Application Form
We are an Equal Opportunity Employer and committed to excellence through diversity.
Personal Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
Street Address
line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What is the best time to contact you?
Please Select
Morning
Lunch Time
Evening
Afternoon
Doesn't Matter
Are you currently legally entitled to work in the country where the job is based?
Yes
No
If applicable, please detail any restrictions:
If not Applicable please input N/A
How did you hear about our company and this job opening?
Company Website
Job Posting
News Paper
Career/Job Fair
Relative/Friend
Michigan House Employee (input name in "other")
Radio Ad
Other
If hired, would you have a reliable means of transportation to and from work?
Yes
No
Have you worked for this Company before?
Yes
No
Please provide your location, manager, the time period you have worked for Company and reason of leave
If not Applicable please input N/A
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
Yes
No
If no, describe the function that cannot be performed.
If not Applicable please input N/A
If selected for employment are you willing to submit a background check?
Yes
No
Position Information
What position are you applying for?
Please Select
Direct Care Staff
Mental Health Clinician
What is your desired employment?
Please Select
Full Time
Part Time
Internship
What is your available start date?
-
Month
-
Day
Year
Date
Education
Work Experience
Please Provide a Reference for Each Job Placement
Qualifications
Microsoft Office
1
2
3
4
5
Communication Skills
1
2
3
4
5
References
Please upload your Resume here
*
Browse Files
Cancel
of
Please upload your Cover Letter here
Browse Files
Cancel
of
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
YES
I hereby authorize MICHIGAN HOUSE to thoroughly investigate my references, work record, education and other matters related to my suitability for employment unless otherwise specified above. I further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships, and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
YES
I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company’s designated representative.
YES
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.
YES
Date
-
Month
-
Day
Year
Date
Signature
Submit
Submit
Should be Empty: