Application for Employment


It is the policy of equal treatment and opportunity in all aspects of employment without regard to race, color, religion, sex, marital status, age, national origin, LGBQT status. ancestry, status as a qualified individual with a disability, veteran status or other legally protected category, unless one of the above factors is a bona fide qualification for the job. This policy applies to all employment practices, including recruiting, hiring, training, compensation, benefits, advancement, pregnancy, and all other conditions of employment.



Present Address:


Phone Number:


Please note that a conviction will not necessarily exclude you from employment.


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Who should be contact in the event of an emergency?



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Number of Years Name, Address & Phone Supervisor Name and Phone Number Position Salary Reason for Leaving


The following information is for the purpose of considering your requests, and it does not constitute a promise or guarantee of employment:












Education
  Name and City Number of Years Completed Did You Graduate? Degrees Received
High School
College
Post-College
Other Education (Trade School)








Name Company Name Business Phone Number (No Cell Phone Numbers) Business E-Mail How do you know this person? Years Acquainted

DO NOT SIGN AS REQUESTED BELOW UNTIL YOU HAVE READ THIS ENTIRE DOCUMENT, UNDERSTAND ITS TERMS AND CONDITIONS, AND AGREE TO THE TERMS AND CONDITIONS SET FORTH HEREIN. YOUR SIGNATURE BELOW INDICATES YOUR AGREEMENT TO THE TERMS AND CONDITIONS SET FORTH IN THIS APPLICATION. THE CONSIDERATION FOR YOUR ACCEPTANCE OF THE TERMS AND CONDITIONS SET FORTH HEREIN IS THE COMPANY’S WILLINGNESS TO REVIEW YOUR APPLICATION AND EMPLOYMENT IF YOU ARE SELECTED FOR EMPLOYMENT.

By signing below, I certify that all answers to questions in the application, and other reference documents referenced above are true and complete to the best of my knowledge. I understand that misrepresentation, omission, or falsified statements on this Application or any other reference documents in any detail shall constitute sufficient cause for disqualification from further consideration for hire or for dismissal whenever discovered.

ADDITIONAL DISCLOSURES AND AGREEMENTS

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard. I further understand that to be eligible for employment, I must complete the entire application process which may include a medical examination.

I expressly authorize, without reservation, the Montmorency County Commission on Aging, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the Montmorency County Commission on Aging, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

In order to process your application, or during the course of your employment, a consumer report may be obtained on you for employment purposes. It may be an investigative consumer report that includes information regarding your character, general reputation, personal characteristics, and mode of living. Such report may also be necessary in relation to any investigation regarding allegations of sexual harassment, discrimination, or disciplinary charges associated with your employment. The employer may utilize an outside organization to obtain a consumer report and/or to conduct investigations. If an investigative consumer report is obtained, you have a right to request disclosure of the nature and scope of the report, which involves personal interviews with sources such as your neighbors, friends, or associates. I hereby authorize the employer to obtain a consumer report on me for employment purposes and to conduct investigations as outlined above.

I understand that the Montmorency County Commission on Aging does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from the Montmorency County Commission on Aging and still wish to be considered for employment, it will be necessary for me to reapply and complete a new application.

In consideration of my employment, I agree to conform to the Montmorency County Commission on Aging’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the Montmorency County Commission on Aging’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no agency representative, other than its Executive Director, and then only when in writing and signed by the Executive Director, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

I further agree that, if employed, I will conform my conduct to Montmorency County Commission on Aging’s rules and regulations, and that I may not enter into any other employment or engage in any business which will conflict with my responsibilities as an employee of Montmorency County Commission on Aging.

By signing below, I certify that all answers to questions in the application, and other reference documents referenced above are true and complete to the best of my knowledge. I understand that misrepresentation, omission, or falsified statements on this application or any other reference documents in any detail shall constitute sufficient cause for disqualification from further consideration for hire or for dismissal whenever discovered.

CRIMINAL BACKGROUND CHECK POLICY AND DISCLOSURE

As a condition of employment, each employee is subject to a criminal background check. In conducting criminal background checks, Montmorency County Commission on Aging will comply with federal laws that protect applicants and employees from discrimination. That includes discrimination based on race, color, national origin, sex, LGBQT status, religion; disability; genetic information (including family medical history); and age (40 or older).

In addition, Montmorency County Commission on Aging, to the extent required, will comply with the Fair Credit Reporting Act (FCRA) with regard to conducting criminal background checks. The Federal Trade Commission (FTC) enforces the FCRA.

Although a disqualification is possible, in accordance with federal and state laws, a previous conviction does not automatically disqualify an applicant from consideration for employment with Montmorency County Commission on Aging, unless such employment involves working with children and the conviction or criminal conduct relates to children or is clean record is required given the job duties, funding source, or employment source.

In conducting criminal background checks and convictions, Montmorency County Commission on Aging complies with the EEOC guidelines regarding the use of criminal background checks and specifically follows the “Green Factors” set forth in Green v. Missouri Pacific Railroad. The “Green Factors” requires Montmorency County Commission on Aging to evaluate the criminal background check report under the following test which assesses whether an exclusion is job related for the position in question and consistent with business necessity:

  • The nature and gravity of the offense or conduct;
  • The time that has passed since the offense or conduct and/or completion of the sentence; and
  • The nature of the job held or sought.

To the extent that the criminal background check reveals conduct that would exclude the person from the specific job applied for after applying the “Green Factors,” and to the extent that the basis for denying the job was related to the criminal background check, Montmorency County Commission on Aging will send out an appropriate letter to the prospective employee explaining the basis for denial of the job. The prospective employee shall have ten days after the date of the correspondence explaining the basis for denial of the job to contact the Montmorency County Commission on Aging and schedule a meeting explaining how the criminal background conduct should not exclude him/her. Failure by the prospective employee to contact Montmorency County Commission on Aging within the ten (10) day period as provided above, shall constitute of waiver of such right to engage the Montmorency County Commission on Aging regarding the decision to deny employment.

If you have any questions regarding your rights, please feel free to contact the Executive Director at MCCOA or the EEOC at www.eeoc.gov.

By signing this Application, I certify that all answers to questions in the application, and other reference documents are true and complete to the best of my knowledge. I understand that misrepresentation, omission, or falsified statements on this application or any other reference documents in any detail shall constitute sufficient cause for disqualification from further consideration for hire or for dismissal whenever discovered.