CHARTER TOWNSHIP OF SHELBY GENERAL EMPLOYEES CIVIL SERVICE COMMISSION APPLICATION FOR EMPLOYMENT

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1 FOR HR USE ONLY Date Application Received MAAO or MMAO Initials of Person Accepting Application Degree Experience MI Certified Personal Property Examiner Driver s License Page 1 of 6 CHARTER TOWNSHIP OF SHELBY GENERAL EMPLOYEES CIVIL SERVICE COMMISSION APPLICATION FOR EMPLOYMENT Applicants are considered for employment without regard to race, religion, color, creed, national origin, sex, age, marital status or the presence of any sensory, mental, or physical disability unless such disability effectively prevents the performance of the essential duties required of the position. Proof of MMAO or MAAO, Degree/ Diploma, Driver s License, and MI Certified Personal Property Examiner certification must accompany this application. Applying for the classification of Appraiser III DATE INSTRUCTIONS Complete this application in ink or using a computer. Your application is part of the examination; be sure it is complete. You may attach your résumé, however, all information requested on this form must be completed (i.e. writing see résumé is not sufficient). Please note that in order for your application to be accepted by the General Employees Civil Service Commission; you must submit all proofs as listed on the job description. INCORRECT, FALSE OR MISLEADING INFORMATION WILL BE CAUSE FOR REJECTION OR DISMISSAL AFTER APPOINTMENT. 1) Full Name Birth Name 2) Address City State Zip 3) Phone No. Cellular Phone No. 4) Address. ***The Human Resource Department will be contacting applicants via - please write your address legibly and ensure ShelbyTwp.org is excluded from spam on your account. *** 5) Are you 18 yrs of age or older? Yes No 6) Previous address, if different from above, for the past three (3) years.

2 7) Are you a United States Citizen or legally entitled to work in the United States? Yes No If you answered no to the previous question, please detail your immigration status. 8) Drivers License No. State 9) Have you previously filed an application with the Charter Township of Shelby? Yes No 10) Have you ever been employed by the Township? Yes No If yes, please explain (include dates): 11) Do you have any friends, relatives, or acquaintances working for the Charter Township of Shelby? Yes No If yes, state name & relationship: 12) Do you have military experience? Yes No If yes, provide the following information: Branch: If you believe you are eligible for Veterans Preference, please submit a copy of your DD ) On what date would you be available to work? 14) Have you ever been convicted or are there any charges pending for a felony violation of any kind? Yes No Answering yes to this question will not necessarily preclude you from being hired. If yes, explain: Page 2 of 6

3 15) Circle the highest year of school successfully completed: Name of School City/State Years Attended Area of Study From To High School/GED Certificate College/University Post Graduate/Professional Business Courses Special Training, Apprenticeships, Correspondence Courses, etc., not included above: Course Where Taken Date Completed Page 3 of 6

4 EMPLOYMENT RECORD 16) Give a complete account of your full-time employment for at least the last fifteen years. BEGIN ON THE FIRST LINE WITH YOUR PRESENT OR MOST RECENT POSITION. Please list each position held with a particular employer separately. Use additional sheets if necessary. A) B) Page 4 of 6

5 C) D) Page 5 of 6

6 17) If currently employed, may the Civil Service Commission contact your previous employer regarding your qualifications? Yes No REFERENCES 18) List two (2) individuals, other than previous employers and relatives, who are familiar with your qualifications and character: Name Address Occupation Phone No STATEMENT I represent and warrant that the answers I have made to each and all of the foregoing questions are full and true to the best of my knowledge and belief. In order that the officials of the Charter Township of Shelby may be fully informed as to my personal character and qualifications for employment, I refer to each of my former employers and to any other person who may have information concerning me. Since this information is furnished at my request and thus for my benefit, I do hereby release the Charter Township of Shelby from any and all liability for damages of any nature incurred by releasing such information. I acknowledge that any false or incomplete statement knowingly made in answering the above questions is good cause for removal from the eligibility list or discharge during or after probation. I authorize investigation of all statements contained in this application and specifically authorize the Employer to investigate any work record with any prior employer. I further authorize my prior employers to disclose all personnel information and specifically waive my right to notice under Section 6 (c) (a) of the Bullard-Plawecki Act. Signature of Applicant Date Page 6 of 6 APPLICATION DEADLINE JULY 10, 2013, 3:00 P.M.