Crawford County Commission on Aging

Serving seniors age 60 and older throughout Crawford County

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Now Serving You at Two Locations in Crawford County:
Old Senior Center: 308 Lawndale Street, Grayling
Old Senior Center: 4388 M72 East, Grayling
989.348.7123

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Employment Application

"*" indicates required fields

APPLICATION FOR EMPLOYMENT


CRAWFORD COUNTY COMMISSION ON AGING IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE ON THE BASIS OF AGE, SEX, RACE, RELIGION, COLOR, NATIONAL ORIGIN, DISABILITY, MARITAL STATUS, GENETIC INFORMATION, HEIGHT, WEIGHT OR OTHER LEGALLY PROTECTED STATUS.
AUXILIARY AIDS, SERVICES, AND ALTERNATIVE FORMAT WILL BE MADE AVAILABLE UPON REQUEST TO INDIVIDUALS WITH DISABILITIES. MICHIGAN RELAY CENTER 1-800-649-3777 (VOICE AND TTY/TDD).

Employment Desired

MM slash DD slash YYYY
Employment Type*
How were you referred to the CCCOA?*

MM slash DD slash YYYY

Personal Information

Name*
Address*
Are any of your relatives employed at CCCOA?*
Ever applied to this company before?*
Ever worked for this company before?*
Are you 18 years old or older?*
If not, do you have proof of eligibility to work?*
Are you Legally Authorized to work in the U.S.?*

EMPLOYMENT

Please provide all full and part-time employment history including Military Service. Start with most recent employer.
Supervisor's Name*
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact this employer for reference?*

Supervisor's Name
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact this employer for reference?

Supervisor's Name
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact this employer for reference?

Supervisor's Name
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact this employer for reference?

Personal References (excluding former employers or relatives)

Reference #1 Name*
Reference #2 Name*
Reference #3 Name*

EDUCATIONAL BACKGROUND

HIGH SCHOOL
Address
Did you graduate?
COLLEGE
Address
Did you graduate?
OTHER
Address
Did you graduate?
OTHER
Address
Did you graduate?
Do you have any Special/Technical Trainings/Accreditations or Endorsements?*
Do you hold any professional licenses or certifications?*
Have you ever had a professional license or certification revoked or suspended?*
Are you currently under investigation by any agency or department concerning any licensure or certification matter?*
Do you presently have a valid driver’s license?*
Have you had any moving violations in the past five years?*
Please provide the following information:
MM slash DD slash YYYY
Have you been convicted of abuse or neglect of children/adults?*
Please provide the following information:
MM slash DD slash YYYY
Have you ever been convicted of a crime, excluding routine traffic offenses?*
Please provide the following information:
MM slash DD slash YYYY
Are there any criminal charges pending against you currently?*
Please provide the following information:
MM slash DD slash YYYY
Do you smoke?*
Accepted file types: pdf, Max. file size: 8 MB.
Resume must be in PDF format only.

AUTHORIZATION AND UNDERSTANDING

I represent that the answers and information given by me in this application are true and complete. I understand that any incomplete, misleading or false statements in this application or in an interview can result in immediate disqualification or termination, if hired.

I authorize CRAWFORD COUNTY COMMISSION ON AGING to verify the information I have provided and to make any investigation of my background deemed necessary both at the time of application and later, during my employment, if I am hired. I understand that the types of investigations that CRAWFORD COUNTY COMMISSION ON AGING may perform include: reference checks including personal, employment and educational reference checks and so forth. I understand that I may have to provide further information to assist in these investigations and I may be fingerprinted. I also authorize third parties (such as former employers, financial institutions, educational institutions) contacted by CRAWFORD COUNTY COMMISSION ON AGING to furnish any information relevant to my application for employment and I further release all persons and organizations from any and all liability for any and all damages whatsoever for releasing such lawful information. I also waive all written notice from all prior employers related to providing such information.

I have no objection to signing an Employee Confidentiality Statement.

In consideration of my employment, I agree to conform to the rules and policies of CRAWFORD COUNTY COMMISSION ON AGING.

This application for employment shall be considered active for the named position at time of posting only. If I wish to be considered for other openings (postings), I understand that I must submit a new application.

Authorization*
This field is for validation purposes and should be left unchanged.

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Now Serving You at Two Locations in Crawford County

Now Serving You at Two Locations in Crawford County

Hours of Operation

  • Monday: 8:30am to 4:30pm
  • Tuesday: 8:30am to 4:30pm
  • Wednesday: 8:30am to 4:30pm
  • Thursday: 8:30am to 4:30pm
  • Friday: 8:30am to 4:30pm
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