Adult Learning Systems
APPLICATION FOR EMPLOYMENT

We are an equal opportunity employer. It is policy of this organization not to discriminate on the basis of race, sex, religion, national origin, marital status, age, weight, height, color or handicap in the hiring, promotion, payment or discipline of employees.

If you are a person with a handicap, you may request any needed accommodation to participate in the application process or interview process. Michigan law requires that a person with a disability or handicap requiring accommodation for employment must notify the employer in writing within 182 days after the need is known.

We will not discriminate against a person with a covered disability under the Americans with Disabilities Act in regard to employment practices, or terms, conditions, and privileges of employment.

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PERSONAL INFORMATION
EMPLOYMENT DESIRED
EMPLOYMENT EXPERIENCE
REFERENCES
EDUCATION INFORMATION
DISCLAIMER

PERSONAL INFORMATION

Last Name
First Name
Middle Initial
Street Address
City
State
Zip
Phone Number
Alternative/cell
Social Security # (last 4 digits only)
Have you ever applied for employment with us?
   If yes, Month/Year Location
Are you legally eligible for employment in the United States?
Are you 18 yrs of age?
Do you have any relatives or friends working for this company?
   If yes, who, type of relationship and where do they work?
If the position you applied for requires driving. Do you currently have a valid driver’s license?
Have you received a job description for all positions for which you have applied?
Can you perform the duties of the job in which you wish to be employed with or without a reasonable accommodation?
Have you been convicted of a crime?
   If yes, please explain
(Note an affirmative answer to this question may not automatically preclude you from consideration for employment.)
Are there any felony charges pending against you?
   If yes, please explain
Have you ever been administratively determined by a federal, state, or local governmental agency to have committed abuse or neglect?
   If yes, when, where and nature of the case
Are you on a court-supervised probation or parole?
   If yes, please explain