Shadonn J.

Jenkins Music Conservatory

Employment Application
Shadonn J. Jenkins Music Conservatory is an equal opportunity employerand will not
discriminate against any applicant on the basis ofany characteristic that is protected
by state or federal law. Michigan law require that person with a disability or handicap
requiring accommodation to perform the essential duties of the job must notify the
employer in writing 182 of the days of the date that need is known or should have
been known.

Applicant's Information
Date of Application:___/___/____
Date you Can Start:___/___/____

Name (____________(Last),_____________(First),___________(M.I)
Date of Birth: (Day)_______, (Month)________, (Year)_________
Social Security #:_______-______-________
Mailing Address:_____________________________(ex. Apt., Street)
Country(not county):________ Zipcode:____________
City:_____________________State:___________________
Email Address:____________________________________
Daytime Telephone Number: (
Additional/Cell Number: (

) ________ _ _________
) ________ _ ___________

-----------------------------------------------------------------------------------------------

School Visit: I have scheluled a visit on_______________(Date)

Are you 18 years or older? _______ Yes _______ No
Are you lawfully entitled to be employed in the Unites States?
_______Yes

_______No

Are there any hours or days of the week you cannot work?_______
_______ If so, when? _______________________________________
Salary Desired_________________Type of Employment:__________
Full-time_____
Part-time_____
Are you employed now?________
May we contact your present employer?_________
Did you ever apply to this Company before?______ Where?_______
Under what name?_________________ When?_________________
Names of friends or relatives who preently work for this company:
__________________________________________________________
__________________________________________________________
_______________________________________________________.
Emergency Contact Information
Name:_________________________Home Phone:_______________
Address:______________________ Work Phone:________________
City:_______________ State:_______________ Zip:______________
How is this person related to you?____________________________

----------------------------------------------------------------------------------------------Employment Position
Position:_________________ Date Started:_____________________
Starting Salary:_______________________
Job responsilbilities:_________________________________________
Training Requirements
Type of training
______________
______________
______________

Location/Amount of time needed Dates

_____________________________ _________
_____________________________ _________
_____________________________ _________

General
List any foreign languages you speak and check your level of fluency:
__________ ______Minimal ______Fluent ______Read______Write
__________ ______Minimal ______Fluent ______Read______Write
__________ ______Minimal ______Fluent ______Read______Write
__________ ______Minimal ______Fluent ______Read______Write
__________ ______Minimal ______Fluent ______Read______Write
(IF YOU SPEAK OR HAVE ANY MORE FLUENCY IN FOREIGN LANGUAGES, FOR EXTRA SPACE OF MORE.. TYPE ON
SEPERATE SHEET OF PAPER AND ATTACH TO APPLICATION). LABEL IT AS "GENERAL".

Security
Have you ever been bonded? _______Yes
______No
If so,
explain:____________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________

__________________________________________________________
_.
IF IN NEED OF EXTRA SPACE, PLEASE FEEL FREE TO ATTACH TO SEPARTE SHEETS OF PAPER. YOU ARE MORE
THAN WELCOME TO PROVIDE LEGAL DOCUMENTATION OF PROOF OF CLEARANCE OR EXPLANATION OF
HAPPENINGS.

Have you been convicted of a felony within the past 5 years?

_______Yes
_______No
If yes,
explain:____________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
_.
IF IN NEED OF EXTRA SPACE, PLEASE FEEL FREE TO ATTACH TO SEPARTE SHEETS OF PAPER. YOU ARE MORE
THAN WELCOME TO PROVIDE LEGAL DOCUMENTATION OF PROOF OF CLEARANCE OR EXPLANATION OF
HAPPENINGS.

Military
Have you served in the military? _______Yes
_______No
Served from _____/______/______ to _____/______/______
Rank:____________
Do you have any military commitment, including National Guard service
that would influence your work schedule?
_______Yes
_______No
If yes,
explain:____________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________

__________________________________________________________
_.
IF IN NEED OF EXTRA SPACE, PLEASE FEEL FREE TO ATTACH TO SEPARTE SHEETS OF PAPER. YOU ARE MORE
THAN WELCOME TO PROVIDE LEGAL DOCUMENTATION OF PROOF OF CLEARANCE OR EXPLANATION OF
HAPPENINGS.

