, letters of reprimand, or other notices of disciplinary action
contained in my personnel records (even if more than four years old). This waiver is made
pursuant to the Bullard-Plawecki Employee Right-to-Know Act.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
3. I authorize the references and current and former employers listed in this application to give you
any and all information concerning my current and previous employment and any pertinent
information they may have (even if more than four years old) and release all parties from any
liability for any damage that may result from furnishing same to you.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
4. I authorize the Charter Township of Waterford to release any information (even if more than four
years old) relating in any way to my employment including disciplinary reports, letters of
reprimand or other notices of disciplinary action when such information is requested by any
prospective or subsequent employers without any obligation (by them or you) to give any notice of
such disclosure.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
5. I understand that any employment offer is conditional upon the result of a drug screening test and
a post offer pre-employment medical examination.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
AN EQUAL OPPORTUNITY EMPLOYER
6
6. I have read the job description(s) for the position(s) for which I am applying. If employed, I
understand that if I am or become handicapped in need of accommodations for employment, I
must notify the Office of Fiscal & Human Resources in writing within 182 days after the need is
known or reasonably should have been known to me. Failure to properly notify the Township
will preclude any claim that the employer failed to accommodate the handicapper.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
7. I understand that, as a condition of my consideration for employment with the Charter Township
of Waterford (“Township”) and as a condition of my continued employment with the Township,
the Township may obtain a consumer report that indicates, but is not limited to, my
creditworthiness or similar characteristics, employment and education verifications, social
security verification, criminal and civil history, personal interviews, driving records, any other
public records and any other information bearing on my credit standing, credit capacity,
character, general reputation, personal characteristics and trustworthiness.
I hereby authorize and consent to the Township’s procurement of such a report. I understand
that, pursuant to the federal Fair Credit Reporting Act, the Township will provide me with a copy
of any such report if the information in such report is, in any way, to be used in making a decision
regarding my fitness for employment with the Township. I further understand that such report
will be made available to me prior to any such decision being made, along with the name and
address of the reporting agency that produced the report.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
8. Applicants for Non-Union Positions Read and Sign Paragraph 8(A). Do Not Sign Paragraph 8(B).
Applicants for Union Positions Read and Sign Paragraph 8(B). Do Not Sign Paragraph 8(A).
8(A) In consideration of my employment, I agree to conform to the rules and regulations of the
Charter Township of Waterford, as they may be amended or changed from time to time, and I
agree that my employment and compensation can be terminated with or without cause and with or
without notice at any time at the option of either the Township or myself. I understand that no
officer or representative of the Township has the authority to enter into an agreement for
employment for any specific period of time, or to make any agreement contrary to the foregoing,
except an official from the Office of Fiscal & Human Resources and any such agreement must be
made in writing, directed to me personally. I further acknowledge that no one has made any
representations or statements to the contrary to this employment at-will statement or about the
Township’s economic outlook or stability to me, either oral or in writing, and I acknowledge and
understand that no one has the authority to make such representations or statements to the
contrary in the future.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
AN EQUAL OPPORTUNITY EMPLOYER
7
8(B) In consideration of my employment, I agree to conform to the rules and regulations of the
Charter Township of Waterford. I further acknowledge I will be on probationary status from my
date of hire. As a probationary employee, I am required to work during the probationary period
without interruptions. As a probationary employee, I understand my employment and
compensation can be terminated at any time with or without cause and with or without notice at
the option of either the Township or myself. I understand that no officer or representative of the
Township has the authority to enter into an agreement for employment for any specific period of
time, or to make any agreement contrary to the foregoing, except an official from the Office of
Fiscal & Human Resources, and any such agreement must be made in writing, directed to me
personally.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
I further acknowledge that after my probationary period ends, I will be subject to the terms and
conditions of a collective bargaining agreement. I acknowledge that no one has made any
representations or statements to the contrary to this probationary at-will statement to me or about
the Township’s economic outlook or stability to me, either oral or in writing, and I acknowledge
and understand that no one has the authority to make such representations or statements to the
contrary in the future.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
9. I agree that any lawsuit against the Township arising out of my employment or termination or
employment, including but not limited to, claims arising under the State or Federal Civil Rights
statutes, must be filed within one year of the event giving rise to the claims or be forever barred. I
waive any limitations period to the contrary.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
I HAVE READ, UNDERSTAND AND AGREE TO THE TERMS OF EACH OF THE ABOVE NINE (9)
INDIVIDUAL STATEMENTS, AS INDICATED ABOVE.
Placing a check in the box serves two purposes: (1) that the person filing this form is the actual
applicant (2) The person understands and agrees to this provision.
We do not accept faxed copies of applications.
You can save and email your application to award@waterfordmi.gov
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Application For Employment (Charter Township of Waterford)

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Completed 17 July 2020

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