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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 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
- No
Do you wish to declare a service-connected disability?
- Yes
- No
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
- No
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
- No
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
- No
Are you related by blood or marriage to any person now working for Alexander County?*
- Yes
- No
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
- No
College(s)/University(ies)
Name and Location
From:
To:
Did you graduate?
- Yes
- No
S/Q Hrs.
Major/Minor
Type of Degree Received
Graduate or Professional
Name and location
From:
To:
Did you graduate?
- Yes
- No
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 at least three references*
Name Phone
Attach Cover Letter (optional)
Accepted file types: pdf.
Attach resume in pdf format only.
Attach Resume (optional)
Accepted file types: pdf.
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
MM
DD
YYYY

Alexander County Government
621 Liledoun Road Taylorsville, NC 28681
Phone: (828) 632-9332 | Fax: (828) 632-0059

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Name	Phone

EQUAL OPPORTUNITY INFORMATION

MILITARY SERVICE

Personal Data

EDUCATION

High School

College(s)/University(ies)

Graduate or Professional

ADDITIONAL SKILLS AND EXPERIENCE

WORK HISTORY