State of North Carolina Application for Employment 2 - Free Download | Page 3
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State of North Carolina Application for Employment 2 Page 3
State of North Carolina Application for Employment 2
Licenses and certifications (List, giving dates and sources of issuance):
SKILLS
CHECK the following skills, experiences, etc., which you have:
Driver’s License
Number State
Chauffeur’s License
Number State
Car for use at work
Sign Language
Foreign language (specify)
Adding Machine/calculator
Typing (specify WPM)
Shorthand/speedwriting (specify WPM)
Legal transcription
Medical transcription
Braille
Word Processing
Other
Have you ever been convicted of an offense against the law other than a minor traffic violation (A conviction does not mean you cannot be hired. The offense and
how recently you were convicted will be evaluated in relation to the job for which you are applying.)
YES NO (If yes, explain fully on an
additional sheet.)
WORK HISTORY (include volunteer experience) Use additional sheets if necessary. As you describe your work history experiences, make sure you highlight your
competencies which demonstrate your qualifications for the position for which you are applying.
Current or Last Employer:
Address:
Job Title:
Supervisor’s Name
Telephone Number
No. Supervised by you:
Date Employed (mo/yr)
Starting Salary
$ per
Ending or Current Salary
$ per
Reason for Leaving
May We Contact Employer
YES
NO
Date Separated (mo/yr)
Full Time Years Months
Part Time Years Months
If part time, number of hours
worked per week:
List major duties that demonstrate your competencies
related to the position for which you are applying in order of their
importance in the job:
Employer:
Address:
Job Title:
Supervisor’s Name
Telephone Number
No. Supervised by you:
Date Employed (mo/yr)
Starting Salary
$ per
Ending or Current Salary
$ per
Reason for Leaving
Date Separated (mo/yr)
Full Time Years Months
Part Time Years Months
If part time, number of hours
worked per week:
List major duties that demonstrate your competencies
related to the position for which you are applying in order of their
importance in the job:
Employer:
Address:
Job Title:
Supervisor’s Name
Telephone Number
No. Supervised by you:
Date Employed (mo/yr)
Starting Salary
$ per
Ending or Current Salary
$ per
Reason for Leaving
Date Separated (mo/yr)
Full Time Years Months
Part Time Years Months
If part time, number of hours
worked per week:
List major duties that demonstrate your competencies
related to the position for which you are applying in order of their
importance in the job:
I certify that I have given true, accurate and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my
work, I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications.
I authorize investigation of all statements made in this application and understand that false information or documentation, or a failure to disclose relevant information
may be grounds for rejection of my application, disciplinary action or dismissal if I am employed, and (or) criminal action. I further understand that dismissal upon
employment shall be mandatory if fraudulent disclosures are given to meet position qualifications (Authority: G.S. 126-30, G.S. 14-122.1.)
Signature of Applicant (unsigned applications will not be processed)
Date
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