Careers Application

"*" indicates required fields

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PLEASE READ THE FOLLOWING BEFORE FILLING OUT THIS APPLICATION:

STATEMENT OF PRINCIPLES: Our objectives are simple and straightforward - we want to be the best, give the highest services, provide the finest quality care and maintain the highest levels of client satisfaction. Everything we do is in an effort to improve our service and quality. In order to continue our success, we must constantly work to maintain and surpass the standards we have set.

Every employee of ours is expected to upload these standards. Working here involves a great deal of commitment and energy - both essential elements of goof service and high quality patient care. We do extensive training with many mandatory meetings and classes for all positions. We have very high expectations and we insist on commitment to a job. If you are a person who is willing to make such a commitment, then take time to fill out the remainder of this application.

NOTE: Please answer the questions to the best of your ability. All information will be treated confidentially. All fields marked "*" are required.

CONTACT

Personal Information

Name*

Date*

MM slash DD slash YYYY

Primary Telephone*

Email*

Address*

Street, City, State, Zip Code

Additional Information

How were you referred to us?*

Type of Work Desired

Untitled

Nursing

CAN

HHA

Caregiver

Administration

Social Work

Office

Therapy

Do you wish to work:*

Full Time

Part Time

Contingent

If you answered contingent, hours or days desired:

Days available to work:*

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Additional Comments on Availability:

Do you have any commitments or conflicts that may effect you employment with us?*

Yes

Skills

Educational Data

High School Name:

Degree, Major or Type of Course Work:

College:

Degree, Major or Type of Course Work:

Graduate School:

Degree, Major or Type of Course Work:

Special Training, certification, licensure:

Degree, Major or Type of Course Work:

Employment History

List present or most recent employer first.

May we contact these employers at this time?*

Yes

Is a resume is attached as an alternative? (You will be able to upload this at the end of the application):

Yes

Most Recent Employer

Employer:

Telephone:

Address:*

Employed

From*

MM slash DD slash YYYY

To*

MM slash DD slash YYYY

If you currently work here, enter today's date in the field and check yes:*

Yes

Supervisor's Name:*

Job Title:*

Duties:*

Salary - Start (per hour):

Salary - Finish (per hour):

Reason for Leaving

Second Most Recent Employer

Employer

Telephone

Address

Employed

From

MM slash DD slash YYYY

If you currently work here, enter today's date in the field and check yes:*

Yes

Supervisor's Name:

Job Title:

Duties:

Salary - Start (per hour):

Salary - Finish (per hour):

Reason for Leaving

Third Most Recent Employer

Employer

Telephone

Address

Employed

From

MM slash DD slash YYYY

If you currently work here, enter today's date in the field and check yes:*

Yes

Supervisor's Name:

Job Title:

Duties:

Salary - Start (per hour):

Salary - Finish (per hour):

Reason for Leaving

Additional Employers

General Information

Are you a US Citizen?*

Yes

If no, what kind of visa do you hold?

Are you over the age of 18?*

Yes

Have you ever been convicted of a criminal offense?*

Yes

If yes

From

MM slash DD slash YYYY

If yes, Nature:

Each applicant's history will be checked. An affirmative answer will not automatically disqualify you from being considered as a candidate for employment.

References

(at least two - not employers or relatives)

Reference No. 1

Name*

Phone*

Address*

Occupation*

Reference No. 1

Name*

Phone*

Address*

Occupation*

Additional References

Authorization and Understanding*

I Agree to all above terms and conditions

Upon the signing of this application, I represent that all of the information now or hereafter given by me in support of my application is true and complete. I authorize you to verify any of the information concerning my employment, education or criminal history with the appropriate individuals, companies, institutions or agencies; and I authorize them to release such information as you require, including my prior disciplinary employment record without any obligation to give me written notice of such disclosure. I also authorize you to release any information requested by any of my prospective or subsequent employers without any obligation to give me written notice of such disclosure. I hereby release you and them from any liability whatsoever as a result of any such inquiries and disclosures. I understand that providing information not specifically asked for in this application or failing to accurately disclose information specifically asked for will disqualify my application from being considered for employment. I understand that any offer of employment is conditioned on the complete accuracy of the information I have provided in this application and addendums, and that inaccuracies can result in my immediate discharge.

I agree that either party may terminate the employment relationship, with or without cause, at any time and I further agree that this arrangement may only be altered in writing directed to me personally and signed by the president of the company. I agree that I shall be found by the other rules, policies, regulations and terms and conditions of employment of the company as they are from time to time changed, and no additional obligations can be imposed on the company those which have been acknowledged in writing by the president or his designated representatives.

I agree that any action or suit against the company arising out of my employment or termination of employment, including but not limited to claims arising under the state or federal civil rights statutes, must be brought within 180 days of the event giving rise to the claims or be forever barred. I waive any limitation periods to the contrary. I further agree that if I should bring any action or claim arising out of my employment against the company in which the company prevails, I will pay to the company any and all costs incurred by the company in defense of said claims of actions, including attorney fees. I further agree that my employments is conditional until such time as the results of my pre-employment screenings, reference, criminal checks, and license are known.

By submitting this form: I HEREBY AUTHORIZE Metro Cares TO CONTACT ANY INDIVIDUAL IT DEEMS APPROPRIATE TO INVESTIGATE MY EMPLOYMENT HISTORY, CHARACTER AND QUALIFICATIONS, AND I GIVE MY FULL AND COMPLETE CONSENT TO THEIR REVEALING ANY AND ALL INFORMATION THEY WISH AS A RESULT OF THIS INVESTIGATION IN ADDITION, I HEREBY WAIVE MY RIGHT TO BRING ANY CAUSE OF ACTION AGAINST THESE INDIVIDUALS FOR DEFAMATIONS, INVASIO OF PRIVACY OR ANY OTHER REASON BECAUSE OF THEIR STATEMENTS.

Optionally Upload your Resume

Drop files here or

Max. file size: 512 MB.

Phone

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

An Equal Opportunity Employer

We are an equal oppurtunity employer and will not unlawfully discriminate on the basis of race, creed, color, genetic information, age, religion, national origin, citizenship, sex, sexual orientation, height, weight, veteran or marital status or mental and physical handicaps or any other category protected by law.

Michigan law requires employers to make accommodations to handicapped applicants and employees where the accommodation does not impose an undue hardship on the employer. Handicapped employees and applicants may request an accommodation of their handicap by notifying the facility in writing of the needs for accommodation within 182 days of the date the handicapper knows or should know that an accommodation is needed. Failure to properly notify the facility will preclude any claim that the employer failed to accommodate the handicapper. This requirement does not waive an individual’s right under the Title 1 of the Americans with Disabilities Act of 1990, as amended.

Careers Application

Personal Information

Additional Information

Type of Work Desired

Skills

Educational Data

Employment History

General Information

References

An Equal Opportunity Employer

Services

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