2017SUMMER INTERNSHIP PROGRAMAPPLICATION

Due date: February 28, 2017

  • You are responsible for ensuring that your completeapplication materials are received by the due date. Late or incomplete applications will not be considered. Please submit the following materials as part of your application package: 1) Resume in which you list relevant coursework, work experience, and other experience; 2) A copy of your next term course schedule (proof of registration). Application materials will not be returned, so make additional photocopies for your records.

Personal Information: (please print)

Last Name: ______First Name: ______Middle Initial: ______

Phone number: ______E-mail:______

High School: ______

College or University: ______

Major: ______

Year in School Fall 2017 (circle one): Sophomore/Junior/SeniorAnticipated graduation date: ______

Have you completed at least 1 year of college courses? Yes No

Referring Terumo Associate:(if applicable)______

Relationship to referring Associate: ______

Are you 18 years old or older? Yes No

Can you provide proof that you are legally eligible to work in the United States within three days of being hired? Yes No

Have you been convicted of a felony within the last 7 years? Yes No

(Conviction will not necessarily disqualify you for the position.) CALIFORNIA APPLICANTS ONLY: Applicant may omit any convictions for the possession of marijuana (except for convictions for the possessions of marijuana on school grounds or possession of concentrated cannabis) that are more than two (2) years old, and any information concerning a referral to, and participation in, any pretrial or post trial diversion program.

Have you been employed previously by Terumo CV Group or its sister companies within the past 2 years? Yes No

If offered a position, are you willing to submit to a drug and background screen? Yes No

Read and sign below:

Certification

  1. The information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification of refusal of employment or if employed, termination from the Company’s employment.
  2. I authorize and request that all of my present and former employers and those individuals I have listed as references furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability from damages arising from furnishing the requested information.
  3. Any offer of employment I may receive from the Company is contingent upon my successful completion of the Company’s total pre-employment screening process, including the Company’s receiving references that it considers satisfactory, and my satisfactory completion of any post-offer pre-employment drug screen that the Company may require as permitted by applicable law. I hereby consent to having the results of any post-offer pre-employment or post-employment drug screen I may be required to take disclosed to the Company.
  4. I understand that as a condition of employment, I may be required to undergo and successfully pass a screening for drugs and a pre-employment background screening. I understand and agree that, if employed, I may be required to submit to an alcohol or drug screening and/or background screening at any time at the discretion of the Company or as otherwise permitted under applicable law. I hereby consent to having the results of any such screening I may be required to undergo disclosed to the Company.
  5. In consideration of my employment, I agree to comply with the policies, rules, regulations, and procedures of the Company and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of either the Company or myself. I further understand that no manager or representative of the Company, other than the President of the Company, has any authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from or contrary to the foregoing. I further understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me and by the President of the Company.

Applicant’s signature: ______Date: ______

Please return completed application and attachments via e-mail or fax to: Human Resources Department

Terumo CV Group

6200 Jackson Rd., Ann Arbor, MI 48103

t. 734-741-6029 | f. 734-741-6414

January 2016