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Employment Form

  1. This Agency 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 accommodation to perform the essential duties of at the job must notify the employer in writing within 182 days of the date that the need is known or should have been known.  

  2. Yes

  3. Yes

  4. Full-time

  5. Yes




  9. Yes

  10. Yes

  11. Yes

  12. REFERENCES: Three individuals not related to you, whom you have know for at least one year:


  14. Yes

  15. Yes

  16. Yes

    Have you been cited with any moving violatoins within the past 5 years?

  17. If you have a resume you can upload it here.
  18. Please read the following statement carefully before signing. 

    understand that, prior to being offered a paid or volunteer position; I may be requested to take an employment/volunteer examination. In the event that I have a disability that will affect my ability to take the test, I will so inform the Agency prior to the test so that a reasonable accommodation can be made. The Agency reserves the right to require medical documentation regarding the need for accommodation.

    I understand and agree that, if offered a position, my term of employment or volunteering is for no definite period and may be terminated with or without cause, at any time, with or without notice. This provision supersedes any oral or written representation to the contrary unless in writing and signed by both the executive director of the Agency and the person to whom the writing is directed.

    I acknowledge that I have been counseled that a person or entity may not procure or cause to be prepared an investigative consumer report on any consumer unless it is clearly and accurately disclosed to the consumer, that an investigative consumer report – including all applicable information as to his or her character, general reputation, personal characteristics, mode of living, education history, driving history and employment history – may be made.  If you are denied employment because of the consumer investigation, it is your right under the Fair Credit Reporting Act (Law 91-508) SS 606 to have the name of the agency or agencies from whom information concerning you was obtained.  You are also entitled to receive free copies of the information supplied by those agencies within sixty days upon written request.  You have the right to directly dispute with the consumer reporting agency the accuracy and completeness of any information furnished by that agency.


    I authorize without reservation, any party or agency contacted by this employer to furnish the above mentioned information. I release BACKGROUND NETWORK, INC. d.b.a. CRIMCHECK.COM and any other person and/or agencies from any suits, liens, judgments, damage and/or liability resulting from this process. The above information is used solely for inquiries and criminal history checks. Falsifying any information on this release form will constitute grounds for immediate dismissal or declining any pending job offers.

  19. I Agree
    I Disagree

  20. or Reset