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Personal Information

Date of Application
Date of Application
First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Are you 18 years or older?*
1. Yes
1. No
Have you ever been convicted of a violation of the law other than a minor traffic violation?*
1. Yes
1. No
Do you have a valid drivers license?*
1. Yes
1. No
Are you eligible to work in the United States?*
1. Yes
1. No
Have you previously worked for Alpena County?*
1. Yes
1. No
Have you previously applied at Alpena County?*
1. Yes
1. No
Upload Your Resume*
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Position Information

Which position are you applying for?*
Type of employment desired*
1. Full Time
1. Part Time
Saraly desired*
Hours of work (per week) desired*
How did you hear about the position?*
Do you have any special training, skills, qualifications or other experiences that relate to the position applying for?*
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Education

High School*
Address*
College*
Address
Degree
Other
Address
Degree
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Employment History

(From Most Recent)
Company*
Position*
Supervisor*
Phone Number*
May we contact your previous supervisor for a reference?*
1. Yes
1. No
Address*
Responsibilities*
Employed From - To (Date)*
Salary*
Reason for leaving*
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for leaving
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for leaving
Please explain all periods of unemployment *
Have you ever been discharged or requested to resign from a position? If yes, explain:*
Have you ever been disciplined or discharged for absenteeism or tardiness? If yes, explain:*
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References

Please list three professional references.
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
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Disclaimer & Signature

I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

I understand that the information in this application will be used by Alpena County and my current and previous employers and others may be contacted to make an inquiry concerning my personal, employment, financial, educational, and medical history and other matters related to employment. I request my current and previous employers, educational institutions and medical providers to answer any inquiry and to provide any requested information contained in any employment, medical or educational records or files relating to me. I hereby release and agree to hold harmless Alpena County and my current and previous employers, educational institutions, and medical providers (and their agents and employees) from any and all claims arising in any way concerning any disclosures made as a part of such inquiry or investigation. I also release and agree to hold harmless Alpena County and the medical/technical testing agencies (and their agents and employees) from any and all claims arising in any way from their administration or use of results of tests from physical examination of me, including any laboratory tests (including tests for drugs and alcohol), and I authorize the medical/testing agencies conducting the examination and/or tests to report the results thereof to the company, its agents and employees.
I understand that my employment shall be on such terms and conditions as Alpena County may determine and change from time to time and is based upon the requirement that employees become familiar with and abide by the rules, regulations, policies and procedures of Alpena County, as may be established and changed from time to time. Such employment is at will, and, therefore, can be terminated by Alpena County at any time, with or without cause and with or without notice. I understand that no one except the Alpena County Board of Commissioners by an action of a quorum of the Board at a Board meeting has any authority to enter into any agreement for employment other than a terminable at will basis, and that no such agreement shall be effective or binding unless it is individually addressed to me in writing and acted on by the Board as provided above.
Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*

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