Fillable Editable Job Application PDF (County Of Pitt)

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Editable Job Application PDF (County Of Pitt)

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U.S.A. forms for County Of Pitt

BROWSE COUNTY OF PITT (NC) FORMS

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APPLICATION
FOR
EMPLOYMENT PITT COUNTY
RESUME WILL NOT BE ACCEPTED IN LIEU OF APPLICATION NORTH CAROLINA
Please Print or Type Return To: Human Resources Dept., 1717 W 5
th
St., Greenville, NC 27834
Date of Application
Last 4 Digits of Social Security
xxx-xx-
Last Name
First Name
Middle Name
Address (Street number and name)
City
State
Zip Code
Phone (Home or where you can be reached)
( )
Email address
___ Availability _________________________________________________________________________________________________________
Do you now work for Pitt County? Are you related by blood or marriage to any person now working for Pitt County? YES NO
YES NO (If yes, give name, relationship to you and the agency where employed.)
If subject to Military Selective Service registration, certify compliance by initialing dotted line: . . . . . . . . . . . . . . .
___ Military Service _____________________________________________________________________________________________________
Have you served honorably in the Armed Forces of the United States on active duty for reasons other than training? YES NO
Give dates of your qualifying active military service:
Entered: ______________________ Separated: ______________________ Branch: ______________________ Rank: __________________
Are you a member of the Military Reserves: YES NO Branch: ________________________ Rank: ____________________________
CHECK the types of work you will accept: 1. Permanent full-time 2. Permanent part-time 3. Temporary full-time
4. Temporary part-time 5. Any of the preceding 6. Work involving travel 7. Shift or split shift work
If you are not available for work now, enter the earliest date you could begin work (mo./day/yr.) _________________________________________
___ Jobs Applied For ___________________________________________________________________________________________________
Enter below the specific title(s) of the job(s) for which you are applying. Please list no more than three on this application.
1. ____________________________________ 2. ____________________________________ 3. __________________________________
How did you learn about this position(s)? Personnel Office ________; Newspaper ad ________; job vacancy announcement _______;
Employment Security Commission ________; Other ________.
___ Education _________________________________________________________________________________________________________
Highest grade completed: GED Years of College
Years of Graduate School
Under S/Q Hrs., list the hours of credit received and if they were semester (S) or quarter (Q) hours.
Schools
Name and Location
Dates Attended
(mo/yr)
From: To:
Graduate?
S/Q Hrs.
Maj/Min Course
Work
Type of
Degree
Received
High School
YES
NO
College(s)
University(ies)
YES
NO
College(s)
University(ies)
YES
NO
Graduate or
Professional
YES
NO
Other educational,
vocational schools,
internships, etc.
YES
NO
Special training programs and seminars you have completed in the last five years (List):
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
If the jobs(s) applied for calls for specific courses, indicate those 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):
_______________________________________________________
________________________________________________
DO NOT COMPLETE THIS BLOCK
DEGREES AND PROFESSIONAL CREDENTIALS
Have been verified
Will be verified within 90 days (G.S. 126-30)
Person responsible: ____________________________________
Revised 07/20
Licenses and certifications (List, giving dates and sources of issuance):
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
__ Skills ______________________________________________________________________________________________
CHECK the following skills, experiences, etc. which you have:
Driver’s license ______________________ Sign language __________________________ Legal transcription
Number State Foreign language (specify) ________________ Medical transcription
Chauffeur’s license _____________________ Adding machine/calculator Braille skills
Number State Typing (specify WPM) ___________________ Word Processing Skills
Car for use at work Shorthand/speedwriting (specify WPM) ______ Other _________________
-- Work History (Include volunteer experience) Use Additional Sheets if Necessary
Current or Last Employer:
Address:
Job Title
Supervisor’s name: Telephone Number:
No. Supervised by you:
Date Employed (mo/yr)
Starting Salary
$ per
Ending Salary
$ per
Reason for Leaving
May We Contact Employer?
YES NO
Date Separated (mo/yr)
List major duties in order of their importance in the job:
___________________________________________________________________________________________
Full Time
Years
Months
___________________________________________________________________________________________
Part Time
Years
Months
___________________________________________________________________________________________
If part time, hours per week:
___________________________________________________________________________________________
Employer:
Address:
Job Title
Supervisor’s name: Telephone Number:
