Application for Employment

City of Hamtramck We are an Equal Opportunity

3401 Evaline Street Employer and are committed to
Hamtramck, MI 48212 excellence through diversity.
313/800-5233
Applicants are considered for all positions without regard to race, creed, sex, religion, national origin, age, height, weight, marital status,
veteran status or disability. Any job offer is contingent on successful completion of any required medical, psychological and substance
abuse examination(s).
Please print or type. The application must be fully completed to be considered. Please complete each section, even if you attach a resume.

Personal Information
Name (Last Name, First Name, Middle Initial) Date of Application

Address City State Zip

Phone Number Mobile Number Email Address

Are you legally eligible for employment in the US? * Have you ever been convicted of a felony? Yes No
If yes, please explain.
Yes No
(A criminal conviction does not automatically disqualify you for employment.)

*The City of Hamtramck conforms to the Immigration Reform and Control Act of 1986, which requires you to furnish documentation
showing your identity and legal authorization to work in the United States once employment has been offered.

Are you related to any current City of Hamtramck employee, the mayor or current member of City Council? Yes No
If yes, provide name and relationship:

Position
Position You Are Applying For Available Start Date Desired Pay

Employment Desired Full Time Part Time

Have you ever been employed by the City

of Hamtramck? If yes, when? Title?

Education
School Name Location Years Attended Degree Received Major
High School

College

College

Vocational Training
[

General
Do you have any special training skills, qualifications, Please list/describe:
licenses, certifications or other experiences that relate to the
position applied for?
Branch of Service:

U.S. Military Service: From: To: Rank or Rating:

If translation services are needed to complete or understand documents, please contact the department head to request accommodations.
.‫ يرجى االتصال بمشرف القسم لطلب اإلقامة‬،‫إذا كانت هناك حاجة لخدمات الترجمة إلكمال أو فهم المستندات‬
যদি নথি সম্পন্ন বা বোঝার জন্য অনুবাদ পরিষেবার প্রয়োজন হয়, অনুগ্রহ করে বাসস্থানের জন্য অনুরোধ করার জন্য ডিপার্টমেন্ট
সুপারভাইজারের সাথে যোগাযোগ করুন।
 Application for Employment
Emergency Contact
Name Phone Number

Medical Examination
In accordance with applicable legal requirements, the City of Hamtramck may require job applicants to undergo a medical
examination after an offer of employment has been made and prior to the commencement of employment duties and may condition
the offer of employment on the results of such examination.

Drug Test/Use
I HEREBY CERTIFY THAT I AM NOT CURRENTLY ENGAGED IN THE ILLEGAL USE OF DRUGS. I understand that as a condition
of employment, I will be required to take a pre-employment drug test for the illegal use of drugs, which may include the collection of a
urine sample. I agree that the results of this test may be submitted to the City of Hamtramck or its authorized representative, and I
expressly release the collection agency and the testing laboratory from any and all liability for performing the requested test, and for
communicating the results to the City. I understand that if the results of any pre-employment drug test are positive, it will be cause for
rejection of my application or, if I am hired, that my employment with the City may be immediately terminated.

Check here to acknowledge that you have read and understand the potential requirements of the Medical Examination
and Drug Test/Use

Employment History Describe all positions you have held, starting with your most recent position and working back.
Employer (1) Job Title Dates Employed

Work Phone Starting Pay Rate Ending Pay Rate

Address City State Zip

May we contact present employer for

Reason for leaving Yes No
a reference?
Name & title of Supervisor

List of job responsibilities

Employer (2) Job Title Dates Employed

Work Phone Starting Pay Rate Ending Pay Rate

Address City State Zip

Reason for leaving

Name and Title of Supervisor:

List of job responsibilities

Employer (3) Job Title Dates Employed

Work Phone Starting Pay Rate Ending Pay Rate

Address City State Zip

Reason for leaving

Name and Title of Supervisor:

List of job responsibilities

References
Name Relationship to Title / Company Phone
 Application for Employment
Applicant

Signature Disclaimer
 I certify that the answers and information given by me in this application are true, correct, and complete without qualification. I
understand that the City of Hamtramck has the right to refuse to hire or immediately discharge me, at any time, if it discovers
that I provided incomplete, untrue, or misleading answers or information in this application or on any other documents or forms
submitted at any time during my employment.
 I hereby authorize the City of Hamtramck to verify the answers and information given by me in this application and to make any
investigation of my background deemed necessary. I authorize former employers, law enforcement organizations, educational
institutions, and any other third party contacted by the City of Hamtramck to release to the City of Hamtramck any information
they have regarding me without providing written notice to me.

