Application For Employment For Rutherford County
Return to RutherfordCountyNC.gov

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

(TAB BETWEEN FIELDS TO FILL OUT THIS FORM)

Position(s) Applied For:

     

Date of Application:     

How Did You Learn About Us?

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Relative

Inquiry

 

Employment Agency

Friend

 

Other

Last Name

     

First Name

 

Middle Name

Address

 

City

   

State

Zip Code

Telephone Number

Social Security Number:
               

Best time to contact you at home is:..........................................................................................   am   pm

 

If you are under 18 years of age, can you provide required proof of your eligibility to work?............................................Yes  No

 

Have you ever filed an application with us before?...........................................................................................................Yes  No

                                        If Yes, give date             

 

Have you ever been employed with us before?............................................................................................................... Yes  No

If Yes, give date          

 

Do any of your friends or relatives, other than spouse, work here?...................................................................................Yes  No

Are you currently employed?..........................................................................................................................................Yes  No

May we contact your present employer?.........................................................................................................................Yes  No

Are you prevented from lawfully becoming employed in this Country because of Visa or Immigration Status
    Proof of citizenship or immigration status will be required upon employment.......................................................Yes  No

Date available for work                        What is your desired salary range?   

Are you available to work:    Full-Time (Please indicate 1   2   3   shift )
                                            Part-Time (Please indicate  Mornings   Afternoons   Evenings)
                                            Temporary (Please indicate dates available    - 

Are you currently on "lay-off" status and subject to recall?..............................................................................................Yes   No

Can you travel if a job requires it?..................................................................................................................................Yes   No

Have you been convicted of a felony within the last five years?........................................................................................Yes   No
A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER


EDUCATION  

 


Name and Address of School

Course of Study

Years

Completed

Diploma

Degree

Elementary
School

 

High
School

 

 

Undergraduate
College

 

 

Graduate
Professional

 

 

Other
(Specify)

 

 

Describe any specialized training, apprenticeship, skills and extra-curricular activities

 

Describe any job-related training received in the United States Military

 Employment Experience  

Start with your present or last job.  Include any job-related military service assignments and volunteer activities.  You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer

Dates Employed

From  To

Work Performed
Address

Telephone Number(s)

Hourly Rate/Salary

Starting  Final

 
Job Title

Supervisor

Reason for Leaving

Employer

Dates Employed

From  To

Work Performed
Address

Telephone Number(s)

Hourly Rate/Salary

Starting   Final

 
Job Title

Supervisor

Reason for Leaving

Employer

Dates Employed

From  To

Work Performed
Address

Telephone Number(s)

Hourly Rate/Salary

Starting   Final

 
Job Title

Supervisor

Reason for Leaving

Employer

Dates Employed

From  To

Work Performed
Address

Telephone Number(s)

Hourly Rate/Salary

Starting   Final

 
Job Title

Supervisor

Reason for Leaving

If you need additional space, please continue on a separate sheet of paper.

List professional, trade, business or civic activities and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:

 

 

Additional Information

 

 

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

SPECIALIZED SKILLS               (CHECK SKILLS/EQUIPMENT OPERATED)

Terminal Spreadsheet Production/Mobile
Machinery (List)

Other
(List)

PC/Mac Word Processing
Typewriter Shorthand
WPM WPM

 

State any additional information you feel maybe helpful to us in considering your application

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN
INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?  A review of the activities involved in such a job or occupation has been given.                                                                                                                                       Yes         No  

 

REFERENCES

1. Name Phone #

     Address:

 City

State

Zip Code

2. Name Phone #

     Address:

 City

State

Zip Code

3. Name Phone #

     Address:

 City

State

Zip Code


 

APPLICANT’S STATEMENT

 

I Certify that answers given herein are true and complete.

 

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

 

This application for employment shall be considered active for a period of time not to exceed 45 days.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

 

I hereby understand and acknowledge that, unless other wise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.  It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

 

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the employer.

 

 

 

Signature of Applicant

Date

  Please enter your email address here:

 

CLICKING THE SUBMIT BUTTON WILL EMAIL YOUR APPLICATION TO DEBRA CONNER, ADMINISTRATIVE ASSISTANT IN THE HUMAN RESOURCES DEPARTMENT OF RUTHERFORD COUNTY AT debra.conner@rutherfordcountync.gov