EMPLOYMENT

APPLICATION

LANSING HOUSING COMMISSION Date: ________________________

P E R S O N A L	Last Name First Name Middle		Home Telephone ( )
	Street Address		Social Security Number
	City, State, Zip		Are you authorized to work in the United States? Yes No All personnel hired will be required to furnish proof of identity and eligibility to work.
	How were you referred to Lansing Housing Commission?	Have you ever been employed by Lansing Housing Commission? Yes No If yes, Where ______________________________________

E D U C A T I O N

Name and Location of School

Course of Study

Years Completed

Grade Completed

E M P L O Y M E N T	Complete Employment History: (If not applicable, list U.S. Military, work performed on a voluntary basis, or personal references.) Company_____________________________________Location_______________________________________________Phone(____)___________________ Job__________________________________________Supervisor_____________________________________________Date Worked From________to____ Salary_________________________________ Reason for leaving ______________________________________________
	Complete Employment History: (If not applicable, list U.S. Military, work performed on a voluntary basis, or personal references.) Company_____________________________________Location_______________________________________________Phone(____)___________________ Job__________________________________________Supervisor_____________________________________________Date Worked From________to____ Salary_________________________________ Reason for leaving ______________________________________________
	Complete Employment History: (If not applicable, list U.S. Military, work performed on a voluntary basis, or personal references.) Company_____________________________________Location_______________________________________________Phone(____)___________________ Job__________________________________________Supervisor_____________________________________________Date Worked From________to____ Salary_________________________________ Reason for leaving ______________________________________________

R E F E R E N C E S	Name		Name		Name
	Address		Address		Address
	Address(2)		Address(2)		Address(2)
	Business	Yrs. Known	Business	Yrs. Known	Business	Yrs. Known
	Phone (________)______________________________		Phone (________)______________________________		Phone (________)______________________________

I certify, to the best of my knowledge, that the information submitted is complete and correct. I understand that if employed, the Lansing Housing Commission may terminate my employment if I have made any false statements or misrepresentations in this application during the interview process.

I understand this application is not an offer of employment.

I understand that employment with the Lansing Housing Commission is contingent upon investigation of my previous employment and references without notification to me by any employer so contacted. I authorize such an investigation and release my current and prior employers, references, and the Lansing Housing Commission from all liability in connection with such an investigation. I understand and agree that if, in the opinion of the Lansing Housing Commission, the result of the investigation is unsatisfactory, that an offer of employment has been made may be withdrawn or my employment with the Lansing Housing Commission may be terminated. I also understand that if I receive an offer of employment, the offer may be contingent upon the successful completion of a physical examination by a physician of the Lansing Housing Commission’s choice.

During the past 10 years, have you been convicted of a felony involving any of the following crimes?

Fraud Receiving Stolen Goods

Theft Drug Related

Have you ever been discharged or requested to resign?

Yes No

If employed, I agree to observe all Lansing Housing Commission policies and procedures. I understand that these policies and procedures may be changed at any time at the Lansing Housing Commission’s sole option.

I have read, understand and agree to the above statements,

Date____________________________Signature________________________________________________Lansing Housing Commission complies with all applicable federal, state and local laws, which prohibit unlawful employment discrimination.