Employment Application for Foster Care/Adoption Positions Only Employment TransportationI have a valid drivers license for the state of Michigan.I have a valid drivers license from another state.I do not have a drivers license from the state of Michigan or another state. Fostercare/Adoption Employment Video Please watch the employment video before continuing. Once the video is complete, use the "Apply Now" link to continue. You may be asked questions about this video, so it is important that you watch it in it's entirety. Thank you. Confirm Video was watched* I agree that I have watched this video in it's entirety. Real Expectations - Foster Care/Adoption Quiz Please answer the following questions. You will not be able to move forward in the application process until all questions have been answered correctly.What is 1 + 2345If you do not see the next button then one or more of your answers are incorrect. Please use the back to video button below to go back and rewatch the video. Dear Applicant Thank you for considering Wolverine Human Services for employment. Due to the large number of applications received it is not always possible for a personal interview to be given when an application is submitted. Once received, your application will be reviewed by management and the best qualified applicants will be contacted for interviews when/if openings occur. Your application will remain on file for one calendar year. You may update the information on it by submitting all changes in writing. If you have not been contacted in 12 months, you may submit a new application. All Applicants Must Carefully Read and Sign I acknowledge that the information I have provided in this application is to the best of my knowledge true. I understand if I am hired, the decision will be based in part on this information and if at anytime, the information provided is found to be not completely accurate, I may be immediately discharged for that reason alone. I authorize Wolverine Human Services to investigate my past employment and information contained herein and release from liability all persons, companies or corporations supplying such information. I understand that such information may also include a record of disciplinary action assessed by previous employers, and hereby release such parties from any obligation to notify me of these investigations of my background. I understand that I will be expected to abide by the policies and procedures outlined by the company, I agree that no action on, including claims of discrimination, will be brought more than 180 days after it arises, and that any longer statues of limitations are waived. I acknowledge no one has made a promise of employment to me, and further, if Wolverine Human Services makes an offer of employment, it will be for an indefinite period and is terminable at will and without cause by either the employer or myself. I further understand that my employment is contingent upon my ability to prove my identity and that I am lawfully entitled to work in the United States of America, and that I maintain that status throughout my period of employment. Applicant's signature required at interview. I am an applicant applying for a position with Wolverine Human Services. I hereby give Wolverine Human Services permission to make inquiry of references and former employers regarding my general character and past performance. This permission form may be attached to request information, and I hereby authorize the party receiving this form to give full and complete information as may be requested by Wolverine Human Services. I further understand and agree that the information requested will become a part of my personnel file, and I agree that the information will be treated as confidential by Wolverine Human Services. I hereby waive written notice from my current employer and/or previous employers as provided by Section 6 of Act No. 397 of Michigan Public Acts of 1978 and authorize them to release information regarding any disciplinary actions taken against me within the past four years. Applicant's signature required at interview. We are an Equal Opportunity Employer. It is the policy of this organization not to discriminate on the basis of race, sex, religion, national origin, marital status, age, weight, height, color or handicap, in the hiring, promotion, payment or discipline of employees. We will not discriminate against a person with a covered disability under the Americans with Disabilities Act in regard to employment practices, or terms, conditions, and privileges of employment. EOE DateName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Home PhoneCell PhoneEmail Address* We are licensed to provide residential care 24 hours a day, 7 days a week, 52 weeks a year. Working overtime hours, days, afternoons, evenings and/or weekends is expected for continued employment. Are you able to meet these requirements?YesNoPosition applying for*Work location (1st Choice)*DetroitFlintSaginawTaylorVassarAdditional Work Location (2nd Choice):Do you currently have a valid Michigan drivers license?*YesNoDriver's license numberDo you have a valid license in any other State?YesNoIf yes, what State?Have you ever served in the U.S. Armed Forces?YesNoIf yes, what branch?Date of entryDate of dischargeAre you at least 20 years of age?*YesNoHave you ever been bonded?YesNoIf yes, what job(s):Are you related to anyone who works at any Wolverine Human Services Program?YesNoIf yes, please explain to whom you are related and how:Have you ever been employed at WHS?*YesNoHave you ever been administratively determined by a federal, state or local governmental agency to have committed abuse or neglect?*YesNoIf yes, please explain when, where and nature of the case:Have you been convicted for violating any law (unless specified; all convictions are included except minor traffic violations)?*NoYes - FelonyYes - MisdemeanorIf yes, date of offense?Type of offense:City/StateWhat was the final outcome?Are you now, or have you ever been, under discipline for sexual misconduct or sexual harassment with with a youth at a previous placement or institution?*YesNoHave you been administratively adjudicated to have engaged in sexual abuse or sexual harassment?*YesNoIf yes, please explain: EducationHave you completed high school or received your GED?*YesNoSchool NameSchool Mailing AddressHave you completed college?YesNoSchool NameMailing AddressMajor and DegreeHave you completed post graduate education?YesNoSchool NameMailing AddressMajor and DegreeHave you completed any other forms of education?YesNoSchool NameMailing AddressMajor and DegreeList other Licenses, Certificates, Training, Qualifications and skills such as CPR, TCI, CAC, typing, languages etc.:State briefly why you would be an asset to this organization: Previous Employment (List last employer first) 1. Name of EmployerName of SupervisorDates of Employment (Start date - End date)EarningsPerHourWeekEvery 2 WeeksMonthYearComplete AddressPhoneJob TitleList the duties you performed2. Name of EmployerName of SupervisorDates of Employment (Start date - End date)EarningsPerHourWeekEvery 2 WeeksMonthYearComplete AddressPhoneJob TitleList the duties you performed3. Name of EmployerName of SupervisorDates of Employment (Start date - End date)EarningsPerHourWeekEvery 2 WeeksMonthYearComplete AddressPhoneJob TitleList the duties you performed Please list 3 references other than relatives and previous employers: 1. Name of reference*Occupation*Full address*Phone*2. Name of reference*Occupation*Full address*Phone*2. Name of reference*Occupation*Full address*Phone* Read carefully before submitting for signature 1. I have read and understand the statements contained herein and certify that they are true and complete without qualification.*Yes2. Wolverine has the right to terminate my employment at any time if it discovers that I have provided incomplete/untrue or misleading answers in this application or any other document or form.*Yes3. I hereby authorize previous employers/educational institutions, law enforcement agencies or other personal references contacted by WHS in connection with this application to fully respond to all inquires concerning previous employment, claimed degrees or achievements and specifically waive prior written notice of disclosure of my personnel record including disciplinary reports, letters, reprimands or other disciplinary action. In consideration of the acceptance of my application, I release WHS, previous employers/educational institutions and law enforcement agencies of any claimed liability arising out of such lawful response and disclosure.*Yes4. I understand that any offer of employment is contingent upon the complete results of WHS conditional job offer.*YesIn the event that I am employed, I agree to comply with all WHS orders/rules and regulations and acknowledge that said orders/rules/regulations do not constitute terms of employment contrary to #6.*Yes6. I hereby acknowledge this application for employment is for an indefinite duration and understand that either party can terminate my employment with or without cause and with or without notice, at any time.*Yes7. I understand that no one other than the President/CEO of WHS has authority to make any agreement (oral, written or implied) or other representations contrary to #6.*YesNameThis field is for validation purposes and should be left unchanged.