State of North Carolina Application for Employment 2 - Free Download | Page 2
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State of North Carolina Application for Employment 2
APPLICATION FOR EMPLOYMENT
STATE OF
NORTH CAROLINA
Date of Application
Last 4 digits of Social Security No.
Last Name
First Name
Middle Name
Address (Street number and name)
City
County
State
Zip Code
Phone (Home or where you can be reached)
Business Phone
Availability
Do you now work
f
o
r
the State of NC
YES NO
Are you related by blood or marriage to any person now working for the State YES NO
If yes, give name, relationship to you and the agency where employed.
If subject to Military Selective
Serv
ice registr
ation, certify
compliance by initialing dotted line
.....................................................
Military Service
Have you served honorably in the Armed Forces of the United State
s
on active duty for reasons other than training
YES NO
Do you wish to declare a service-connected disability
YES NO
At the time of this application, are you the surviving spouse or dependent of a
deceased veteran who died from service-related reasons
YES NO
Do you wish to declare eligibility for veterans preferen
ce as the spouse of a disabled veteran
YES NO
Give dates of your (or spouse’s) qualifying a
ctive military service:
Entered:
Separated: Branch: Rank
AGENCY USE ONLY: ELIGIBILITY FOR VETERAN’S PREFERENCE: YES NO
CHECK the types of work you will accept: 1. Permanent full-time 2. Permanent part-time 3. Temporary full-time 4. Temporary part-time
5. Any of the preceding 6. Work involving Travel 7. Shift or Split Shift Work
If you are not available for work now, enter the earliest
date you could begin work (mo/day/yr.)
Will you accept work anywhere in N.C. YES NO (If no, list below the counties in which you would be willing to work.)
1. 2. 3. 4. 5.
Job Applied For
Enter below the specific title and vacancy number of
the job for which you are applying.
Job Title:
Vacancy Number:
Referral Source
Please indicate your referral source:
If you were referred by the Employment Security Commission (Job Service) please indicate which local office:
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
Under S/Q Hrs., list the hours of credit received and if they were seme
ster (S) or quarter (Q) hours.
Schools
Name and Location
Dates Attended (mo/yr)
From: To:
Grad
S/Q Hrs.
Major/Minor Course Work
Type of Degree
Received
High School
YES
NO
College(s)
University (s)
YES
NO
Graduate or
Professional
YES
NO
Other educational,
vocational school,
internshi
p
s
,
etc.
YES
NO
Special training programs and seminars you have completed in the last five years (list):
If the job(s) applied for calls for specific courses, indicate those courses taken and credits received:
Current professional status: (List fields of work for which you have been registered)
Registration:
State: No.
Registration: State: No.
Membership in professional, honorary, or technical societies (list):
DO NOT COMPLETE THIS BLOCK
DEGREES AND PROFESSIONAL CREDENTIALS
Have been verified
Will be verified within 90 days (G.S. 126-30)
Person Responsible:
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