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Application for Employment

To print and send in a completed application, please fill out the form below and click the Preview button to view the form in a new window. If all of the fields are filled out appropriately, select Print from your browser file menu to send the form to your printer. Clicking the Submit button will send your application via email.

EMPLOYMENT APPLICATION
AN EQUAL OPPORTUNITY EMPLOYER

Mail the completed form to:
ROAD COMMISSION FOR OAKLAND COUNTY
Human Resources Department
31001 LAHSER
BEVERLY HILLS, MI 48025

Or fax to (248) 645-5792.

POSITION DESIRED

First Choice:

Years Experience:

Second Choice:

Years Experience:

PERSONAL INFORMATION

First Name:

Middle Initial:

Last Name:

Other name(s), if any, under which you have worked or attended school:

Social Security Number:

- -

Street Address:

City:

State:

Zip Code:

Phone Number:

Alternate Phone Number:

Driver License Number:

Issuing State:

List commercial drivers license endorsement(s):

Are you legally eligible to work in the US?

Yes No

Are you over the age of 18?

Yes No

Have you ever been convicted of a misdemeanor or felony? (do not include minor traffic violations)

Yes No

If yes, complete the following:

Date:

Place:

Offense:

Disposition:

EMPLOYMENT DESIRED

Permanent Summer

Date Available:

Will you accept employment anywhere in the county?

Yes No

US MILITARY SERVICE

Branch of Service	From	To	Rank or Rating	Principle Assignment

EDUCATION

Institution Name	Location	Years	Major	Degree/Diploma

ADDITIONAL INFORMATION

Other Training:

List professional certificates:

Professional societies of which you are a member:

Registration Number:

Are you a former Road Commission employee?

Yes No

Department last worked in:

Date Left:

Do you have any relatives working for the Road Commission?

Yes No

Relative's Name:

WORK EXPERIENCE
(Please list all previous employment and begin by using your last or present employment first)

Company Name:

Company Address:

Employment Dates:

From: To:

Wages or Salary:

Reason for leaving:

State duties clearly and briefly:

Company Name:

Company Address:

Employment Dates:

From: To:

Wages or Salary:

Reason for leaving:

State duties clearly and briefly:

Company Name:

Company Address:

Employment Dates:

From: To:

Wages or Salary:

Reason for leaving:

State duties clearly and briefly:

Company Name:

Company Address:

Employment Dates:

From: To:

Wages or Salary:

Reason for leaving:

State duties clearly and briefly:

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