Employment Application

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Step 1 of 4

Employment History
List your last three employers, or all employers for the last ten years, whichever is greater. Please answer all inquires. "See Resume" is not acceptable.
Employer 1
Employer's Name
Dates (month and year)
From To
Address
Street Address Address Line 2 City State ZIP Code
Supervisor (Name & Title)
Your title
Duties & responsibilities
Reason for leaving
Employer 2
Employer's Name
Dates (month and year)
From To
Address
Street Address Address Line 2 City State ZIP Code
Supervisor (Name & Title)
Your title
Duties & responsibilities
Reason for leaving
Employer 3
Employer's Name
Dates (month and year)
From To
Address
Street Address Address Line 2 City State ZIP Code
Supervisor (Name & Title)
Your title
Duties & responsibilities
Reason for leaving
Have you ever been discharged by an employer or resigned in lieu of discharge?
- Yes
- No
Have you ever been disciplined (other than discharged) by an employer?
- Yes
- No
If you answered yes to any of the previous questions, explain all such incidents, giving facts, dates, describing any action you took and any resolution.*

Education
Total number of years of formal education and including, first grade:
High School
Address
Street Address Address Line 2 City State ZIP Code
Degree
Business School
Address
Street Address Address Line 2 City State ZIP Code
Degree
College/University
Address
Street Address Address Line 2 City State ZIP Code
Degree
Trade/Vocational School
Address
Street Address Address Line 2 City State ZIP Code
Degree
Extracurricular activities & honors received in school
Professional Licenses, Registrations, and/or Certifications
List all types of any licenses or certificates which have been issued to you (including national certifications) and identify the state or organization which issued them.
Have you ever had any license or certification placed under investigation, disciplinary action, suspended, revoked or put on probation?
- Yes
- No
Have you ever been denied a license or certification?
- Yes
- No
Miscellaneous
Are you 18 years of age or older?*
- Yes
- No

Do you have any relatives employed by this employer?
- Yes
- No
Name*
Relationship*
Department*
In case of Emergency Notify
Name Address Telephone
Attach Resume*
Max. file size: 50 MB.
References
Give the names of three persons not related to you, whom you have know at least one year.
1.*
Name Address Telephone
2.*
Name Address Telephone
3.*
Name Address Telephone
Applicant Statement
I affirm that the information provided in this application (and accompanying resume, if any) is true and complete. I understand and agree that any false information, misrepresentations, or omissions may disqualify me from further consideration for employment or may result in discipline or dismissal if discovered at a later date.
I authorize Emmet County to investigate all statements contained in this application through all references and resources concerning me, including, but not limited to, school records, records of licensing or certification agencies, disciplinary records of any current and former employers. I authorize all such references and resources, and Emmet County, to release this information without liability for giving it. I waive any written notice of the release of such records that may be required by State or federal law.
Should I receive a conditional offer of employment, I agree to submit to a physical medical examination, which may include a drug test. I authorize any physician or entity conducting such examination or test to release the results of such examination or test to Emmet County.
I understand that, if I have a protected disability that affects my ability to perform the essential functions of the job I seek, I may ask Emmet County to make a reasonable accommodation for it. I must make my request in writing to the Emmet County / Human Resources Director as soon as possible, and under the Michigan Persons with Disabilities Civil Rights Act, as amended, such notice must be given no later than 182 days after the date I know or reasonably should know that accommodation is needed.
I understand and agree that, if I am hired, unless covered by a collective bargaining agreement or other written agreement to the contrary which is signed by me or on my behalf as a bargaining unit member, my employment is at will and that it may be terminated, either by me or by Emmet County, at any time, with or without notice or cause. It is with this understanding of Emmet County’s right to make discharge decisions, that I will accept the employment offered to me.
Date*
MM slash DD slash YYYY
Name of Applicant*
Email
This field is for validation purposes and should be left unchanged.

Step 1 of 4

If you have a disability and require reasonable accommodation in the application process, please call (231) 348-0676.

Personal

Military Service

Employment History

Employer 1

Employer 2

Employer 3

Education

Professional Licenses, Registrations, and/or Certifications

Miscellaneous

References

Applicant Statement

From	To

From	To

From	To

Name	Address	Telephone