Are you a Vietnam veteran? _______Yes

_______No
Are you a disabled verteran? _______Yes
_______No
Are you a special disabled veteran? _______Yes
_______No
Reasonable Accommodations: In the event you believe you will need
reasonable accomodations to assist you in performing your job, please
contact your supervisor or human resources coordinator.
Education
*Elementary School*:
Name and Address_______________________________________________
No. of Years Attended____________________
Did you Graduate?_______________________
Subject/Major___________________________
*High School*:
Name and Address_______________________________________________
No. of Years Attended____________________
Did you Graduate?_______________________
Subject/Major___________________________
*College*:
Name and Address_______________________________________________
No. of Years Attended____________________
Did you Graduate?_______________________
Subject/Major___________________________
*College*:
Name and Address_______________________________________________
No. of Years Attended____________________
Did you Graduate?_______________________
Subject/Major___________________________

*Specialized Training, manage experience, equipment operation or

qualifications*:
Name and Address_______________________________________________
No. of Years Attended____________________
Did you Graduate?_______________________
Subject/Major___________________________
*Specialized Training, manage experience, equipment operation or
qualifications*:
Name and Address_______________________________________________
No. of Years Attended____________________
Did you Graduate?_______________________
Subject/Major___________________________

References: Three Individuals Not Related To You, Whom You Have Known For
At Least One Year:
NAME

ADDRESS AND TELEPHONE

YEARS AQUAINTED RELATIONSHIP

(1)________________________________________________________________
NAME

ADDRESS AND TELEPHONE

YEARS AQUAINTED RELATIONSHIP

(2)________________________________________________________________
NAME

ADDRESS AND TELEPHONE

YEARS AQUAINTED RELATIONSHIP

(3)________________________________________________________________

CURRENT AND FORMER EMPLOYERS: (MOST RECENT ONE FIRST)

To:Date
Month/Date:___/___/____
From:Date
Month/Date:___/___/____
Name, Address and Telephone No. of Employer
_______________(Name) _________________(# of Employer)
________________________________(Address)

Salary Starting/Ending:___________________/__________________
Last Position held/Responsibilities:____________________________
Reason for
Leaving:____________________________________________________
________________________________________________________.

To:Date
Month/Date:___/___/____
From:Date
Month/Date:___/___/____
Name, Address and Telephone No. of Employer
_______________(Name) _________________(# of Employer)
________________________________(Address)
Salary Starting/Ending:___________________/__________________
Last Position held/Responsibilities:____________________________
Reason for
Leaving:____________________________________________________
________________________________________________________.

To:Date
Month/Date:___/___/____
From:Date
Month/Date:___/___/____
Name, Address and Telephone No. of Employer

_______________(Name) _________________(# of Employer)

________________________________(Address)
Salary Starting/Ending:___________________/__________________
Last Position held/Responsibilities:____________________________
Reason for
Leaving:____________________________________________________
________________________________________________________.
PLEASE READ THE FOLLOWING STATEMENT CAREFULLY BEFORE
SIGNING TO INDICATE YOUR UNDERSTANDING:
I understand that, prior to being offered employment, I may be
requesten to take an employment examination. In the event that I have
a disability that will affect my ability to take the test, I will so inform
The Shadonn J. Jenkins Music Conservatory prior to the administration
of the test so that a reasonable accomodation can be made. The
Shadonn J. Jenkins Music Conservatory, reserves the right to require
medical documentation regarding the need for accomodation.
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 may result in
termination.
I understand and agree that, if hired, my employment is no
definite period and may, regardless of the date of payment wages and
salary, be terminated with or without cause, at any time, with or
without notice.
I authorize invesigation of all statements contained in this
application for any employment-related purpose. I release the listed
references and all employers, except those specifically excepted, *

provide you with any and all applicable information they may have. I
hereby release these references and former employers from all liability
for any information they may give you.
AUTHORIZATION
I certify that the facts contained in this form are true and complete to
the best of my knowledge and understand that if employed, falsified
statements on this form will be grounds for dismissal.

X____________________ EMPLOYEE SIGNATURE

X____________________ (PLEASE PRINT NAME)
DATE___/___/____
*Employers spcifically excepted:______________________________
----------------------------------------------------------------------------------------------For Employer Use Only
Interviewed By:_______________________Date:________________
Hired: ______ YES ______ NO

___/___/____ PENDING......

Starting Date:___/___/____ Position:________________

Wage:__________________
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