No. Supervised by you:
Date Employed (mo/yr)
Starting Salary
$ per
Ending Salary
$ per
Reason for Leaving
Date Separated (mo/yr)
List major duties in order of their importance in the job:
___________________________________________________________________________________________
Full Time
Years
Months
___________________________________________________________________________________________
Part Time
Years
Months
___________________________________________________________________________________________
If part time, hours per week:
___________________________________________________________________________________________
Employer:
Address:
Job Title
Supervisor’s name: Telephone Number:
No. Supervised by you:
Date Employed (mo/yr)
Starting Salary
$ per
Ending Salary
$ per
Reason for Leaving
Date Separated (mo/yr)
List major duties in order of their importance in the job:
___________________________________________________________________________________________
Full Time
Years
Months
___________________________________________________________________________________________
Part Time
Years
Months
___________________________________________________________________________________________
If part time, hours per week:
___________________________________________________________________________________________
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 that false information or
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 that dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet
position qualifications. (Authority: G.S. 126-30, G.S. 14-122.1).
_______________________________________________________________________________ __________________________________
Signature of Applicant (unsigned applications will not be processed) Date
Revised 07/20
PITT COUNTY
Last 4 Digits of Social Security Number:
xxx-xx-
Last Name
An Equal Opportunity/Affirmative Action Employer
Employer:
Address:
Job Title
Supervisor’s name: Telephone Number:
No. Supervised by you:
Date Employed (mo/yr)
Starting Salary
$ per
Ending Salary
$ per
Reason for Leaving
Date Separated (mo/yr)
List major duties in order of their importance in the job:
___________________________________________________________________________________________
Full Time
Years
Months
___________________________________________________________________________________________
Part Time
Years
Months
___________________________________________________________________________________________
If part time, hours per week:
___________________________________________________________________________________________
Employer:
Address:
Job Title
Supervisor’s name: Telephone Number:
No. Supervised by you:
Date Employed (mo/yr)
Starting Salary
$ per
Ending Salary
$ per
Reason for Leaving
Date Separated (mo/yr)
List major duties in order of their importance in the job:
___________________________________________________________________________________________
Full Time
Years
Months
___________________________________________________________________________________________
Part Time
Years
Months
___________________________________________________________________________________________
If part time, hours per week:
___________________________________________________________________________________________
Employer:
Address:
Job Title
Supervisor’s name: Telephone Number:
No. Supervised by you:
Date Employed (mo/yr)
Starting Salary
$ per
Ending Salary
$ per
Reason for Leaving
Date Separated (mo/yr)
List major duties in order of their importance in the job:
___________________________________________________________________________________________
Full Time
Years
Months
___________________________________________________________________________________________
Part Time
Years
Months
___________________________________________________________________________________________
If part time, hours per week:
___________________________________________________________________________________________
Employer:
Address:
Job Title
Supervisor’s name: Telephone Number:
No. Supervised by you:
Date Employed (mo/yr)
Starting Salary
$ per
Ending Salary
$ per
Reason for Leaving
Date Separated (mo/yr)
List major duties in order of their importance in the job:
___________________________________________________________________________________________
Full Time
Years
Months
___________________________________________________________________________________________
Part Time
Years
Months
___________________________________________________________________________________________
If part time, hours per week:
___________________________________________________________________________________________
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 that false information or
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 that dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet
position qualifications. (Authority: G.S. 126-30, G.S. 14-122.1).
_______________________________________________________________________________ __________________________________
Signature of Applicant (unsigned applications will not be processed) Date
Revised 07/20
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Editable Job Application PDF (County Of Pitt)

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Completed 18 July 2020

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