RSDC Job Application Form Name* First Middle Last Email* Phone*Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If you are under 18 of age, Do you have a work permit?-------YesNoPosition Desired Production Clerical Others If Others: Date you can Start? MM slash DD slash YYYY Are you willing to work the following? Check all that apply Overtime Weekends Shift work Temporary What shifts are you able to work?* 1st Shift 2nd Shift 3rd Shift Are you willing to work:* Full-time Part-time Are you currently employed?------YesNoMay we contact your present employer?------YesNoAre you on layoff and subject to recall?------YesNoIf subject to recall, where? Have you ever worked for the RSDC before?-----YesNoDo you know anyone who works at this company? If so, who? Can you travel if the job requires it?-----YesNoHow did you learn about us?*------ReferralIndeed.comRSDC WebsiteMichigan WorksSocial MediaOtherIf other, please specify: EDUCATION AND SPECIAL SKILLSHigh School City State Graduated----YesNoBusiness or Trade School City State Graduated-----YesNoUndergraduate School City State Graduated-----YesNoGraduate Professional City State Graduated-----YesNoOther City State Graduated-----YesNoOther City State Graduated-----YesNoDescribe your skills, training, or experience with the following items. Include your years of experience with each.Specialized Training Apprenticeship Skills Factory/Shop Machines Operated Production Computer Equipment/Software Used Typing Skills/Office Machines Job Related Training in the US Military PRESENT OR PREVIOUS EMPLOYMENTName of Employer Type of Business Address City/State Date Started MM slash DD slash YYYY Date Left MM slash DD slash YYYY Starting Pay Final Pay Was this position Full Time Part Time Job Title Supervisor Name Company Phone NumberMay we contact this employer?-----YesNoReason for leaving Description of work and responsibilitiesWill you receive a satisfatory reference from this employer? If "NO" please explain: PREVIOUS EMPLOYMENTName of Employer Type of Business Address City/State Date Started MM slash DD slash YYYY Name Date Left MM slash DD slash YYYY Starting Pay Final Pay Was this position Full Time Part Time Job Title Supervisor Name Company Phone NumberMay we contact this employer?-----YesNoReason for leaving Description of work and responsibilitiesWill you receive a satisfatory reference from this employer? If "NO" please explain: REFERENCES REFERENCE 1Name Telephone Address State Relationship REFERENCE 2Name Telephone Address State Relationship REFERENCE 3Name Telephone Address State Relationship UPLOAD RESUMEUpload ResumeMax. file size: 2 MB. By entering the CAPTCHA below, I certify that I have read, understand, and agree to each of the following statements: All of the information I have supplied on this application is true, accurate, and complete to the best of my knowledge, and I have not knowingly withheld any information which, if known to the Company, would affect my application unfavorably. If I am hired by the Company and if the Company discovers at any time during my employment that any of the statements or answers on this application are false, misleading or incomplete, I may be dismissed immediately from my job. I agree to submit to a medical examination which may include testing for drugs, alcohol or any illegal substance prior to beginning work with the Company and I understand that if I am employed by the Company, I may be required, from time-to-time, and agree, to undergo a medical examination for any reason, including drug or alcohol detection. If I am employed by RSDC OF MICHIGAN, my employment may be terminated at any time, with our without cause, and with or without notice. Policy manuals, employee handbooks, and statements of employee benefits are informational only and do not create an employment contract or alter my status as an at-will employee, and no employee representative of the Company, other than an officer of the RSDC OF MICHIGAN, has authority to enter into any agreement that alters my status as an at-will employee. I agree to release to the Company or its designated agents all medical information, including but not limited to files, reports, x-rays, evaluations, and opinions held by medical personnel, that affect or are related to the terms and condition of my employment . I acknowledge that this is a general release and that, if hired, it remains in effect for the duration of my employment. I give the Company my permission to conduct any investigation regarding the information contained in my employment application, which the Company thinks is necessary to determine my qualifications for assuming a job with the Company. I give the Company my permission to contact any current/former employer, school, college or university, any personal or professional reference, or any other appropriate source or individual for the purpose of gathering any information, personal or otherwise, that such source to release to the Company whatever information they have about me. I also unconditionally release all named and unnamed sources form any and all liability which might result from furnishing any information about me. If I am offered and accept employment with RSDC OF MICHIGAN I understand and agree that my placement is contingent on successful completion of the following: 1) Job related medical examination which may include testing for alcohol, drugs, or other illegal substances. 2) Completion of an I-9 form as required by Immigration Reform and Control Act of 1986.Signature* By typing in your full name, you state you accept the terms of this agreement and have completed your application truthfully, to the best of your knowledge.Enter this code:
