Employment Application | Detroit Exposure Services

Personal

Full Name (First + Middle + Last)*

Drivers License Number*

Drivers License State*

Permanent Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone*

Email*

Date of Birth*

Other name(s) under which you have been previously employed

Names of friends or relatives employed in this organization

Have you ever applied to this organization before?*

Yes

No

If Yes, give date and position applied for

Have you ever been employed by this organization before?*

Yes

No

If yes, list dates of employment

Do you have any family, business, health, or social restrictions or obligations that would prevent you from performing the job responsibilities?*

Yes

No

Do you have any physical or mental condition or handicap which would endanger the health or safety of yourself and or others or that may affect your ability to perform the job(s) for which you are applying?*

Yes

No

If yes, please describe such condition or handicap.

Have you ever been convicted of a felony?*

Yes

No

If yes, list dates, offenses, and disposition.

Convictions are not an automatic disqualification from employment.

Will you comply with the safety work and attendance policies of our organization?*

Yes

No

Employment Interests

Date Available*

Type of Employment You Are Seeking:*

Part Time

Temporary

How will you get to work?*

How were you referred to our organization?*

Name of Referral Source:

Education/U.S. Military Service

Where did you attend high school & college? (Click the + button to add a new row)*

School Name & Address

Major

Years Completed

GPA

Degree/Diploma

Are you taking any educational course(s) presently?*

Yes

No

I will be soon

If Yes or you will be soon, what and where?

Have you ever served in the U.S. Armed Services?

Yes

No

Other

US Military Duties and special training

Rank held at discharge

References

List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)

Name

Address

Occupation

Years Known

Employment History

Give employment record as completely as possible listing current or most recent employer first. Show unemployed or self-employed periods and indicate dates and comment on each period. Include part time or summer work.

Company Name (Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From

To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

No

Did you have another job before this one?*

Yes

No

Company Name (Second Most Recent)

(optional)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From

To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

No

Would you like to list another previous job?

Yes

No

Company Name (Third Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From

To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

No

Would you like to list a 4th job?

Yes

No

Company Name (Fourth Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From

To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

No

I agree to a Drug Screening at the company's expense.*

Yes

No

I agree to a Criminal Background Check at the company's expense.*

Yes

No

Acknowledgement

Insert Your Legal Terms of Service Here

Digital Signature:

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date

Resume Upload (optional)

Accepted file types: doc, docx, pages, odt, rtf, tex, txt, wpd, wps, pdf, Max. file size: 512 MB.

If you have a resume you'd like to attach, please do so here. This is not required.

Would you like to add a cover letter?

Yes

No

Cover Letter (optional)

Max. file size: 512 MB.

Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.