Job Application

First Name

Middle Name

Last Name

Street Address

City

State

Zip

Country

Phone

Email

Date of Birth

Position applied for

How did you hear about this opening?

When can you start?

Requested Starting Wage $

Do you have current and unrestricted authorization to work in the U.S.? (You may be required to provide documentation [I-9 form])

YesNo

Have you ever been convicted of a crime?

YesNo

Have you ever lived (maintained a residence) outside of Michigan?

YesNo

Education

High School

College

Other Training

In addition to your work history, are there other skills, qualifications, or experience that we should consider?

OTHER CURRENT EMPLOYMENT

What other employment or “sideline” business do you have? Please describe.

Would you want to continue it if employed by us?

YesNo

PERSONAL REFERENCES

Please include the name, email address, and phone number of the reference.

REFERENCE #1

First Name

Last Name

Email

Phone

REFERENCE #2

First Name

Last Name

Email

Phone

REFERENCE #3

First Name

Last Name

Email

Phone

EMPLOYMENT HISTORY

List below past and present employment, starting with most recent. Include employment with U.S. military service. Do not skip any employers.

EMPLOYER #1

Name and Address

Position

Starting Wage

Ending Wage

Description of Duties

Supervisor Name

Date Employed From

Date Employed To

Reason(s) for leaving:

EMPLOYER #2

Name and Address

Position

Starting Wage

Ending Wage

Description of Duties

Supervisor Name

Date Employed From

Date Employed To

Reason(s) for leaving:

EMPLOYER #3

Name and Address

Position

Starting Wage

Ending Wage

Description of Duties

Supervisor Name

Date Employed From

Date Employed To

Reason(s) for leaving:

APPLICANT ACKNOWLEDGEMENT AND CONSENT

I authorize this company to investigate all statements contained in this application, including records of any former employers, police departments, and other references or sources concerning me. I authorize all such references and sources (and the company) to release this information without liability for damage incurred in giving it. I waive any written notice of the release of such records that may be required by state or federal law. I affirm that the information provided on this application (and accompanying resume and notes, if any) is true and complete. I also agree that any false information, misrepresentations, or omissions—oral or written—may disqualify me from further consideration for employment and may result in discipline or dismissal if discovered at a later date. Should I receive a conditional offer of employment, I agree to submit to any physical medical examination. I further authorize any physician or entity conducting such medical examination to release the results of such examination to J&M, Inc. I also understand that if I have a protected disability that affects my ability to do the job I seek, I may ask J&M, Inc. to attempt to make a reasonable accommodation for it. I must make my request in writing to the Personnel Department as soon as possible, and under the Michigan Persons With Disabilities Civil Rights Act, such notice must be given no later than 182 days after the date I know or reasonably should know that accommodation is needed. Should I receive a conditional offer of employment, I give my consent for J&M, Inc., through an authorized testing service of its choice, to collect blood, urine, or saliva samples from me and to conduct any other necessary medical tests to determine the presence of alcohol, drugs, or controlled substances, and I release J&M, Inc. from any liability arising out of such test or its results. Further, I give my consent for the release of the test results and other relevant medical information to authorized J&M, Inc. management for appropriate review. If I am accepted for employment by J&M, Inc., I consent to be tested in the above manner during my employment when, in the Company’s judgment, such testing is appropriate, and I acknowledge that remaining free of illegal drug use and complying with the Company’s substance abuse policy is a condition of my employment. I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.

Signature

Resume*

Cover Letter*