Fillable Application For Employment (City of Kannapolis)

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Application For Employment (City of Kannapolis)

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Application For Employment
City of Kannapolis, North Carolina
401 Laureate Way
Kannapolis, NC 28081
704-920-4300
We consider applications for all positions without regard to race, color, religion, creed, gender,
national origin, age, disability, marital or veteran status, or any other legally protected status.
PLEASE PRINT
Position Applied For: Department:
North Carolina Driver’s License (if applicable): Date of Application:
Last Name First Name Middle Name
Address Number & Street or P.O. Box City State Zip Code
Telephone Number(s)
Email
Best time to contact you: _____________am/pm
H
ave you filed an application with us before? If Yes, give date __________________ Yes No
Have you ever been employed with us before? If Yes, give date_________________ Yes No
Do any of your friends or relatives work here? Yes No
If Yes, state name and relationship__________________________________________________________
Are you currently employed? Yes No
May we contact your present employer? Yes No
Date available for work _________________ Salary range desired __________________
Are you available to work Full Time Part Time Temporary
Have you ever been convicted of a felony offense? (A “yes” answer will not automatically disqualify you from employment) Yes No
Have you ever been convicted of a traffic offense? (Answer if applying for a position that requires a driver’s license) Yes No
For each conviction, please list (use additional sheet(s) if necessary):
Date
Offense
City/State
Disposition
NOTE: A conviction record will not necessarily exclude you from employment. Factors such as age at time of offense, rehabilitation efforts, how recent the offense
was, and nature of the offense will be taken into consideration.
Note to applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review
of the activities involved in such a job or occupation has been given. ___Yes ____No
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
Employment History
(Start with present or last job. Include any job-related military service assignments and volunteer activities. Exclude organizations which indicate
race, color, religion, gender, national origin, disabilities or other protected status.)
EMPLOYER__________________________________________ DUTIES____________________________________________________
Your job title__________________________________________ ___________________________________________________________
From ___________________ To _______________________ ___________________________________________________________
Address ____________________________________________ ___________________________________________________________
Telephone __________________________________________ ___________________________________________________________
Supervisor __________________________________________ ___________________________________________________________
Starting Salary _________________ Ending ______________ May we contact Yes No
Reason for leaving __________________________________________________________________________________________________
EMPLOYER__________________________________________ DUTIES____________________________________________________
Your job title__________________________________________ ___________________________________________________________
From ___________________ To _______________________ ___________________________________________________________
Address ____________________________________________ ___________________________________________________________
Telephone __________________________________________ ___________________________________________________________
Supervisor __________________________________________ ___________________________________________________________
Starting Salary _________________ Ending ______________ May we contact Yes No
Reason for leaving __________________________________________________________________________________________________
EMPLOYER__________________________________________ DUTIES____________________________________________________
Your job title__________________________________________ ___________________________________________________________
From ___________________ To _______________________ ___________________________________________________________
Address ____________________________________________ ___________________________________________________________
Telephone __________________________________________ ___________________________________________________________
Supervisor __________________________________________ ___________________________________________________________
Starting Salary _________________ Ending ______________ May we contact Yes No
Reason for leaving __________________________________________________________________________________________________
EMPLOYER__________________________________________ DUTIES____________________________________________________
Your job title__________________________________________ ___________________________________________________________
From ___________________ To _______________________ ___________________________________________________________
Address ____________________________________________ ___________________________________________________________
Telephone __________________________________________ ___________________________________________________________
Supervisor __________________________________________ ___________________________________________________________
Starting Salary _________________ Ending ______________ May we contact Yes No
