Job Application - Neighborhood Legal Services

GENERAL INFORMATION

What kind of job are you applying for? Give title and announcement number (if any)

If the announcement lists several job titles, which jobs are you applying for?

Are you 18 years of age?

First Name

Middle Name

Last Name

Street Address or RFD number (include apartment number, if any)

City

State/Province

ZIP / Postal Code

Other names used:

Sex: (for statistical use)MaleFemale

Home Phone Number:

Work Number:

EMAIL

AVAILABILITY

When can you start to work? (Month and Year)

What is the lowest pay you will accept? (Pay $ Per)

Are you willing to work:

40 hours per week (full time)?YesNo

25-30 hours per week (part-time)?YesNo

17-24 hours per week (part time)?YesNo

16 or fewer hours per week (part-time)?YesNo

In an intermittent job (on-call/seasonal)?YesNo

Weekends, shifts, or rotating shifts?YesNo

Are you willing to take a temporary job lasting:

5 to 12 months (sometimes longer)?YesNo

1 to 4 months?YesNo

Less than 1 monthYesNo

BACKGROUND INFORMATION

Are you a citizen of the United States?YesNo

If "NO" write the country or countries you are a citizen of:

During the last 10 years, were you fired from any job for any reasons? Did you quit after being told you would be fired, or did you leave by mutual agreement because of a specific problem? If "YES" fill in below:YesNo

NAME OF EMPLOYER:

Date

REASONS FOR LEAVING:

Are any of your relatives employed for Neighborhood Legal Services Michigan /served as Board Members for NLSM in the past? If "YES" fill in below:YesNo

Name

RELATIONSHIP:

DEPARTMENT:

REFERENCES"RESUME

No file chosen

WORK EXPERIENCE: PLEASE STATE MOST RECENT JOB FIRST, THEN WORK BACKWARD CHRONOLOGICALLY.

Field Group 1

Name and addresses of employer's organization (include Zip Code: if known)

Organization:

Address:

City

State/Province

ZIP / Postal Code

Supervisor's Name:

Exact title of your job:

Dates employed (give month and year)

From:

To:

Salary: $

Reason for Leaving:

Field Group 2

Name and addresses of employer's organization (include Zip Code: if known)

Organization:

Address:

City

State/Province

ZIP / Postal Code

Supervisor's Name:

Exact title of your job:

Dates employed (give month and year)

From:

To:

Salary: $

Reason for Leaving:

Field Group 3

Name and addresses of employer's organization (include Zip Code: if known)

Organization:

Address:

City

State/Province

ZIP / Postal Code

Supervisor's Name:

Exact title of your job:

Dates employed (give month and year)

From:

To:

Salary: $

Reason for Leaving:

Field Group 4

Name and addresses of employer's organization (include Zip Code: if known)

Organization:

Address:

City

State/Province

ZIP / Postal Code

Supervisor's Name:

Exact title of your job:

Dates employed (give month and year)

From:

To:

Salary: $

Reason for Leaving:

Field Group 5

Name and addresses of employer's organization (include Zip Code: if known)

Organization:

Address:

City

State/Province

ZIP / Postal Code

Supervisor's Name:

Exact title of your job:

Dates employed (give month and year)

From:

To:

Salary: $

Reason for Leaving:

EDUCATION

Did you graduate from high school? If you have a GED high school equivalency or will graduate within the next nine months, answer "YES".

If "YES" give month and year of graduation:

If "NO" give the highest grade you completed:

Write the name and location (city and state) of the last high school you attended:

Have you ever attended college or graduate school?YesNo

NAME AND LOCATION (city, state, and zip code) of COLLEGE, UNIVERSITY.

Name & Location

From:

To:

Type of Degree

Year of Degree

CHIEF UNDERGRADUATE SUBJECTS | NUMBER OF CREDITS COMPLETED

Have you completed any other courses or training related to the kind of jobs you are applying forexample, trade, vocation Armed Forces or business?YesNo

Field Group

MONTH AND YEAR TRAINING COMPLETED

TOTAL CLASSROOM HOURS

SUBJECТ

Field Group

NAME AND LOCATION OF SCHOOL

CERTIFICATE DIPLOMA

SPECIAL SKILLS, ACCOMPLISHMENTS AND AWARDS

Typing (w.p.m.)

Do you speak or read a language other than English (include Sign Language)?YesNo

Group

LANGUAGE(S)

FLUENTLY

DIFFICULTY

PROFESSIONAL CERTIFICATION

Are you a member of the Michigan Bar Association?YesNo

What jurisdiction?

If not, which Bar?

If not a member of any Bar, when will you be taking the Bar?SPECIAL SKILLS, ACCOMPLISHMENTS AND AWARDS CONTINUED............

List any honors, awards, or fellowships you have received. For each, give the year it was received.

STATEMENT OF LIVED EXPERIENCED

How has your personal history, background, or life experiences shaped your ability to perform the role you're applying for?

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REFERENCES

List three people who are not related to you and know your qualifications and fitness for the kind of job you are applying for:

NAMЕ:

ADDRESS:

TELEPHONE NUMBER:

OCCUPATION:

RELATIONSHIP:

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SIGNATURE, CERTIFICATION AND RELEASE OF INFORMATION YOU MUST SIGN THIS APPLICATION.

Read the following carefully before you sign. I understand that any information I give may be investigated as allowed by law; I consent to the release of information about my ability and fitness. I certify that, to the best of my knowledge and belief, all of my statements are true, correct, complete and made in good faith.

Digital Signature

Date Signed