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APPLICATION FOR EMPLOYMENT TOWN OF WAYNESVILLE
16 S. Main Street
Waynesville, NC 28786
(828) 456-2028 Equal access to programs, services and employment is available to all persons. Those applicants requiring
reasonable accommodation to the application and/or interview process should notify a representative of
the Human Resources Department.
Name _______________________________________________________________________________________
Last First Middle
Address _____________________________________________________________________________________
Street City State Zip Code
Telephone ________________Mobile __________________E-Mail Address __________________________ Position(s) applied for ___________________________________________ Date of Application __________ Referral Source (please check the appropriate category and name the source.)
__ Walk-in__________________________________ __ School__________________________________
__ Employee________________________________ __ Job Fair_________________________________
__ Advertisement_____________________________ __ Staffing Agency____________________________
__ Company?s Website ________________________ __ Government Employment Agency______________
__ Other Internet______________________________ __ Other___________________________________ If necessary, best time to call you at home is ____________ am/pm
May we contact you at work? Yes/No. If yes, work number and best time to call:__________________ am/pm
If you are under 18 and it is required, can you furnish a work permit Yes/No
Have you submitted an application here before? Yes/No
If yes, give date(s) and position(s) __________________________________________________________
Have you ever been employed here before? Yes/No If yes, give dates from _____________ to _____________
Are you legally eligible for employment in this country? Yes/No
Date available for work ______________________
What is your desired salary range or hourly rate of pay? $_____________ Per ____________
Type of employment desired:___Full Time ___Part -Time ___Educational Co-Op ___Seasonal ___Temporary
Will you relocate if job requires it? Yes/No
Will you travel if job requires it? Yes/No
If they have been explained to you, are you able to meet the attendance requirements of the position?
___ N/A _____Yes _____No
Will you work overtime if required? ____Yes ____No If no, please explain __________________________
____________________________________________________________________________________
Driver?s license number required if driving may be required in the job for which you are applying: __________________________________________ State __________________________
Have you ever been bonded? ____Yes ____No Answering ?yes? to the following question does not constitute an automatic bar to employment. Factors such as
date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken
into account. Have you ever pled ?guilty? or ?no contest? to, or been convicted of a crime? ____Yes ____No
If yes, please provide date(s) and details _____________________________________________________
_____________________________________________________________________________________ Employment History
Starting with your most recent employer, provide the following information.
Employer___________________________________________________Telephone #_________________
Street Address ______________________________________ City________________ State ___________
Starting job title/final job title________________________________________________________________
Immediate supervisor and title (for most recent position held)______________________________________
Why did you leave?_______________________________________________________________________
Summarize the type of work performed and job responsibilities._____________________________________
______________________________________________________________________________________
What did you like most about your position?____________________________________________________
What were the things you like least about the position?____________________________________________
Month/Year Month/Year
Dates employed:_______ To _______ Compensation(Starting) __Hourly __ Salary $________per ________
Commission/Bonus/Other Compensation $____________________
Compensation(Final) ___Hourly ___ Salary $________per________
Commission/Bonus/Other Compensation _____________________ Employer___________________________________________________Telephone #__________________
Street Address ______________________________________ City________________ State ____________
Starting job title/final job title_________________________________________________________________
Immediate supervisor and title (for most recent position held)_______________________________________
Why did you leave?_______________________________________________________________________
Summarize the type of work performed and job responsibilities._____________________________________
______________________________________________________________________________________
What did you like most about your position?____________________________________________________
What were the things you like least about the position?____________________________________________
Month/Year Month/Year
Dates employed:_______ To _______ Compensation(Starting) __Hourly __ Salary $________per ________
Commission/Bonus/Other Compensation $____________________
Compensation(Final) ___Hourly ___ Salary $________per________
Commission/Bonus/Other Compensation _____________________
Employer___________________________________________________Telephone #__________________
Street Address ______________________________________ City________________ State ____________
Starting job title/final job title_________________________________________________________________
Immediate supervisor and title (for most recent position held)_______________________________________
Why did you leave?_______________________________________________________________________
Summarize the type of work performed and job responsibilities._____________________________________
______________________________________________________________________________________
What did you like most about your position?____________________________________________________
What were the things you like least about the position?____________________________________________
Month/Year Month/Year
Dates employed:_______ To _______ Compensation(Starting) __Hourly __ Salary $________per ________
Commission/Bonus/Other Compensation $____________________
Compensation(Final) ___Hourly ___ Salary $________per________
Commission/Bonus/Other Compensation _____________________ Employer___________________________________________________Telephone #__________________
Street Address ______________________________________ City________________ State ____________
Starting job title/final job title_________________________________________________________________
Immediate supervisor and title (for most recent position held)_______________________________________
Why did you leave?_______________________________________________________________________
Summarize the type of work performed and job responsibilities._____________________________________
______________________________________________________________________________________
What did you like most about your position?____________________________________________________
What were the things you like least about the position?____________________________________________
Month/Year Month/Year
Dates employed:_______ To _______ Compensation(Starting) __Hourly __ Salary $________per ________
Commission/Bonus/Other Compensation $____________________
Compensation(Final) ___Hourly ___ Salary $________per________
Commission/Bonus/Other Compensation _____________________
Explain any gaps in your employment, other than those due to personal illness, injury or disability. __________
______________________________________________________________________________________
______________________________________________________________________________________
If not addressed on previous page, have you ever been fired or asked to resign from a job? ____Yes ____No
If yes, please explain ____________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Skills and Qualifications
Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying. ___________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Computer Skills (check appropriate boxes. Include software titles and years of experience.)
____ Word Processing ______________________________________________________ Years: _______
____ Spreadsheet __________________________________________________________ Years: _______
____ Presentation __________________________________________________________ Years: _______
____ E-mail _______________________________________________________________ Years: _______
____ Internet ______________________________________________________________ Years: _______
____ Other ________________________________________________________________ Years: _______
____ Other ________________________________________________________________ Years: _______
____ Other ________________________________________________________________ Years: _______
____ Other ________________________________________________________________ Years: _______ Educational Background
Starting with your most recent school attended, provide the following information. School (include City and State) Years Completed GPA Major/Minor
Completed Class Rank
__ Diploma __ GED
__ Degree_______________
__ Certification____________
__ Other_________________ School (include City and State) Years Completed GPA Major/Minor
Completed Class Rank
__ Diploma __ GED
__ Degree_______________
__ Certification____________
__ Other_________________ School (include City and State) Years Completed GPA Major/Minor
Completed Class Rank
__ Diploma __ GED
__ Degree_______________
__ Certification____________
__ Other_________________ School (include City and State) Years Completed GPA Major/Minor
Completed Class Rank
__ Diploma __ GED
__ Degree_______________
__ Certification____________
__ Other_________________ References
List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Name Title Relationship Telephone Number of
To You Years Known
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________ Related Information To what job-related organizations (professional, trade, etc) do you belong?
Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.
Organization Offices Held
______________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
List special accomplishments, publications, awards, etc.
Exclude information that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
In your current or a prior job, have you ever written instructions or directions to be followed by employees or customers? _____Yes _____No _____Not Applicable
If yes, please explain: _____________________________________________________________________
______________________________________________________________________________________
Is there any other job-related information you want us to know about you? _____________________________
______________________________________________________________________________________
______________________________________________________________________________________ Applicant Statement I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered fro employment, it will be necessary for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer?s president. 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. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer?s service, whenever it is discovered. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. Signature of Applicant ________________________________________________ Date ________________ |
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