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Employment Application

Mail: Huron County Road Commission, 417 South Hanselman Street, Bad Axe, MI 48413
Fax: (989) 269-8491

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APPLICATION FOR EMPLOYMENT

(PRE-EMPLOYMENT QUESTIONAIRE)

(AN EQUAL OPPORTUNITY EMPLOYER)

417 SOUTH HANSELMAN STREET, BAD AXE, MI 48413
PHONE: 989-269-6404 – FAX: 989-269-8491

PERSONAL INFORMATION

NAME

LAST NAME

FIRST NAME

MIDDLE NAME

PERMANENT ADDRESS

STREET

CITY

STATE

ZIP

ARE YOU 18 YEARS OR OLDER?

YES

PHONE NO

EMAIL ADDRESS

EMPLOYMENT DESIRED

POSITION

DATE YOU CAN START

SALARY DESIRED

ARE YOU EMPLOYED NOW?

EVER WORKED FOR THIS COMPANY BEFORE?

WHERE?

WHEN?

NAME OF LAST SUPERVISOR AT THIS COMPANY

WHO REFERRED YOU TO THIS COMPANY

OTHER SPECIAL SKILLS/LICENSES

EDUCATION

NAME AND LOCATION OF HIGH SCHOOL

SUBJECTS STUDIED SPECIAL TRAINING SPECIAL SKILLS OF HIGH SCHOOL

NAME AND LOCATION OF COLLEGE

SUBJECTS STUDIED SPECIAL TRAINING SPECIAL SKILLS OF COLLEGE

NAME AND LOCATION OF TRADE OR BUSINESS SCHOOL

SUBJECTS STUDIED SPECIAL TRAINING SPECIAL SKILLS OF TRADE OR BUSINESS SCHOOL

REFERENCES:

LIST THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.

FIRST REFERENCE

NAME

BUSINESS

YEARS ACQUAINTED

ADDRESS

SECOND REFERENCE

NAME

BUSINESS

YEARS ACQUAINTED

ADDRESS

THIRD REFERENCE

NAME

BUSINESS

YEARS ACQUAINTED

ADDRESS

*The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of Age with respect to individuals who are at least 40 years of age

PRESENT AND FORMER EMPLOYERS

NAME OF PRESENT EMPLOYER

ADDRESS OF PRESENT EMPLOYER

STARTING DATE

MONTH

YEAR

LEAVING DATE

MONTH

YEAR

WEEKLY STARTING SALARY

WEEKLY FINAL SALARY

JOB TITLE

MAY WE CONTACT SUPERVISOR?

YES

NAME AND TITLE OF SUPERVISOR

PHONE NO.

DESCRIPTION OF WORK

REASON FOR LEAVING

NAME OF PRESENT EMPLOYER

ADDRESS OF PRESENT EMPLOYER

STARTING DATE

MONTH

YEAR

LEAVING DATE

MONTH

YEAR

WEEKLY STARTING SALARY

WEEKLY FINAL SALARY

JOB TITLE

MAY WE CONTACT SUPERVISOR?

YES

NAME AND TITLE OF SUPERVISOR

PHONE NO.

DESCRIPTION OF WORK

REASON FOR LEAVING

NAME OF PRESENT EMPLOYER

ADDRESS OF PRESENT EMPLOYER

STARTING DATE

MONTH

YEAR

LEAVING DATE

MONTH

YEAR

WEEKLY STARTING SALARY

WEEKLY FINAL SALARY

JOB TITLE

MAY WE CONTACT SUPERVISOR?

YES

NAME AND TITLE OF SUPERVISOR

PHONE NO.

DESCRIPTION OF WORK

REASON FOR LEAVING

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

SIGNATURE(Required)

DATE

Fill out my online form.

Employment

Employment Application

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

NAME

PERMANENT ADDRESS

EMPLOYMENT DESIRED

EDUCATION

REFERENCES:

FIRST REFERENCE

SECOND REFERENCE

THIRD REFERENCE

PRESENT AND FORMER EMPLOYERS

STARTING DATE

LEAVING DATE

STARTING DATE

LEAVING DATE

STARTING DATE

LEAVING DATE

DISCLAIMER AND SIGNATURE

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Employment

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Contact with Us

Employment

Employment Application

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

NAME

PERMANENT ADDRESS

EMPLOYMENT DESIRED

EDUCATION

REFERENCES:

FIRST REFERENCE

SECOND REFERENCE

THIRD REFERENCE

PRESENT AND FORMER EMPLOYERS

STARTING DATE

LEAVING DATE

STARTING DATE

LEAVING DATE

STARTING DATE

LEAVING DATE

DISCLAIMER AND SIGNATURE

Get Involved Today, Help Safer County Roads

Links

Employment

Contact

Contact with Us

Get Involved Today, Help
Safer County Roads