EMPLOYMENT APPLICATION

This Company is an equal opportunity employer and will not discriminate against any applicant on the basis of any characteristic that is protected by State or Federal law. Michigan law requires that a person with a disability or handicap requiring accomodation to perform the essential duties of the job must notify the employer in writing within 182 days of the date that the need is known or should have been known. Please fill out the application below Name: Email Address: Street Address: City: Zip Code: State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Home Phone: Cell Phone: Are you 18 or older?: yes no Position applied for: Date availbe to start: (mm/dd/yy) Are you employed now: yes no Do you have reliable transportation?: yes no Have you been convicted of a felony?: yes no If yes, please explain:

16063 Clinton Avenue, Macomb TWP, MI 48042

Toll Free | 877.229.3939   Phone | 586.855.8333   Fax | 586.992.1317

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