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Applicant Information

Application for Employment
Date:*
Date:
Position Applying for Today:*
Pay Desired:*
First Name*
Middle
Last Name*
Email Address*
Phone Number*
Address*
City*
State*
Zip Code*
How did you learn of this position?*
Example: Township website, referred by someone, job board, MML, LinkedIn, etc...
Have you filed an application here before?*
1. Yes
2. No
If yes, when?
Have you ever been employed by Grand Blanc Township?*
1. Yes
2. No
If yes, when?
Are you over the age 18?*
1. Yes
2. No
Are you currently employed?*
1. Yes
2. No
Are you available to work:*
1. Full-time
2. Part-time
3. Seasonal
On what date are you available for work?*
Do you have a valid Driver's License?*
1. Yes
2. No
If hired, can you provide the documents required to prove that you are legally able to work in the U.S.?*
1. Yes
2. No
Please provide any special information we may need about your name or use of another name for us to be able to check your work record and otherwise verify the information given in this application:
Can you perform all of the job functions of the position(s) for which you are applying, with or without a reasonable accommodation ***
1. Yes
2. No
**The need for an accommodation does not necessarily bar employment. A determination will be made as to the effectiveness with which the accommodation will allow you to perform the essential functions of the positions and the hardship it would impose on the employer.
Have you ever been convicted of a crime or are there any felony charges pending against you?**
1. Yes
2. No
*A yes response does not automatically disqualify a job applicant from further consideration. Each situation is evaluated relative to the job being sought. Factors such as the age and nature of the offense, and rehabilitation, will be taken into account.
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Education and Skills

Education Record
High School Name:*
Location
Graduated *
College/University
Major Subject(s) Studied:
Degree or Certificate
Years Completed:
College/University
Major Subject(s) studied:
Degree or Certificate
Years Completed:
Other Education obtained:
Summarize special skills and qualifications acquired from employment or other experience, as well as how you believe they would be of value to Grand Blanc Township.*
Summarize software/office skills relevant to this position:
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References

References
Provide the name of three persons who are not related to you, whom you have known at least one year.
Name*
Years Acquainted:
Employer & Title
Address
Email Address
Phone Number*
Name*
Years Acquainted:
Employer & Title
Address
Email Address
Phone Number*
Name*
Years Acquainted:
Employer & Title
Address
Email Address
Phone Number*
Military Service Record
Did you serve in the U.S. Armed Forces?*
1. Yes
2. No
Branch of Service
Dishonorable discharge?
Rank at Discharge:
Date of discharge
Date of discharge
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Employment History

Start with present employer and work back, listing all previous employment.
Employer's Name*
Address and Phone Number*
Position(s)*
Dates (starting & ending)*
Supervisor's Name & Title*
Salary (starting & ending)*
Reason for leaving*
Employer's Name*
Address and Phone Number*
Position(s)*
Dates (starting & ending)*
Supervisor's Name & Title*
Salary (starting & ending)*
Reason for leaving*
Employer's Name
Address and Phone Number
Position(s)
Dates (starting & ending)
Supervisor's (Name & Title)
Salary (starting & ending)
Reason for leaving
Employer's Name
Address and Phone Number
Position(s)
Dates (starting & ending)
Supervisor's (Name & Title)
Salary (starting & ending)
Reason for leaving
Employer's Name
Address and Phone Number
Position(s)
Dates (starting & ending)
Supervisor's (Name & Title)
Salary (starting & ending)
Reason for leaving
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Authorization and Understanding

I certify that information given in this Application and related documentation is true and complete without qualification. I understand that Grand Blanc Township may investigate my work and personal history and verify all data given on this Application, on related papers, and in interviews and I authorize Grand Blanc Township to do the same. This inquiry may include information as to my character, general reputation and personal characteristics, and I consent to the conduct of this inquiry. I understand and acknowledge that Grand Blanc Township is entitled to rely on the representations made by me in the hiring process, and therefore I understand and acknowledge that any misrepresentation or omission of fact by me can result in immediate discharge if deemed appropriate by the Township. I also understand and acknowledge that, if hired my employment and compensation will be at the will of Grand Blanc Township and can be terminated, with or without cause, and with or without notice, at any time at the option of either Grand Blanc Township or myself. I further understand and agree that no manager, representative, agent or employee of Grand Blanc Township other than its Supervisor, has now or has had in the past any authority to enter into any agreement for employment for any specified period of time or to make any agreement which is contrary to or a modification of the above described employment relationship, and that any such agreement or representation must be in writing and signed by both myself and the Supervisor of Grand Blanc Township in order to be effective. Furthermore, I agree that if I become employed by Grand Blanc Township, then in consideration for my employment I will not commence any action, including any administrative claim or suit, against the Supervisor or its agents more than 180 calendar days after the date of the event giving rise to said action(s), including but not limited to any action which in any way relates to my employment and/or termination of my employment, and I hereby waive any statute of limitations to the contrary. I further understand and acknowledge that, as part of the hiring process and throughout my employment, if hired, I may be required to submit to medical/physical examinations(which may include tests for communicable diseases, drugs and/or alcohol) at the Township’s discretion and expense.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Today's Date*
Today's Date
File Upload
Applicant may submit cover letter and resume for review.
This application will only be considered for the ninety calendar day period after its receipt by Grand Blanc Township. Should you wish to be considered after the expiration of this period, you must reapply. Grand Blanc Township is an equal opportunity employer and complies with all laws prohibiting discrimination on the basis of race, color, age, sex, national origin, religion, citizenship, handicap, height, weight, and marital status. Under the Michigan Handicapper’s Civil Rights Act and the federal Americans With Disabilities Act, an employer has a legal obligation to accommodate an employee’s or job applicant’s handicap unless the accommodation would impose an undue hardship on the employer. A handicapper may allege a violation against an employer regarding a failure to accommodate his or her handicap under Michigan law only if the handicapper notifies the employer in writing of the need for accommodation within 182 days after the handicapper knew or reasonably should have known that an accommodation was needed.

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Grand Blanc Township Employment Application

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