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PLEASE READ AND FOLLOW CAREFULLY (Randolph County)

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U.S.A. forms for Randolph County

BROWSE RANDOLPH COUNTY (NC) FORMS

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Thank you for your interest in Randolph County Government.
We are an Equal Opportunity Employer and an E-Verify Employer
PLEASE READ AND FOLLOW CAREFULLY
Keep this Information Page for Your Records. Do not return with your completed application.
RANDOLPH COUNTY GOVERNMENT
Randolph County Human Resources 725 McDowell Road, Asheboro,
North Carolina 27205 Phone (336)318-6600 Fax (336)636-7586
Website www.RandolphCountyNC.gov Email jobs@RandolphCountyNC.gov
Incomplete applications will not be considered. Applications that are received
unsigned, undated, incomplete, illegible, with postage due or after the closing
date will be eliminated from consideration.
We strive to notify every applicant as to the status of his/her application once
interviewing has been completed. In order to do this, you must provide your email
address. Bear in mind, this notification may take up to a month after the last day
we accept applications for the vacancy.
Applications are accepted for current Randolph County vacancies only. You may apply for up to three current
vacancies with one application. If you apply for any future vacancies, a separate application will be required.
Please type or print application information. Do not copy and paste from Word document. If additional
space is needed, attach separate pages and date and sign those pages.
Your completed Randolph County Employment Application must be RECEIVED in the Human Resources
Office by 5:00 pm on the closing date of the position in order to be considered.
Resumes and cover letters may be submitted with the completed application as supplemental information.
Due to State of North Carolina guidelines, you must submit your OFFICIAL college transcript for all Social
Services or Public Health positions requiring a college degree. Official transcripts must be received in the
Human Resources office within 5 business days of the closing date for the position.
Randolph County Government is a drug-free workplace. All persons offered employment must complete a
negative drug screen before being employed. Randolph County Government mandates that all applicants
agree to a criminal background check prior to employment. All persons offered employment must complete a
background screen before being employed.
You must provide proof of eligibility for employment in the United States of America.
As you consider making an application for employment with Randolph County Government, please note that the following is public
record in North Carolina with respect to each county employee: Name, Age, Date of original employment or appointment to
county service, Terms of any contract by which the employee is employed, Current position, Title, Current salary, The
office/department to which the employee is currently assigned, Date and amount of each increase or decrease in salary with that
county, Date and type of each promotion, demotion, transfer, suspension, separation, or other change in position classification with
that county, Date and general description of the reasons for each promotion with that county, Date and type of each dismissal,
suspension, or demotion for disciplinary reasons taken by the county. If the disciplinary action was a dismissal, a copy of the written
notice of the final decision of the county setting forth the specific acts or omissions that are the basis of the dismissal.
Application for Employment
First Name
MI
Last Name
Email
Address
State
Zip Code
County
Cell Phone
EDUCATION
Education:
Circle highest grade completed 1 2 3 4 5 6 7 8 9 10 11 12 GED College 1 2 3 4 Graduate School 1 2 3 4
Detail below your education as indicated above. Under “S/Q Hours”, list hours completed and if they were Semester (S) or Quarter (Q).
Schools
Name & Location
Dates Attended
From: To: (Mo/Yr)
Grad?
Sem or Qtr
Hours Compl
Major and/or
Minor
Type Degree
Received
High School
Yes
No
Community/
Tech College
Yes
No
College/
University
Yes
No
Graduate/
Professional
Yes
No
Other Education,
Vocational school,
Internship etc.
Yes
No
SKILLS / SPECIAL TRAINING / LICENSES
List licenses, certifications, registrations, special courses, office or special skills such as foreign language fluencies, computer
skills, typing (wpm), sign language, etc. and/or memberships in professional, honorary or technical societies:
GENERAL INFORMATION
Are you a current or former employee of Randolph County Government?
Yes
No
If yes, indicate department and employment dates ____________________________________________________
Are you related by blood or marriage to any person currently employed by Randolph County?
Yes
No
If yes, indicate name, dept., and relationship ________________________________________________________
Have you ever worked or been educated under another name? If yes, please list _______________________________
Yes
No
Do you have a valid driver’s license? If yes, indicate state and number ________________________________________
Yes
No
Have you ever been convicted of any unlawful offenses, other than a minor traffic violation? If yes, explain in detail on
separate sheet of paper. NOTE: A conviction record will not necessarily exclude you from employment. Factors such as age at the time of offense,
rehabilitation efforts, how recent the offense was, nature of the crime and the type of job for which you are applying will be considered.
Yes
No
Please indicate your referral source _____________________________________________(e.g. employee, ESC, JobLink, newspaper, website, walk-in)
