(269) 673-2195

Job Application

I understand that the information provided may be reviewed and my qualifications considered for possible job openings now or in the near future. If the Company finds that my qualifications and employment background match a current opening, and an offer is made, I will be required to complete additional employment paperwork. I understand that any misrepresentation, falsification or omission on this or any other document shall be sufficient reason for refusal to hire or rescission of an offer of employment.

APPLICATION FOR EMPLOYMENT

Personal Information

*First & Last Name:

*Phone Number:

*Email:

*Present Address:

*City:

*State:

*Zip:

Are you 18 years or older?

Availability

Days Available:

Hours Available Per Week:

Available:

Employment History

Current or Last Employer

Name:

Phone Number:

Dates:

Rate of Pay:

Supervisor:

Position:

Reason for Leaving:

Previous Employer

Name:

Phone Number:

Dates:

Rate of Pay:

Supervisor:

Position:

Reason for Leaving:

Previous Employer

Name:

Phone Number:

Dates:

Rate of Pay:

Supervisor:

Position:

Reason for Leaving:

Education

Name of High School

Courses Studied

Years Attended

Name of Trade School

Courses Studied

Years Attended

Name of College

Courses Studied/Degree(s)

Years Attended

Position Applying For

*Position:

*Date Available to Start:

Union Membership, If Any:

Have you applied to this company before?

Are you eligible to work in the United States? (Proof required)

Notice: If hired, per US Department of homeland Security and the Social Security Administration, we will require 2 current/unexpired forms of ID — one of them must be a photo ID. A list of acceptable documents can be found at https://www.uscis.gov/i-9-central/acceptable-documents under list A, B and C.

Have you, since the age of 18, ever been convicted of a crime? Note: a conviction will not necessarily bar you from employment. Each conviction will be judged on its own merits regarding time, circumstances and seriousness.

Please explain the conviction(s):

Equal Opportunity Employer Statement

The Company is an equal opportunity employer and will not discriminate against any employee or applicant for employment in any manner prohibited by law. This policy extends to all terms, conditions, and privileges of employment. All individuals considered for employment are evaluated without regard to race, color, religion, sex, national origin, age, marital or veteran status, disability and any other basis protected by federal, state or local law. We reserve the right to perform drug and alcohol testing on any current and/or prospective employee.

Were you referred by another employee? (Please enter their name below)

Tell us about your skills, certifications, training or other applicable information.

*Signature: (Type your name if you agree)

Michigan Department of Transportation (MDOT) - On the Job Training Program (OJT)