Community Services Assistant

First name*

Last name*

Email address*

Location

Phone number*

Resume*

Please provide your drivers license number below*

Type of employment desired*

Have you ever worked for Van Buren County in the past? If yes, please provide details such as: department, name of last supervisor, dates of employment, and reason for leaving:*

Do you have any relatives working for the County? If yes, provide names of all relatives and their relationship to you.*

Do you have any employment records under a name other than listed above? If yes, please list additional names*

Have you ever been suspended or discharged from a former employer? If yes, please explain.*

Are you currently employed?*

What is your current or most recent salary?*

Why are you interested in this position?*

Please list applicable skills, including: supervision skills, specialized equipment or software, or information regarding the career/occupation you wish to bring to the County's attention.*

Previous employer:*

Job Title:*

Start Date:*

End Date:*

Status:*

City, State and Zip Code of past employer:*

Job duties:*

Reason for leaving:*

Salary:*

Supervisor name:*

Supervisor Contact Information:*

May we contact for a reference?*

Previous employer:*

Job Title:*

Start Date:*

End Date:*

Status:*

City, State and Zip Code of past employer:*

Job duties:*

Reason for leaving:*

Salary:*

Supervisor name:*

Supervisor Contact Information:*

May we contact for a reference?*

Previous employer:*

Job Title:*

Start Date:*

End Date:*

Status:*

City, State and Zip Code of past employer:*

Job duties:*

Reason for leaving:*

Salary:*

Supervisor name:*

Supervisor Contact Information:*

May we contact for a reference?*

Please upload any other supporting documents.

The County of Van Buren is committed to ensuring honorably discharged members of the armed forces of the United States are provided preference in public employment consistent with Michigan Public Act 205 of 1897, as amended. If you meet the definition of a “veteran” provided by MCL 35.61.

I am an individual who served in the United States Armed Forces, including the reserve components and was discharged or released under conditions other than dishonorable.*

Are you a guard or reserve member?*

I certify that my answers are accurate and complete to the best of my knowledge.
I authorize the investigation of all statements, including references, in this application for employment as necessary for arriving at an employment decision. I also specifically waive any written notice requirements of Section 67 of 1978 PA 397 pertaining to disciplinary reports, letters of reprimand, or other disciplinary actions. I also waive any claim against VAN BUREN COUNTY GOVERNMENT and all current or former employers arising from such investigation or disclosure, including, but not limited to, slander and libel that may result from furnishing any information to VAN BUREN COUNTY GOVERNMENT.
This employment application shall be considered active for a period not to exceed 90 days. Any applicant wishing to be considered for employment beyond this period should inquire whether applications are being accepted at that time. I hereby understand and acknowledge that in the absence of an express written contract or agreement to the contrary; any employment relationship with VAN BUREN COUNTY GOVERNMENT of an “at-will” nature, which means that the employee may resign at any time and the Employer may discharge the employee at any time with or without cause.
In the event of employment, I understand that false or misleading information given in my application or interview(s) would be grounds for discharge. I understand, also, that I am required to abide by all rules and regulations of VAN BUREN COUNTY GOVERNMENT.
I further understand that if I am offered employment, a physical, which may include drug testing (at VAN BUREN COUNTY GOVERNMENT’s expense) may be required, proof of educational and licensing attainment must be submitted. If any driving is done for VAN BUREN COUNTY GOVERNMENT purposes, I must be both eligible to drive and be qualified for insurance coverage. Employment by VAN BUREN COUNTY GOVERNMENT is conditioned upon such results being satisfactory to VAN BUREN COUNTY GOVERNMENT.*

I agree that any action or suit against VAN BUREN COUNTY GOVERNMENT or its board elected or appointed officials, officers, and/or employees arising out of my application for employment, employment, or termination of employment, including but not limited to claims arising under 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.*

Human Check*