Application of Employment

April 6, 2017| momentum |

7730 Smale St, Washington, MI 48094
Posted 8 years ago

Website Friends & Family, Inc.

Providing community-based services to the special needs population.

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

If you are a person with a disability, you may request any needed, reasonable 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.

NOTE: 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.

Full name

Address

Email address

Phone Number

Position Applied for

Do you currently have a valid Michigan drivers license?

Drivers License Number

Are you 18 years of age or older?

Can you perform the duties of the job for which you are applying with or without accommodation?

If no, please explain (optional)

How were you referred to us?

Others: (optional)

We are licensed to provide adult foster care for 24 hours a day, 7 days a week, and 52 weeks a year. Availability for a variety of shifts is expected for continued employment. Please select your availability:

Are you interested in Part-Time or Full-Time employment?

Have you ever been convicted of a crime?

(Note: Affirmative answers to this question may not automatically preclude you from consideration for employment.) If yes, please explain: (optional)

Are there any felony charges pending against you?

If yes, please explain: (optional)

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: (optional)

Have charges ever been substantiated against you for abuse, neglect, exploitation, mishandling consumer funds or any other recipient rights violations in an investigation by:

If you marked any of the above or your answer includes multiple departments, please explain: (optional)

Have you ever been employed by this organization before?

If yes, please state date and whether or not you were employed under a different name: (optional)

Please indicate the names of any relatives already employed by this organization: (optional)

Have you received MORC (Macomb Oakland Regional Center) part 1 training

High School Attended (Name, City, State)

Did you graduate?

School(s) Attended (optional)

School Name | Address | Degree/Major | Graduation Date

Training or Certifications: (optional)

Please provide at least three professional references (optional)

Experience (1) (optional)

Employer | Phone Number | Job Position/Title | Dates employed | Reason For Leaving

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Experience (2) (optional)

Employer | Phone Number | Job Position/Title | Dates employed | Reason For Leaving

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Experience (3) (optional)

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Application of Employment

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