Reason for leaving __________________________________________________________________________________________________
Education
School
Name and Address of School
Course of Study
No. of Years
Completed
High School
Technical, Business, or
Trade School
College(s)
Graduate School
Skills, Certifications, Additional Information
Please list any skills, abilities, special certifications, licenses, special training, or courses you have had that you feel are applicable to the position for
which you are applying. Include skills with equipment or machines you operate. If you wish consideration for clerical positions, indicate speeds for
typing, computer software experience, etc. State any additional information you feel may be helpful to us in considering your application, including
any job related training in the U.S. Military. Include professional affiliations and memberships.
References
List three persons who are not related to you and who have knowledge of your qualifications and fitness for the position for which you are applying.
Do not include past supervisors.
Name
Business/Occupation
Address
Telephone
Are you able to furnish proof of employment authorization verifying your eligibility to work in the United States as required by the US Citizenship
Immigration Services?
____________Yes ____________No
FOR MALES AGE 18 THROUGH 25 ONLY
Males who are 18 through 25 are required to register with the Federal Government in accordance with the Military Selective
Service Act. State Law prohibits local government from employing anyone who has not complied with this requirement.
Please indicate if you have registered for Selective Service: _________Yes _______No
Conditions of Employment Statement
I certify that the information I have provided on my application is complete and accurate and give the City of Kannapolis the right to investigate all
information given and to secure additional appropriate information if necessary. In accordance with the law and my understanding of this statement, I
authorize my current and former employers to give any information regarding my employment and hereby release from all liability all persons,
companies, or corporations furnishing such information in good faith.
I understand and acknowledge that any employment relationship with the City of Kannapolis is of an “at will” nature, which means that the Employee
may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will”
employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by
an authorized executive of the City of Kannapolis. Additionally, the completed application is not a contract or guarantee of employment.
I further understand that any misleading or incorrect statements or the failure to complete any part of this application not prohibited by law may
render this application void and if employed, could be cause for immediate discharge. Also, I understand that if employed I would be required to
abide by all rules and regulations of the Employer.
It is the policy of the City of Kannapolis to ensure that its employees are free from the effects of alcohol and drugs. I understand that all applicants
selected for employment must satisfactorily pass a drug-screening test. Those applicants with a confirmed positive test for drugs/alcohol will not be
hired.
______________________________________________ ______________________________________
APPLICANT’S SIGNATURE DATE
Please make sure you have filled out all sections COMPLETELY and to the best of your ability. Your application will be used as part of the
examination process and, therefore, should represent your best effort. Once submitted, application materials become property of the City. An
application must be received in Human Resources by 5pm on the closing date posted to ensure consideration.
COMPLETED APPLICATIONS MUST BE RETURNED TO:
City of Kannapolis
Human Resources Department
Location: 401 Laureate Way, Kannapolis, NC 28081
AFFIRMATIVE ACTION DATA RECORD
Employees are treated during the hiring process and employment without regard to race, color, religion, creed, gender, national origin, age, disability,
marital or veteran status, or any other legally protected status.
As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action responsibilities where they
apply.
The purpose for this Data Record is to comply with government recordkeeping, reporting, and other legal requirements. Periodic reports are made to
the government on the following information. The completion of this Data Record is optional. If you choose to volunteer the requested information
please note that all Data Records are kept in a Confidential File and are not a part of your Application for Employment or personnel file. Please
note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT
DECISION.
PLEASE PRINT
Last Name First Name Middle Name
Address Number & Street or P.O. Box City State Zip Code
Telephone Number(s)
Cell Phone
REFERRAL SOURCE:
___Advertisement ____Employee ____Relative ____Private Employment Agency
____Friend ____Inquiry ____Government Employment Agency ____Other__________________
COMPLETE THE FOLLOWING:
Current Job:
Date of Birth:
Gender: ________Male __________Female
Ethnic Origin: ________White ________Black ________Hispanic ________American Indian/Alaskan Native
________Asian/Pacific Islander ________Other___________________________
Check If Any Of The Following Are Applicable: ________Vietnam Era Veteran ________Disabled Veteran ________Disabled Individual
________________________________________ ___________________________________
Signature of Applicant Date
401 Laureate Way, Kannapolis, NC 28081
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Application For Employment (City of Kannapolis)

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Completed 23 January 2021

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