APPLY

  • Personal Information

  • Residence History

  • Mo/Yr. to Mo/Yr.AddressCityStateZip CodeOwned by you? (Y/N) 
  • Educational Background

  • High Schools (Diploma or Equivalency)School NameAddressCityStateZip CodeDegree Name 
  • High Schools (Diploma or Equivalency)School NameAddressCityStateZip CodeDegree Name 
  • High Schools (Diploma or Equivalency)School NameAddressCityStateZip CodeDegree Name 
  • Employment Background

    List in reverse chronological order all part-time and full-time places of employment as well as periods of unemployment (beginning with your most recent employer) since receiving your undergraduate degree. Please provide a copy of your resume, including references.
  • Mo/Yr. to Mo/Yr.EmployerAddressCityStateZip CodeJob TitleTelephone Number 
  • Mo/Yr. to Mo/Yr.EmployerAddressCityStateZip CodeJob TitleTelephone Number 
  • Military Service

  • Mo/Yr. to Mo/Yr.Branch of ServiceActive or ReserveArmed Services Identification Number 
  • Professional Licensure/Certification/Registrations

  • Filing DateName of Professional Certification/LicenseJurisdictionDisposition 
  • Business Involvement

  • Business NameAddressForm of BusinessJurisdiction where Articles or Other Form Business Creation Documents are Filed 
  • Mo/Yr. to Mo/Yr.Business NamePosition HeldStreet AddressCityStateZip Code 
  • Financial Data

  • Employer NameFull AddressMo/Yr. Applied or Dates EmployedNature of Work 
  • Civil Litigation

  • Criminal History

    With regard to the disclosure of criminal matters referenced in this section of the questionnaire, for each affirmative answer you must further disclose the date of arrest, underlying factual circumstances, name and address of arresting agency, nature of charges, name and address court and sentencing information, including the terms of probation and the probation offer’s identity, if applicable.
  • Potential Conflicts of Interest

  • Community, Civic or Professional Activity

  • Additional Information

  • Digital/Social Media

  • RÉSUMÉ

  • NOTICE AND AUTHORIZATION OF BACKGROUND INVESTIGATION

    This notice is being provided to advise you that Michigan Transition may obtain information about you from a consumer reporting agency in order to make decisions regarding your employment. Thus, you may be the subject of one or more “consumer reports” that may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may be obtained at any time after receipt of your authorization and, if you are hired, throughout your employment.
  • I acknowledge receipt of this Notice Regarding Background Investigation and a Summary of Your Rights Under the Fair Credit Reporting Act and certify that I have read and understand both documents I hearby authorize Employer to obtain one or more “consumer reports” at any time after receipt of this authorization and, if I am hired, throughout my employment. I agree that a facsimile, electronic, or photographic copy of this Acknowledgement and Authorization shall be as valid as the original.
  • I hereby solemnly swear that the foregoing answers provided are true and accurate to the best of my knowledge and belief.

  • Equal Opportunity Employer