TOWNOFGIBSONVILLEEMPLOYMENTAPPLICATION

Applicationsmaybemailedto:Townof Gibsonville Attn: Human Resources129 West Main Street Gibsonville, NC 27249 or emailed to .

Fillout allsectionsCOMPLETELYandtothebest ofyourability.Yourapplicationwill beused aspart oftheexaminationprocessand, therefore,shouldrepresentyourbesteffort. Oncesubmitted, application materialsbecomethepropertyoftheTown. Anapplication mustbereceived inTownHallby5pmontheclosingdate postedtoensureconsideration. Photocopied applicationsmusthaveanoriginal signatureandcurrentdate. PRINT OR TYPE ALL INFORMATION.

CURRENTINFORMATION

POSITIONTITLEDATE:

Whenwillyoubeavailableforemployment?(i.e.immediately,2weeksnotice)

Areyouseeking Full-timeregular Part-timeregular Temp./preferregular TemporaryOnly

NAME:

(Last)(First)(Middle)

ADDRESS:

StreetNo.or P.O.BoxCityStateZip

HOMETEL#() OTHER TEL#()

E-MAILADDRESS (if applicable) Areyou18orolder?Yes No Areyoua Veteran?Yes No

Selective Service Registration If you are a male between the ages of 18 to 25, have you registered for Selective Service? Yes No. If not, you will have 30 days to comply if selected for a position as required by law.

Immigration Reform & Control Act After employment, you will be required to submit verification of your legal right to work in the United States. The Town of Gibsonville employs only United States citizens or aliens who can provide proof of identity and work authorization within 3 working days of employment.

Equal Opportunity Employer It is the policy of the Town of Gibsonville to foster, maintain, and promote equal employment opportunity. The Town shall select employees on the basis of applicants’ qualifications and without regard to sex, race, national origin , ethnicity, color, religion, creed, age, marital status, veteran’s status, disability, genetic information or political affiliation, except where specific age, sex or physical requirements constitute a bona fide occupational qualification necessary for job performance.

Drug Screening AllFINALapplicants mustpassa drugscreeningprocess. Furtherinformationwillbeprovidedattheappropriatetime inthe employment process.

GENERALINFORMATION

Ifyouneedto explainanyanswer,usethespaceunderEXPLANATIONSneartheendof this application.

HaveyoueverbeenemployedwiththeTownof Gibsonville?Yes No

IfYES,whatdepartmentandwhen:

AreyounoworwereyoupreviouslyrelatedinanywaytoaTownemployee?Yes No

IfYES,givename,relationshipanddepartment:

Doyoucurrentlyhaveauthorizationto work intheU.S.?Yes No

EDUCATION

Provideyourcompletehistory

Indicatehighestschoolyearcompleted:(i.e.8,12,16)

NameofHighSchool City State

Haveyoureceivedahighschooldiplomaorequivalent?Yes No

Education
Beyond
HighSchool / NameandLocation / DidYou
Graduate? / Degree,Diploma, CertificateEarned or# ofYrs. / Major
Minor
College(s)
University(ies) / Yes No N/A
Graduateor Professional Schools / Yes No N/A
Technical Institutes, Internship, Other / Yes No N/A

KNOWLEDGE,SKILLSABILITIES

Please list any knowledge, skills or abilities you have that you feel are applicable to the position for which you are applying. Include skills with equipment or machines you can operate and/or word processing software packages known or used.

REGISTRATIONS,LICENSES,CERTIFICATIONS

List fields of work for which you have been registered, licensed or certified.

EMPLOYMENT

Recordyourcompleteworkhistoryin thespacesbelow.If needed,additionalsheetscontainingthesameinformationandin thesame formatareacceptable.BEGINwithyourcurrentormostrecentposition.Includemilitaryandrelatedvolunteerexperience.Besureto accountforgapsin youremploymenthistory.ALLSPACESMUSTBECOMPLETEDORMARKEDN/A(notapplicable)."See attachedresume"is NOTacceptablein thedutiesspace.

A.CURRENTORMOSTRECENTEMPLOYMENT(orexplaingapinemployment)

JOBTITLE StartingSalary LastSalary

DateemployedDateSeparated

Employerorcompany Telephone#()

Employerorcompanyaddress

NameandTitleofmostcurrentsupervisor

Full Time for how long?

Ifyouworkedpart-time,thenumberofhoursworkedperweek

DUTIESINORDEROFIMPORTANCE

REASONFORLEAVINGordesiringachange

B.NEXTMOSTRECENTEMPLOYMENT(orexplaingapinemployment)

JOBTITLE StartingSalary LastSalary

DateemployedDateSeparated

Employerorcompany Telephone#()

Employerorcompanyaddress

NameandTitleofmostcurrentsupervisor

Full Time for how long?

Ifyouworkedpart-time,thenumberofhoursworkedperweek

DUTIESINORDEROFIMPORTANCE

REASONFORLEAVINGordesiringachange

C.NEXTMOSTRECENTEMPLOYMENT(orexplaingapinemployment)

JOBTITLE StartingSalary LastSalary

DateemployedDateSeparated

Employerorcompany Telephone#()

Employerorcompanyaddress

NameandTitleofmostcurrentsupervisor

Full Time for how long?

Ifyouworkedpart-time,thenumberofhoursworkedperweek

DUTIESINORDEROFIMPORTANCE

REASONFORLEAVINGordesiringachange

D.NEXTMOSTRECENTEMPLOYMENT(orexplaingapinemployment)

JOBTITLE StartingSalary LastSalary

DateemployedDateSeparated

Employerorcompany Telephone#()

Employerorcompanyaddress

NameandTitleofmostcurrentsupervisor

Full Time for how long?

Ifyouworkedpart-time,thenumberofhoursworkedperweek

DUTIESINORDEROFIMPORTANCE

REASONFORLEAVINGordesiringachange

E.NEXTMOSTRECENTEMPLOYMENT(orexplaingapinemployment)

JOBTITLE StartingSalary LastSalary

DateemployedDateSeparated

Employerorcompany Telephone#()

Employerorcompanyaddress

NameandTitleofmostcurrentsupervisor

Full Time for how long?

Ifyouworkedpart-time,thenumberofhoursworkedperweek

DUTIESINORDEROFIMPORTANCE

REASONFORLEAVINGordesiringachange

Maywecontact yourpresentemployerforreferencepriortoaninterview(if granted)?YesNo

Ifyouarenotcurrentlyemployed,pleasecheckhereN/A().IfNO,explainunderEXPLANATIONS.

EXPLANATIONS

CertificationandRelease(MUSTBESIGNEDANDDATEDBELOW)

•To thebestofmy knowledgeandbelief,theinformationgiven truly represents my backgroundandexperience.Iunderstand thatifIhave knowingly ornegligently misrepresented,falsifiedoromittedany informationduring theapplicationprocess,orhavemadeany changesto the formatorwordingofthisapplication form,Imay bedisqualified foremploymentconsiderationordismissed fromemploymentwith theTown.

•Iauthorizemy currentand formeremployerstogiveany informationregardingmeormy employment,whetherornotitison theirrecords.Ihereby release themfromany damagewhatsoever forissuing same.

•Iunderstandandacknowledge thatshouldIbeemployedby theTownofGibsonville,thenIserve "atwill".This meansthatImay be terminatedat any time.Ifurtherunderstand thatthis"atwill"employmentrelationshipmay notbe changedby any writtendocumentorby conductunlesssuch changeisspecifically approvedby theTownManager.

•Please sign below or in lieu of signature please type your name in signature line below.

SIGNATUREDATE_____