APPLICATION FOR EMPLOYMENT
City of Sault Ste. Marie Police Department
ATTN: Sgt. Micki Leppien
401 Hursley Street
Sault Ste. Marie, MI 49783
Phone:(906)632-3344 Fax:(906)632-6618
To the applicant: We appreciate your interest in City employment and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in seeking to place you in a poistion which, in our judgement, best meets your qualifications.
We are an equal opportunity employer and will not unlawfully discriminate on the basis of race, color, sex, religion, national origin, marital or veteran status, the presence of a medical condition or handicap, height, weight, or any other protected status.
Name:__________________________________ Date of Application:_________________
Address:_______________________________ Telephone Number:______________________
Social Security No.____________________ Are you 18 years or older? Yes[ ] No[ ]
Are you a U.S. citizen? Yes[ ] No[ ]
Are you authorized to work in the United States? Yes[ ] No[ ]
Have you been previously employed here? Yes[ ] No[ ] If yes, date(s)__________________ Supervisor Name(s)___________________________
Have you filed an application before? Yes[ ] No[ ] If yes, date(s)_____________________
List any friends or relatives working here__________________________________________
What method of transportation will you use to come to work?________________________________________
EMPLOYMENT DESIRED:
Position(s) applied for AUXILIARY POLICE
Kind of work sought: Full time[ ] Part time[ ] Other___________________________
Do you have any special training, skills, qualifications or other experiences that relate to the position(s) applied for?_______________________________________________________________________
_______________________________________________________________________
Date available to work_______________________
EMPLOYMENT EXPERIENCE (List current or most recent jom first)
1.Employer:_________________________ Address:_________________________
Job Title:____________________ Supervisor:_________________________
Reason for Leaving:______________________________
Work Performed:______________________________
Date: From __________ to __________
Hourly Rate/Salary: starting __________ Final __________
2.Employer:_________________________ Address:_________________________
Job Title:____________________ Supervisor:_________________________
Reason for Leaving:______________________________
Work Performed:______________________________
Date: From __________ to __________
Hourly Rate/Salary: starting __________ Final __________
3.Employer:_________________________ Address:_________________________
Job Title:____________________ Supervisor:_________________________
Reason for Leaving:______________________________
Work Performed:______________________________
Date: From __________ to __________
Hourly Rate/Salary: starting __________ Final __________
4.Employer:_________________________ Address:_________________________
Job Title:____________________ Supervisor:_________________________
Reason for Leaving:______________________________
Work Performed:______________________________
Date: From __________ to __________
Hourly Rate/Salary: starting __________ Final __________
EDUCATION
Elementary: Name/Location_________________________________________________________
Years Completed:_______ Diploma/Degree:_____________ Courses of Study:________________________
High School:
Name/Location:________________________________________________________
Years Completed:_______ Diploma/Degree:_____________
Courses of Study:________________________
College:
Name/Location________________________________________________________
Years Completed:_______ Diploma/Degree:_____________
Courses of Study:________________________
Graduate:
Name/Location________________________________________________________
Years Completed:_______ Diploma/Degree:_____________
Courses of Study:________________________
Vocational/Training:
Name/Location_________________________________
Years Completed:_______ Diploma/Degree:_____________
Courses of Study:________________________
Any other educational training: ____________________________________________________________________________________________________
REFERENCES (Do not include releatives or former employers)
1.Name_________________________Address___________________________Phone Number_____________
Years Acquainted_____
2.Name_________________________Address___________________________Phone Number_____________
Years Acquainted_____
3.Name_________________________Address___________________________Phone Number_____________
Years Acquainted_____
MILITARY SERVICE RECORD
Have you had any experience in the Armed Forces of the United States or in a State National Guard? Yes[ ] No[ ]
If yes, what branch?________________ Rank at Discharge______________ Date of Discharge_____________
Are you in the reserves? Yes[ ] No[ ] If yes, date obligation ends______________
Special/Technical training________________________________________
ADDITIONAL INFORMATION
Have you been convicted of a crime? Yes[ ] No[ ]
If so, where, when and nature of offence____________________________________________
Do you have a valid drivers license? Yes[ ] No[ ] License No.____________________________State________
List professional trade, business or civic activities and offices held excluding groups the name or character of which indicate race, color, religion, sex, national origin, handicap, marital or veterans status, height, weight or age _________________________________________________________________
State any additional information that you feel may be helpful to us in considering your application ___________________________________________________________________________________________
Name, address, and telephone number of the person to be notified in the event of accident or emergency ____________________________________________________________________________
AUTHORIZATION AND UNDERSTANDING:
Upon the signing of this application, I represent that all of the information now or hereafter given by me in support of my application is true and complete. I authorize you to verify any of the information concerning my employment, education, credit or medical history with the appropriate individuals, companies, insitutions or agencies, and I authorize them to release such information as you require, including my prior disciplinary employment record, without any obligation to give me written notice of such disclosure. I hereby release you and them from any liability whatsoever as a result of any such inquiries and disclosures. I agree that any false information in support of my application may subject me to discharge at any time during the period of my employment.
I agree that either party may terminate the employment relationship with or without cause, at any time, and I further agree that this arrangement may only be altered in writing directed to me personally and signed by the City Manager. I agree that I shall be bound by the other rules, policies, regulations and terms and conditions of employment of the City as they are from time to time changed, and no additional obligations can be imposed on the City except those which have been acknowledged in writing, by the City Manager or his designated representatives.
I agree that any action or suit against the City arising out of my employment or termination of employment, including, but not limited to claims arising under State or Federal civil rights statutes, must be brought within 180 days of the event giving rise to the claims or be forever barred. I waive any limitation periods to the contrary. I further agree that if I should bring any non-statutory action or claim arising out of my employment against the City, in which the City prevails, I will pay to the City and and all such costs incurred by the City in defense of said claims or actions, including attorney fees. I further agree that my employment is conditional until such time as the results of my post-offer physical (if such physical is required) are known.
Signature________________________________ Date_____________
