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JobApplication.aspx Job Application

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APPLICATION FOR EMPLOYMENT
CITY OF ECORSE
HUMAN RESOURCE DEPARTMENT
3869 W. Jefferson
ECORSE, MICHIGAN 48229
PHONE # 313-386-2520
INSTRUCTIONS: Type or print in ink. Complete all questions, even if you enclose a resume. Extra pages may be attached if you
need them. If required in the Job Announcement, please provide all proofs of education or certifications. The original, signed form
(no scan, copy or fax) may be turned in at the Human Resource Department or mailed to the address above.
STATE EXACT TITLE OF POSITION FROM THE JOB ANNOUNCEMENT
DATE OF APPLICATION
DATE AVAILABLE FOR WORK
LAST NAME
FIRST NAME
MIDDLE INITIAL
ADDRESS
CITY
ZIP CODE
HOME PHONE (INCLUDING AREA CODE)
CELL/MOBILE PHONE (INCLUDING AREA CODE)
EMAIL ADDRESS
DO YOU HAVE A VALID DRIVER’S LICENSE?
(NOT REQUIRED FOR ALL POSITIONS)
YES NO
CLASS / TYPE (O – Operator; C – Chauffeur; CDL – Commercial Driver’s License, etc.)
ISSUED BY THE STATE OF
EXPIRATION DATE
DATES OF U.S. MILITARY SERVICE
FROM _________/_________ TO
_________/_________
BRANCH OF SERVICE
TYPE OF DISCHARGE
If you are claiming preference as a veteran, or as the spouse or child of
a disabled veteran, you must attach a copy of your discharge documents
and, if applicable, your V.A. disability letter and claim number.
CHECK THE BOX FOR EACH QUESTION
YES
NO
YES
NO
Are you legally authorized to work in the United States?
Can you provide documentation showing you're
authorized to work in the United States?
Have you ever been convicted of a crime other than a minor traffic
violation? If so, state when and the nature of the crime. (A yes
answer does not automatically disqualify you.)
Are there any felony charges currently pending against
you?
Are you at least 18 years old?
Have you ever been discharged or asked to resign from a position?
If yes – Explain fully using a separate sheet of paper, if necessary. (An
affirmative answer does not automatically disqualify you from employment)
Have you ever been employed by the City Of Ecorse?
If yes - What was your title? When?
EDUCATION
Name / Location
# of Years
Completed
Diploma or
Degree Y/N
Courses of Study
High School
College
College
Graduate
Vocational Training
SPECIAL SKILLS
What skill(s) or additional training do you have that is relevant to the job for which you are applying?
What machines or equipment can you operate that are relevant to the job for which you are applying?
Have you had any off-the-job training or experience which would help you in this job? For example: hobbies, school work, community groups, or
military experience?
List any licenses, registrations, or certifications you possess (i.e. CPA, Registered Engineer)
_ NAME (LAST, FIRST) ________________________ POSITION
HR USE ONLY
EDUCATION _________________
CERTIFICATION _________________
CONSENT _________________
E E O _________________
EMPLOYMENT EXPERIENCE
Begin with your present employer or your last job. List a promotion as a new job. List all employers. Attach extra pages if needed.
Employer Name
Telephone (Including Area Code)
Address
Dates of Employment
From
To
Your Job Title
Wages
Start
Last
Name and Title of Supervisor
Reason for Leaving
May we contact your present employer for a reference? Yes No
Employer Name
Telephone (Including Area Code)
Address
Dates of Employment
From
To
Your Job Title
Wages
Start
Last
Name and Title of Supervisor
Reason for Leaving
May we contact your previous employer for a reference? Yes No
Employer Name
Telephone (Including Area Code)
Address
Dates of Employment
From
To
Your Job Title
Wages
Start
Last
Name and Title of Supervisor
Reason for Leaving
May we contact your previous employer for a reference? Yes No
REFERENCES
List at least two responsible adults who have knowledge of your work ethic, experience, and ability.
Name
Address
Telephone # (Incl. Area Code)
Occupation
CERTIFICATION / SIGNATURE
Read Carefully Before Signing:
I certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements and answers, and that the entries
made by me are true and complete.
I further agree and consent in advance that any misrepresentation or falsification of any of the above information shall be cause, without
any hearing, for rejection of this application, or termination of employment, depending upon when the falsification is discovered.
I also consent for the City of Ecorse to verify the information I have provided including my educational and professional certifications, and
check with previous employers. I release the City and previous employers from any liability arising from disclosure of information
concerning my past employment or personal history.
I agree and understand that any employment offer will be contingent upon the successful completion of a background investigation and
post-offer medical exam.
Further, I understand and agree that my employment is for no definite period of time and my employment and compensation can be
terminated at any time, with or without cause, with or without notice, at the option of either the employer or myself, unless otherwise
provided by union contracts, applicable handbook rules or written employment agreement signed by the City Administrator.
Signature ____________________________________________________________________ Date ____________________________
Revised 09/15 AN EQUAL OPPORTUNITY EMPLOYER
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Completed 12 July 2020

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