Application For Employment Alexander County, NC

Instructions To Applicants: To be considered for employment with Alexander County, you must complete all sections of this application. Alexander County employs only U.S. citizens or aliens who can provide proof of identity and work authorization within three business days of employment. Males subject to military selective service registration must certify compliance. When completing this application, give complete information on your education and work history. “See Resume” is not acceptable. Check for accuracy, electronically sign and date your application.

"*" indicates required fields

* INDICATES REQUIRED FIELD

EQUAL OPPORTUNITY INFORMATION

Local Government policy prohibits discrimination based on race, sex, color, creed, national origin, age, genetic information or disability. The information requested below will in no way affect you as an applicant, the sole use will be to see how well our recruitment efforts are reaching all segments of the population.

Date of Birth*

Gender

Male

Female

ETHNIC GROUP*

White (non-Hispanic)

Black (non-Hispanic)

Hispanic (Mexican, Puerto Rican, Cuban, Central or South American, other Spanish origin)

Asian (including Pacific Islander)

American Indian (including Alaskan native)

Check the types of work you will accept:*

Full-time

Part-time

Seasonal

Temporary

Position Applied For:*

Please indicate your referral source:

MILITARY SERVICE

If subject to Military Selective Service registration

Certify compliance by checking

Have you served honorably in the Armed Forces of the United States?*

Yes

Do you wish to declare a service-connected disability?

Yes

Give dates of your (or spouse’s) qualifying active military service:

Entered

Separated

Branch of Service

Highest Rank Attained

Are you a member of the Military Reserves?

Yes

Branch

Rank

At the time of application, are you the surviving spouse or dependent of a deceased veteran who died from service-related reasons?

Yes

Personal Data

Last Name*

First Name*

Middle Name*

Address*

(Street number and name)

City*

State*

Zip*

County*

Phone*

Format: (###)###-####

Business Phone

Format: (###)###-####

Do you now work for Alexander County?*

Yes

Are you related by blood or marriage to any person now working for Alexander County?*

Yes

If yes, give the name, relationship and department.

Driver’s License Number

Driver's License State Issued

Last 4 Digits of SS #

EDUCATION

Select highest grade completed:*

High School

Name and Location

From:

To:

Did you graduate?

Yes

College(s)/University(ies)

Name and Location

From:

To:

Did you graduate?

Yes

S/Q Hrs.

Major/Minor

Type of Degree Received

Graduate or Professional

Name and location

From:

To:

Did you graduate?

Yes

S/Q Hrs.

Major/Minor

Type of Degree Received

List training programs and seminars completed in the last five years

If the job(s) applied for calls for specific courses, indicate the courses taken and credits received:

Current Professional Status: (List fields of work for which you have been registered)

Registration:

State:

No:

Registration:

State:

No:

Membership in Professional, Honorary, or Technical Societies (list):

ADDITIONAL SKILLS AND EXPERIENCE

Please check the following skills, experiences, etc., you have:

Sign Language

Legal Transcription

Typing

Foreign Language

Medical Transcription

Word Processing

Braille

Adding Machine/Calculator

Other

List other skills

If you have typing experience, specify WPM

If you know a foreign language, please specify

WORK HISTORY

Current or Previous Employer*

Employer Address*

Supervisor's Name*

Supervisor's Telephone Number*

May We Contact Employer*

Job Title*

Number Supervised by You*

Length of Employment*

Date Employed*

Month/Year

Date Separated*

Month/Year

Reason for Leaving*

Starting Salary*

Ending or Current Salary*

List major duties in order of importance in the job:*

Previous Employer*

Employer Address*

Supervisor's Name*

Supervisor's Telephone Number*

May We Contact Employer*

Job Title*

Number Supervised by you*

Length of Employment*

Date Employed*

Month/Year

Date Separated*

Month/Year

Reason for Leaving*

Starting Salary*

Ending Salary*

List major duties in order of importance in the job:*

Previous Employer

Employer Address

Supervisor's Name

Supervisor's Telephone Number

May We Contact Employer

Job Title

Number Supervised by you

Length of Employment

Date Employed

Month/Year

Date Separated

Month/Year

Reason for Leaving

Starting Salary

Ending Salary

List major duties in order of importance in the job:

Previous Employer

Employer Address

Supervisor's Name

Supervisor's Telephone Number

May We Contact Employer

Job Title

Number Supervised by you

Length of Employment

Date Employed

Month/Year

Date Separated

Month/Year

Reason for Leaving

Starting Salary

Ending Salary

List major duties in order of importance in the job:

List three references

Name*

First Last

Phone*

Name*

First Last

Phone*

Name*

First Last

Phone*

Attach Cover Letter (optional)

Accepted file types: pdf, Max. file size: 2 MB.

Attach resume in pdf format only.

Attach Resume (optional)

Accepted file types: pdf, Max. file size: 2 MB.

Attach resume in pdf format only.

I certify that I have given true, accurate and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigation of all statements made in this application and understand false information, documentation or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action or dismissal if I am employed, and (or) criminal action. I further understand dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet position qualifications.

Digital Signature of Applicant*

Date

Name

This field is for validation purposes and should be left unchanged.