Position(s) Applied For (no more than 3 open positions per application)
1. ________________________________ 2. _________________________________ 3. __________________________________
For County Personnel Use Only
Date Received ______________________
RANDOLPH COUNTY GOVERNMENT
Randolph County Human Resources 725 McDowell Road, Asheboro,
North Carolina 27205 Phone (336)318-6600 Fax (336)636-7586
Website www.RandolphCountyNC.gov
Email jobs@RandolphCountyNC.gov
Randolph County Application for Employment Last Name ________________________ Date ____________
Page 2
EMPLOYMENT HISTORY - List work (and volunteer) experiences. Incomplete information will result
in the disqualification of your application. DO NOT REFER TO RESUME.
Do not paste bulleted items from
Word documents - bulleted items do not appear on application when emailed.
Current or Last Employer:
Address:
Job Title:
Supervisor Name:
Telephone Number:
Date Employed (mo./yr)
Ending Salary
$ per
Reason for leaving
May we contact employer? Yes No
Date Separated mo./yr.)
Duties:
Full time
Part Time
If part time, number of
hours worked per week:
Employer:
Address:
Job Title:
Supervisor Name:
Telephone Number:
Date Employed (mo./yr)
Ending Salary
$ per
Reason for leaving
Date Separated mo./yr.)
Duties:
Full time
Part Time
If part time, number of
hours worked per week:
Employer:
Address:
Job Title:
Supervisor Name:
Telephone Number:
Date Employed (mo./yr)
Ending Salary
$ per
Reason for leaving
Date Separated mo./yr.)
Duties:
Full time
Part Time
If part time, number of
hours worked per week:
Employer:
Address:
Job Title:
Supervisor Name:
Telephone Number:
Date Employed (mo./yr)
Ending Salary
$ per
Reason for leaving
Date Separated mo./yr.)
Duties:
Full time
Part Time
If part time, number of
hours worked per week:
Do not paste bulleted items from Word. Bulleted items from list will not appear on application when emailed.
Do not paste bulleted items from Word. Bulleted items from list will not appear on application when emailed.
Do not paste bulleted items from Word. Bulleted items from list will not appear on application when emailed.
Do not paste bulleted items from Word. Bulleted items from list will not appear on application when emailed.
Randolph County Application for Employment Last Name ________________________ Date ____________
Page 3
EMPLOYMENT HISTORY CONTINUE - List work (and volunteer) experiences. Incomplete
information will result in the disqualification of your application. DO NOT REFER TO RESUME.
AFFIDAVIT PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING
I certify that all information provided in this employment application is true and complete. I understand that any false information or
omission will disqualify me from consideration. Dismissal of employment shall be mandatory if fraudulent disclosures are given to meet
position qualifications.
I understand that pre-employment screens are a condition of my employment. A background check of my driving, criminal, or other
records will be conducted before employment. I will also be required to successfully pass a drug screen examination. By signing
below, I consent to both a pre-employment drug and criminal background screen. I also consent to post-employment drug screens per
Randolph County Government Policy.
I understand that as a condition of my employment, I will be required to furnish documentation verifying my identity and eligibility to
work in the United States.
I authorize my current and previous employers listed on my application to provide Randolph County Government with any job-related
information requested. I waive any right to legal claims against a disclosing person, employer, or institution and the prospective
employer seeking and using this information for hiring purposes. Notwithstanding any provisions of federal or state law, I also waive
any right I may have to review confidential material/information received by Randolph County from a person, employer, or institution.
I certify that if I am a male between the ages of 18 and 26, I am aware of and in compliance with all applicable registration
requirements of the Military Selective Service Act. (NC GS 143B-421.1)
I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment
for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may
be terminated at any time, with or without cause and with or without notice.
I have read, understand and by my signature, consent to these standards. If applying electronically, I understand that
my email address serves as my signature of consent to all information submitted within this application.
_______________________________________ ___________________________________ _________________________
Full Name (Please Print) Signature Date
Employer:
Address:
Job Title:
Supervisor Name:
Telephone Number:
Date Employed (mo./yr)
Ending Salary
$ per
Reason for leaving
Date Separated mo./yr.)
Duties:
Full time
Part Time
If part time, number of
hours worked per week:
Employer:
Address:
Job Title:
Supervisor Name:
Telephone Number:
Date Employed (mo./yr)
Ending Salary
$ per
Reason for leaving
Date Separated mo./yr.)
Duties:
Full time
Part Time
If part time, number of
hours worked per week:
Employer:
Address:
Job Title:
Supervisor Name:
Telephone Number:
Date Employed (mo./yr)
Ending Salary
$ per
Reason for leaving
Date Separated mo./yr.)
Duties:
Full time
Part Time
If part time, number of
hours worked per week:
Please save application to your computer | attach to email | send to jobs@RandolphCountyNC.gov
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PLEASE READ AND FOLLOW CAREFULLY (Randolph County)

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Completed 18 July 2020

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