Fillable Application for Employment (Town of Waynesville)

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Application for Employment (Town of Waynesville)

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Town of Waynesville
Application for Employment
An Equal Opportunity Employer
16 S. Main St. * P.O. Box 100 * Waynesville, N.C. 28786 * (828) 452- 2491
This application form is designed to protect individual rights and privacy and to ensure equal employment
opportunity. All questions are considered important for employment and no other use is intended for the
information you submit.
1. Position(s) applied for: Date:
(mm/dd/yy)
Name:
Last First Middle (If married use Maiden)
2. Do you have a valid North Carolina Driver’s License? License Number
3. Present Address
Street Address City State Zip Code
Telephone (Home) Telephone (Cell)
Email Address
4. When will you be available for employment?
5. Are you age 18 or above? If no, what is your birthdate?
(mm/dd/yy)
6. Have you ever worked before for the Town of Waynesville? From
(mm/yy) To
(mm/yy)
7. May we inquire of your present employer regarding your character, qualifications, etc.?
8. Are you related by blood or marriage to any person now employed by the Town?
If yes, give name, relationship and department employing relative
9. Military Service: Are you a veteran?
Date of entry into active service
(mm/yy) Date of separation from active service
(mm/yy)
Type of separation
10. Have you ever been convicted of an offense against law or forfeited a bond?
If yes, explain
Note: a criminal record will not necessarily exclude you from employment. Such factors as the nature and gravity of
the offense, the time passed since the conviction, and the nature of the job for which you have applied shall be
considered. You may omit traffic violations of which you paid a fine of $30 or less. A criminal records check will be
done to verify this information. Failure to disclose information may result in rejection of your application.
11. REFERENCES. If you wish to list references, list persons who are not related to you and who have
knowledge of your qualifications for the position(s) for which you are applying, such as former co-
workers, teachers, etc. Do not repeat the names of supervisors you will list under Section 16, Employment
Record, on pages 3 and 4 of this application.
A. Name Address
Telephone Number
B. Name Address
Telephone Number
C. Name Address
Telephone Number
12. EDUCATION. Give your complete educational history.
Name of last high school attended
Location
Highest year completed
Did you graduate from high school?
If you did not graduate, do you have a GED?
Education
Beyond
High School
Name and
Location
Attended
From To
Mo./Yr.
Mo./Yr
Check
Number
Years
Completed
Did you
Graduate?
Degree or
Diploma and
Year
Received
Major
Subject
College or
University
Graduate or
Professional
Other
Education,
Internships,
Etc.
13. List fields of work or activities for which you are licensed, registered, or certified, giving date(s) and
source(s) of issuance.
14. List typing and clerical skills, machines you can operate computer software in which you are proficient,
and others skills in which you are proficient.
15. If the position(s) applied for calls for specific courses, indicated course and credits received.
16. EMPLOYMENT RECORD. Answer questions for each period of employment. Include military service
and previous employment with the Town of Waynesville. Failure to give complete information may
result in rejection of your application. Begin with your present or last position. If more space is
needed, use a continuation sheet. Experience acquired more than 10 years ago may be summarized
in one block if not applicable to the position(s) for which you are applying.
A. Title of present or last position
Employer Address
Name and title of supervisor
Number of employees supervised by you Telephone number
Date employed (mm/yy) Date Separated (mm/yy) Number of hours
worked per week
Starting salary Last salary
Duties
Reason for leaving or desiring change
B. Title of present or last position
Employer Address
Name and title of supervisor
Number of employees supervised by you Telephone number
Date employed (mm/yy) Date Separated (mm/yy) Number of hours
worked per week
Starting salary Last salary
Duties
Reason for leaving or desiring change
C. Title of present o
r last position
Employer Address
Name and title of supervisor
Number of employees supervised by you Telephone number
Date employed (mm/yy) Date Separated (mm/yy) Number of hours
worked per week
Starting salary Last salary
Duties
Reason for leaving or desiring change
D. Title of present or last position
Employer Address
Name and title of supervisor
Number of employees supervised by you Telephone number
Date employed (mm/yy) Date Separated (mm/yy) Number of hours
worked per week
Starting salary Last salary
Duties
Reason for leaving or desiring change
E. Title of present
or last position
Employer Address
Name and title of supervisor
Number of employees supervised by you Telephone number
Date employed (mm/yy) Date Separated (mm/yy) Number of hours
worked per week
Starting salary Last salary
Duties
Reason for leaving or desiring change
CERTIFICATE OF APPLICANT
I certify that I have given true, accurate and complete information on this form to the best of my
knowledge. I hereby authorize the Town of Waynesville to investigate my past employment,
performance, salary and educational history as well as my criminal background; to gather any
other information necessary to process my application for employment; and to administer any
pre-employment testing, including but not limited to a pre-employment drug test, that is
necessary. I also understand and acknowledge that a negative pre-employment drug test is a
condition of employment with the Town of Waynesville. I also understand that if I am hired, I will
be required to provide proof of identity and legal authorization to work in the United States and
that federal immigration laws require me to complete an I-9 Form in this regard.
Applicant’s Electronic Signature
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Application for Employment (Town of Waynesville)

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Completed 19 January 2021

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