DPM Consulting Services, Inc.

Transcription

1 DPM Consulting Services, Inc. APPLICATION FOR EMPLOYMENT of Application Please print clearly and please refrain from including information not specifically requested such as Veteran, Boy Scout, or union member. THIS COMPANY IS AN AT-WILL EMPLOYER. THIS MEANS THAT EITHER YOU OR THE COMPANY MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TME, FOR ANY REASON, WITH OR WITHOUT CAUSE AND WITHOUT NOTICE. THIS FORM HAS BEEN DESIGNED TO COMPLY WITH MICHIGAN AND FEDERAL FAIR EMPLOYMENT PRACTICE LAWS PROHIBITING DISCRIMINATION. ALL QUALIFIED APPLICANTS WILL RECEIVE EQUAL CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, RELIGION, COLOR, SEX, NATIONAL ORIGIN, AGE, MILITARY BACKGROUND OR HANDICAP. Name _ Home Telephone Number Last, Middle, First Cell or Alternate Number Present From to City, State, Zip Previous From to City, State, Zip If applicable, list below any other names by which you have been known which may be necessary to allow us to confirm your work and educational record. For example, change of name, use of an assumed name, nickname, etc. May we contact you at work? Yes No If yes, work number Best time to call Emergency Contact: Name Relationship Home Phone Work Phone Position Desired Full Time Part Time Wages Desired you can start work Education School Name and Location (, City, State) Course of Study Graduate? High School Yes No College Yes No Bus./Tech/Trade Or Post College Yes No # of Years Completed Degree/Major Applicant s Initials

2 Have you ever applied for employment with If you were employed by this Company previously, provide reason for this Company before? Yes No separation from employment. Have you ever been employed with this Company before? Yes No If Yes, give dates: INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS: Do not include convictions that were sealed, eradicated, erased, annulled by a court; or expunged, or convictions that resulted in referral to a diversion program. Have you ever plead guilty or no contest to, or been convicted of any criminal offense other than the applicable exceptions listed above? Yes No Have you ever been arrested for any matters for which you currently are out on bail or on your own recognizance pending trial? Yes No If you answered Yes, to either of the above two questions, please provide the date(s) and explain in accordance with the above instructions so that individual circumstances can be considered. Criminal convictions or arrests will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, the substantial relation to the position s functions and qualifications, the number of occurrences, the applicant s age at the time of the crime, the time elapsed since the crime, the applicant s entire work and educational history, employment references and recommendations, and the business necessity of any exclusion when required by law. List any special skills that you feel qualify you for the job for which you are applying (for example, computer programming, software skills, equipment or machinery operation, special tools, etc.) If you are under 18, can you furnish a work permit? Are you related to anyone currently employed Yes No by this Company? Yes No Are you a citizen of the U.S.? Yes No If yes, give name and relationship If no, are you legally eligible for employment in this Country? Yes No Have you ever been discharged or required to resign from a position? Yes No If yes, when & why? Do you have a valid operator's permit/driver's License? Yes No Driver's License No. State Do you own a car? Yes No Has your operator's permit (Driver's License) ever been suspended, revoked or restricted? Yes No Are you on a lay-off and subject to recall? Yes No Will you relocate if job requires it? Yes No 2 Applicant s Initials

3 Will you work overtime? Yes No Do you hold a job elsewhere? Y Yes No If employed, will you continue to hold such employment? Yes No Do you belong to any professional organizations that deal with the position for which you are applying? If yes, please explain and list offices held. You may exclude memberships which reveal sex, race, age, or any other protected class. EMPLOYMENT EXPERIENCE Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color, religion, sex or national origin. s Employed 1 Employer Telephone From To Work Performed Job Title Starting Final s Employed 2 Employer Telephone From To Work Performed Job Title Starting Final Applicant s Initials 3

4 s Employed 3 Employer Telephone From To Work Performed Job Title Starting Final s Employed 4 Employer Telephone From To Work Performed Job Title Starting Final If there are any periods between these employers when you were not employed, please state the dates you were not employed and the reasons for the non-employment. PROFESSIONAL REFERENCES (Please provide Name, Company Name, Phone Number and ) Acknowledgement and Agreements 1. I certify that answers given in this application are true and complete to the best of my knowledge and understand that false or misleading information or omission of information given in my application or interview(s) may result in rejection of my application or, if hired, dismissal of my employment with DPM Consulting Services, Inc. 4

5 2. In consideration of my employment, I agree to the rules and regulations of DPM Consulting Services, Inc., and I agree that my employment and compensation can be terminated at any time with or without cause and with or without notice at the option of either the company or myself. I understand that no representative of the company has the authority to enter into an agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing, except an Officer of DPM Consulting Services, Inc., and any such agreement must be made in a signed writing directed to me personally. I further acknowledge that no one has made any representations or statements contrary to the company's at-will policy to me, or about the company's economic outlook or stability either orally or in writing, and I acknowledge that no one has the authority to make such representations or statements to the contrary in the future. I further acknowledge that if I accept an offer of employment with DPM Consulting Services, Inc., I have not relied on any oral or written representations relating to the terms and conditions of my employment or otherwise in accepting or continuing my employment with DPM Consulting Services, Inc. _ 3. If employed, I understand that if I am or become handicapped in need of accommodations for employment, under Michigan law, I must notify the Human Resources Department in writing within 182 days after the need is known or reasonably should have been known to me. The notice within 182 days is not required by Title I of the Americans with Disabilities Act. 4. I authorize the employers listed in my employment application to provide you with any and all information concerning my previous employment and any pertinent information they may have (even if more than four years old), and release you and all parties from any liability for any damages that may result from furnishing same to you. This releases DPM Consulting Services, Inc. and any current or previous employers from giving me any notice of such disclosure of information. 5. I authorize DPM Consulting Services, Inc. to release any information (even if more than four years old) relating to my employment when such information is requested by any of my prospective or subsequent employers without any obligation (by them or you) to give me notice of such disclosure. _ 5

6 6. I agree and understand that any employment offer is conditional upon the results of a drug screening and the results of a motor vehicle report which I authorize DPM to obtain. I further understand and agree that if employed and I drive for work, DPM will obtain annual motor vehicle reports. 7. I understand that any employment offer is conditional upon my consent to and the results of a criminal background check. Criminal convictions or arrests will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, the substantial relation to the position s functions and qualifications, the number of occurrences, the applicant s age at the time of the crime, the time elapsed since the crime, the applicant s entire work and educational history, employment references and recommendations, and the business necessity of any exclusion when required by law. 8. I agree that any lawsuit against DPM Consulting Services, Inc. or any of its officers, members, employees or agents arising out of my employment or termination of employment, including but not limited to, claims arising under the State or Federal Civil Rights statutes, must be filed within one hundred and eighty days of the event giving rise to the claims or be forever barred. I understand that the limitation periods for these claims are generally longer and agree to waive those periods. 9. I have read, understand and voluntarily agree to the terms in each of the eight (8) individual statements indicated above. 6