Employment Application

Muskegon Township

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The form will be submitted to jhodges@muskegontwp.org

General Information

Date(Required)

MM slash DD slash YYYY

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Daytime Phone Number(Required)

Evening Phone Number(Required)

Email(Required)

Position Applying For:(Required)

Personal Data

Are you less than 18 years old?(Required)

Yes

No

Are you legally eligible for employment in the United States?(Required)

Yes

No

Have you ever been convicted of a crime or are you presently charged with a felony(Required)

Yes

No

If so, where and when? Please explain your circumstances.

If your application is considered favorably, how much notice would you need to give?(Required)

Educational Background

Highschool

High School (Name, Address)

Course of Study

Last Year Attended

Did You Graduate High School?

Yes

No

Diploma/Degree

College

College (Name, Address)

Course of Study

Last Year Attended

Did You Graduate College?

Yes

No

Diploma/Degree

Other

Other - specify (Name, Address)

Course of Study

Last Year Attended

Did You Graduate (or Equivalent)?

Yes

No

Diploma/Degree

Do we have your permission to check your records at the above institutions?

Yes

No

Employment History

1. Employer

Name of Employer(Required)

Phone Number of Employer(Required)

Address of Employer(Required)

Street Address Address Line 2 City State ZIP Code

Position Held(Required)

Duties and Responsibilities(Required)

Start Date(Required)

MM slash DD slash YYYY

End Date(Required)

MM slash DD slash YYYY

Reason for Leaving(Required)

Starting Salary(Required)

Ending Salary(Required)

Name of Supervisor(Required)

First Last

May we contact them for reference?(Required)

Yes

No

2. Employer

Name of Employer

Phone Number of Employer

Address of Employer

Street Address Address Line 2 City State ZIP Code

Position Held

Duties and Responsibilities

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Reason for Leaving

Starting Salary

Ending Salary

Name of Supervisor

First Last

May we contact them for reference?

Yes

No

3. Employer

Name of Employer

Phone Number of Employer

Address of Employer

Street Address Address Line 2 City State ZIP Code

Position Held

Duties and Responsibilities

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Reason for Leaving

Starting Salary

Ending Salary

Name of Supervisor

First Last

May we contact them for reference?

Yes

No

4. Employer

Name of Employer

Phone Number of Employer

Address of Employer

Street Address Address Line 2 City State ZIP Code

Position Held

Duties and Responsibilities

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Reason for Leaving

Starting Salary

Ending Salary

Name of Supervisor

First Last

May we contact them for reference?

Yes

No

Military Service Record

Were you in the U.S. Armed Forces?(Required)

Yes

No

What branch?

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Rank at Discharge

List duties in service, including special training.

Personal References

Give names of three people who are not related to you.

Name(Required)

First Last

Occupation(Required)

Phone(Required)

Years Known(Required)

Name(Required)

First Last

Occupation(Required)

Phone(Required)

Years Known(Required)

Name(Required)

First Last

Occupation(Required)

Phone(Required)

Years Known(Required)

Name

First Last

Occupation

Phone

Years Known

Additional Information

Are there any skills or experiences which you feel would especially qualify you to work for Muskegon Charter Township?(Required)

Do you have any relatives currently working for Muskegon Charter Township (including Township Board members)?(Required)

Yes

No

Name of Relative

First Last

Relation

The facts set forth in my application for employment are true and complete. I understand that, if employed, any misrepresentations or omissions made by me on this application shall be sufficient cause for dismissal from the employee’s service, whenever it is discovered.

Muskegon Charter Township is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, disability, national origin or other legally protected characteristics.

READ CAREFULLY AND SIGN BELOW IF YOU AGREE TO THESE TERMS OF EMPLOYMENT

I affirm that all statements I have made on this employment application are true and complete. I understand that any false or misleading statements or material omissions may result in the denial of employment or, if I am employed, in the termination of my employment.

I agree that my employment with Muskegon Charter Township will be at will and may be terminated by me or the company at any time, with or without cause and with or without notice.

I agree that I will not disclose to anyone or use for my own purposes any of the Township’s confidential or proprietary information, either during or after my employment, except at the request and for the benefit of the Township. I agree that information about the Township’s customers, vendors, sources of supply, pricing, costs, and other financial information, products, services, methods of operation, marketing, engineering methods, production, and the like is confidential and proprietary information that belongs to the Township. If my employment with the Township ends, I will not retain any copies or summaries of any such information, but will promptly return all such information to the Township.

I agree to submit to physical examinations permitted by law before and during my employment, at the request and expense of the Township, and I agree to disclose all information lawfully requested at such examinations about my physical and mental condition and medical history. I also agree that before and during my employment, at the request and expense of the Township, I will cooperate in such lawful medical tests (including blood, urine or other testing) as the Township requests to check for drugs or alcohol in my system. I waive any claims against the Township or its agents or any testing agency retained by the Township or its agents relating to any such testing, or from lawful decisions made regarding my employment or termination of employment based upon the results of such testing or analysis.

I agree that except as prohibited by law the Township may, during or after my employment, disclose or discuss any information or opinions relating to me or my employment to employees of the Township or third parties. I waive written or other notice of any such disclosure, including disclosure of disciplinary matters, and I waive any claims against the Township or its agents relating to any such disclosure or discussion.

I agree that I will not commence any action or lawsuit relating to my employment or application for employment with Muskegon Charter Township more than 6 months after the employment action that is the subject of the action or lawsuit, and I agree to waive any statute of limitations to the contrary. I understand that this means that even if the law would give me the right to wait a longer time to make a claim, I am freely and knowingly waiving that right, and that any claims not brought within 6 months after the relevant employment action will be barred.

I agree to the above terms of employment. I agree that if any of the above terms are ever found to be legally unenforceable as written, such invalidity will not affect the validity of the rest of this agreement, and such term shall be limited to allow its enforcement as far as legally possible. I agree that no one other than the Township Supervisor, by a written directive, has any authority to modify the above terms of employment, or to make any exception to them, or to offer employment on any other terms.

I agree that I will be bound by and will adhere to any other rules and policies issued by the Township, including all rules and policies contained in the Muskegon Charter Township Employee Handbook and Policies.

I understand that it is the policy of Muskegon Charter Township to verify employment eligibility, including social security numbers, for all employees.

Signature of Applicant

Date

MM slash DD slash YYYY

CAPTCHA

Email

This field is for validation purposes and should be left unchanged.

Township Hall

Address:
1990 E. Apple Ave
Muskegon, MI 49442

Hours:
Monday – Thursday: 7:30 am – 6:00 pm
closed for lunch from 1:00 to 1:30
Fridays by appointment only

Contact Us

Phone:
(231) 777-2555

Fax:
(231) 777-4912

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