Fran Coy’s Salon & Spa Employment Application

418 S. Wagner Rd. Ann Arbor, MI 48103 Phone (734) 665-7207 Fax (734) 665-5740

Today’s Date:

POSITION APPLED FOR

Desired Salary:

Per hour:

GENERAL INFORMATION
^Name (last, first, middle initial)                                                       Social Security No. (Optional)
^Street Address                                                                                                                                                                       City, State, Zip
^Home Phone No.                                                                                                  Work Phone No.                                      Message Phone No.
^Are you authorized to work in the United States?   Proof of Authorization will be required post hire Yes   No
TRAINING AND EDUCATION
Circle highest grade completed:           8                  9                  10             11               12             GED
^Colleges/other training	^Major/subject		^Degree/certificates
ADDITIONAL SKILLS  Describe skills relevant to the job for which you are applying
SKILL	TYPE OF EXPERIENCE				LEVEL OF EXPERTISE
Office equipment, computers, software (typing speed, programs, etc.)
Technical skills, professional licenses
Advanced Training
Other
Can you perform the essential functions of the job with or without reasonable accommodation?      Yes                No
BACKGROUND INFORMATION
each case is considered separately based on job duties and performance areas
Do you have a valid Michigan State Driver's License?                   Yes              No                 Other State _____________
(If position applied for involves driving), have you been convicted, pleaded to no contention or paid a fine for any traffic violations in the past three (3) years?                         Yes              No           If yes please explain:
Have you been convicted of a felony or served time in prison within the last ten (10) years?  Yes             No Conviction will not necessarily bar you from employment.  If yes, please explain:
How/where did you hear about the position for which you are applying?  (Check one)
______ Friend or relative		______ Fran Coy’s Employee		______ Internet
______ Newspaper ad		______ Fran Coy’s Customer		Which?__________________________
______ Other please specify  _________________________________________________

	EMPLOYMENT HISTORY
	Beginning with your present or most recent employment, list your employment history.  Include self-employment, military service, volunteer experience and periods of unemployment.  The following sections MUST be completed even if a resume is submitted.
	Employer					Employed from:				To:
	Address:					Supervisor
	Phone	Hours worked/week						Starting Hourly Rate
	Position						Last Hourly Rate
	Primary duties
	May we contact this employer				Supervisor's phone
	Reason for leaving
	Employer					Employed from:				To:
	Address:					Supervisor
	Phone	Hours worked/week						Starting Hourly Rate
	Position						Last Hourly Rate
	Primary duties
	May we contact this employer				Supervisor's phone
	Reason for leaving
	Employer					Employed from:				To:
	Address:					Supervisor
	Phone	Hours worked/week						Starting Hourly Rate
	Position						Last Hourly Rate
	Primary duties
	May we contact this employer				Supervisor's phone
	Reason for leaving
PROFESSIONAL REFERENCES				Please list below any people in addition to supervisors listed above who can responsibly evaluate your work performance
	Name		Place of employment & title						Phone

It is understood and agreed that the foregoing is true to the best of my knowledge, and that my falsification of this application will be grounds for

elimination from further consideration or, if employed Fran Coy’s Salon & Spa, for dismissal. I authorize Fran Coy’s Salon & Spa to solicit information

regarding my character, general reputation, credit, previous employment, and similar background information, and to contact any and all references

I have given on my application.  I release all parties and persons connected with any such request for information from all claims, liabilities,

and damages that may arise out of the furnishing of such information.  If employed, I release Fran Coy’s Salon & Spa from any liability for

future references it may provide regarding my work history at the firm.

I understand that employment with the Employer is “at-will”, which means that either Fran Coy’s or I can terminate the employment relationship

at any time, with or without prior notice, and for any reason not prohibited by statute.  All employment is continued on that basis.  I understand

that no supervisor, manager or executive of the Employer, other than the General Manager has any authority to alter the foregoing.

Applicant's signature____________________________________________________ Date____________________________

Thank you for your interest in Fran Coy’s Salon & Spa as an employer.