Holly Ridge

Employment Form

EMPLOYMENT APPLICATION

TOWN OF HOLLY RIDGE

212 N. Dyson Street

Holly Ridge, NC 28445

Telephone: (910) 329-7081

Fax: (910) 329-1593

Qualified applicants are considered for openings without regard to race, color, sex, national origin, age, martial status, religion, or handicap unrelated to job requirements. This application is designed to protect individual rights and privacy and to ensure equal employment opportunity. All questions are considered important for employment and other use of this information is intended.

Position(s) applied for

Date

Referral Source:

Advertisement Town Website Town Employees ESC Other

Name

Last

First

Middle

Address

City

State

Zip Code

Telephone: Home

Business

If none, other phone

Type work seeking:

Full-time Part-time

Have you ever been employed by the Town before?

Yes No

If "Yes", dates:

Do you have a valid driver’s license?

Type

State

Number

Do you have a dependable means of transportation to work?

Please answer the following questions and explain any "Yes" answers below:

Are you on lay-off and subject to recall?

Yes / No

Are you a veteran, widow of a veteran, or wife of a disable veteran?

Yes / No

Are you related by blood or marriage to any other town employee?

Yes / No

Do you object to working on weekends or overtime if necessary?

Yes / No

Do you object to reference inquiries to your present employer?

Yes / No

Have you ever been convicted of an offense against the law or forfeited a bond?

Yes / No

(A record or conviction will not necessarily exclude you from employment. Factors such as age at time of offense, seriousness of offense, and rehabilitation efforts, will be considered)

Explanations:

Educational History (Give your complete educational history below)

	Name of School & Location	Attended		Number of Years Completed	Credit Hours	Did You Graduate?	Degree or Diploma & Yr. Received	Major Subject Area(s)
	Name of School & Location	From Mo./Yr.	To Mo./Yr.	Number of Years Completed	Credit Hours	Did You Graduate?	Degree or Diploma & Yr. Received	Major Subject Area(s)
High School or Highest Grade
College or University
Graduate or Professional
Other Education or Internships

List fields of work, for which you are licensed, registered, or certified, giving dates and sources of issuance:

List special skills and qualifications, including areas of knowledge and machine operation skills:

List professional or career memberships and achievements:

Employment Experience: Beginning with your present or last position, list each job held. Include military service and previous town employment. If you need additional space, please continue of an additional sheet of paper. You may also attach a personal resume if you desire, but please complete this application in full.

Employer	Dates		Work Performed
	From	To
Address
Telephone	Salary or Wage Rate
	Starting	Final
Job Title
Supervisor			Reason for Leaving

Employer	Dates		Work Performed
	From	To
Address
Telephone	Salary or Wage Rate
	Starting	Final
Job Title
Supervisor			Reason for Leaving

Employer	Dates		Work Performed
	From	To
Address
Telephone	Salary or Wage Rate
	Starting	Final
Job Title
Supervisor			Reason for Leaving

Employer	Dates		Work Performed
	From	To
Address
Telephone	Salary or Wage Rate
	Starting	Final
Job Title
Supervisor			Reason for Leaving

Other information related to your qualifications for this position:

References. You may list as references 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 have listed under your employment experience.

1. Name

Address

Phone

2. Name

Address

Phone

3. Name

Address

Phone

Certificate of Applicant. I certify that the information given herein is true and complete to the best of my knowledge. I authorize investigation of any statements given on this application as may be necessary in considering me for employment. I understand that any false or misleading information given may result in disqualification or, if employed, discharge. I agree, if employed, to abide by all work rules and requirements of the Town.

Signature of Applicant

Date

Employment Form

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