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Last Name *
Email *
Which position are you applying for? * Daytime Phone Number *
Evening Phone Number *
Street Address *
Address Line 2 *
City *
State *
ZIP Code *
Are you 18 years of age or older? * If you are under 18, can you provide a work permit if required? If hired, can you provide written evidence that you are authorized to work in the U.S.? * Have you ever been convicted of a crime? Are there currently any felony charges against you? If you answered yes to either of the above, please state the date, place, and nature of conviction (a conviction does not constitute automatic bar from employment.)
High School Name *
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Did you graduate from High School? College Name
Number of years College attended
Did you graduate from College? College Major
College degree or certification received
Technical or Other School Name
Number of years attended
Did you graduate?
What was your major?
What degree or certification did you receive?
Branch of Military
Years served
Rank at discharge
Major
Training
Reference #1 Name
Phone
Business
Years Acquainted
Reference #2 Name
Phone
Business
Years Acquainted
Reference #3 Name
Phone
Business
Years Acquainted
Employer #1 Name
Employer Contact Phone Number
Start Date
End Date
Supervisor Name
Supervisor Title
Position
Starting Salary
Ending Salary
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Employer #2 Name
Employer Contact Phone Number
Start Date
End Date
Supervisor Name
Supervisor Title
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Ending Salary
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Employer #3 Name
Employer Contact Phone Number
Start Date
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To Be Read and Agreed to by All Applicants. Applicants are considered for employment without regard to race, religion, color, national origin, sex, age, marital status, or the presence of any disability unless such disability effectively prevents the performance of the essential duties and functions required of the position. If you have a physical, mental or medical impairment which would interfere with your ability to perform in a position at Gordon Water Systems but which may be accommodated by, for instance, the purchasing of equipment or devices, the provision of readers or interpreters or the restructuring or altering of work schedules, Michigan law requires that you notify Gordon Water Systems in writing of your need for accommodation within 182 days after you become aware or should reasonably have known the accommodation was needed. NOTICE ON DRUG TESTING: It is our policy to maintain a work place that is free from the effects of both legal and illegal drugs and/or alcohol abuse. We may conduct drug testing of job applicants. Should we consider you for employment, you may be contacted regarding the time and location of the drug test. Refusal to take or failing the drug test will disqualify you from considerations for employment. I understand that this application is not a contract of employment. I certify that the answers given by me to the forgoing questions and statements are true and correct without consequential omissions of any kind whatsoever. I hereby authorize all person and institutions mentioned on this application to give information relative to possible future employment. I agree to release said persons, institutions, Midwest Employer Service, Inc. from all liability in regard to the final outcome(s) due to the transmission of reference material. I understand that falsification of any material information on this application may be considered sufficient cause for immediate termination. I understand the employer follows an “employment at will” in that I, or the employer, may terminate my employment at any time for any reason consistent with applicable State or Federal Law. *By submitting this form you agree to the Terms of Service
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