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11494 N. Zip Road

Manistee, MI • 49660

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Employment

We are glad you are interested in applying for a job with Mike Zimmerman Construction,Inc.

Please fill out the form below and submit.

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11494 N. Zip Road • Manistee, MI • 49660.

Employment Application

Full name*

Email*

Phone*

Address*

Permanent address (if different than above)

Social SecurityNumber*

Drivers License #*

Any Driving Restrictions?*

Yes

No

Employment Desired

Position Desired*

Date you can start*

Salary Desired*

Are you employed now, if yes where?*

If yes, can we reach out to your employer?*

Yes

No

Have you ever applied to this company before?*

Yes

No

Have you ever been convicted of a felony in the last five years? (You will be denied employment soley because of a conviction record, unless the offense is related to the job for which this application is for).*

Yes

No

If yes, describe the offense

Education

GRAMMER SCHOOL/Name & Location/Yrs. Attended/Did you graduate?/Course of study*

HIGH SCHOOL/Name & Location/Yrs. Attended/Did you graduate?/Course of study*

COLLEGE/Name & Location/Yrs. Attended/Did you graduate?/Course of study*

TRADE SCHOOL/Name & Location/Yrs. Attended/Did you graduate?/Course of study*

Former Employment

List below your last 4 employers starting with the last one first.

LAST EMPLOYER/From what date to what date/Name & Address of employer/Salary/Position/Reason for leaving?*

PREVIOUS EMPLOYER/From what date to what date/Name & Address of employer/Salary/Position/Reason for leaving?*

PREVIOUS EMPLOYER/From what date to what date/Name & Address of employer/Salary/Position/Reason for leaving?*

PREVIOUS EMPLOYER/From what date to what date/Name & Address of employer/Salary/Position/Reason for leaving?*

References

REFERENCES NAME/ADDRESS/BUSINESS/YEARS AQUAINTED List the names of three persons not related to you, whom you have known at least one year. *

Physical Record

Do you have any physical limitations that preclude you from performing any work for which you are being considered?*

Yes

No

If yes, what can be dome to accommodate your limitation?*

Emergency Contact

Emergency Contact Name and Phone Number*

BY CHECKING THE BOX BELOW, I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PATIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.

I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGUARDLESS OF THE DATE OF PAYMENT OF MY WADGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE.

I AGREE

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