 I authorize the City of Hamtramck to use any information in its possession concerning me for any purpose it deems appropriate,
including disclosure of information to any third party, future employer or prospective future employer without notification to me
of such disclosure, and I release the City of Hamtramck from any liability in connection with such use or disclosure.
 If I am offered employment by the City of Hamtramck, I acknowledge that I may be required to undergo a pre-employment
medical examination and/or drug test. I further understand that if the results of these tests are not satisfactory, it will be cause
for rejection of this application or, if I am hired, that my employment may be immediately terminated.

 If I am hired by the City of Hamtramck, I understand and agree that I will be bound by the rules, regulations, policies,
procedures, and other terms and conditions of employment of the City of Hamtramck, as they are from time-to-time changed,
with or without notice.
 If I am hired by the City of Hamtramck, I understand that I have the right to terminate my employment at any time and for any
reason, with or without notice. I further understand that the City of Hamtramck can terminate the employment relationship at
any time for any lawful reason, with or without notice. This employment relationship exists regardless of any other written
statements or policies, any other City of Hamtramck document, or any verbal statements to the contrary. No one except the
City of Hamtramck’s City Manager can enter into any kind of employment relationship or agreement that is contrary to the
above. To be enforceable, any employment relationship or agreement that is contrary to the above must be in writing and
personally signed by the City Manager and myself.

 I agree not to commence any action or claim relating to my employment with the City of Hamtramck or this application for
employment more than six (6) months after the date of the challenged action or this application, and to waive any statute of
limitations. I further agree that this provision does not extend any statute of limitations or filing period that is less than six (6)
months. Where the statute of limitations for a claim is less than six (6) months, I understand and agree that the shorter
limitations period shall apply to any such claim.
 I understand that my rights as an applicant and this application will be governed by, construed and enforced under the laws of
the state of Michigan. The venue for an action will be the State of Michigan, and I consent to the jurisdiction of the courts of the
State of Michigan, County of Wayne, and the U.S. District Court, Eastern District of Michigan.

Name (Please Print) Signature Date

Please return this application by:

Mail: Human Resources
City of Hamtramck
3401 Evaline Street
Hamtramck, MI 48212
Fax: 313/974-7973
Email: hr@hamtramckcity.com

Any questions with respect to the position applied for should be directed to the City of Hamtramck’s Human Resources department.
 Application for Employment
FCRA Authorization to Obtain a Consumer Report (Background/Credit Check)

Pursuant to the federal Fair Credit Reporting Act, I hereby authorize the city of Hamtramck and its
designated agents and representatives to conduct a comprehensive review of my background
through a consumer report and/or an investigative consumer report to be generated for employment,
promotion, reassignment or retention as an employee. I understand that the scope of the consumer
report/investigative consumer report may include, but is not limited to, the following areas: verification
of Social Security number; current and previous residences; employment history, including all
personnel files; education; references; credit history and reports; criminal history, including records
from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor
vehicle records, including traffic citations and registration; and any other public records.

I, enter full name, authorize the complete release of these records or data pertaining to me that an
individual, company, firm, corporation or public agency may have. I hereby authorize and request any
present or former employer, school, police department, financial institution or other persons having
personal knowledge of me to furnish City of Hamtramck or its designated agents with any and all
information in their possession regarding me in connection with an application of employment. I am
authorizing that a photocopy of this authorization be accepted with the same authority as the original.

I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be
taken based upon the consumer report, a copy of the report and a summary of the consumer’s rights
will be provided to me.

___________________________________ _enter date___

Signature Date