Driver’s License Foreign language (specify) transcription Number State Other CDL (A, B, or C?) Typing (specify WPM) Other Number State Car for use at work Shorthand/speedwriting (specify WPM) Sign Language Braille Adding Machine/calculator Medical transcription Specialized Skills - List in the appropriate blanks below the specialized skills you are proficient in or have received training in: Building/grounds maintenance Construction/heavy equipment Trades (carpentry, welding, plumbing, etc.) Computers (software, hardware, networking) Other Skills - Describe any job-related skills, knowledge, special training, or licenses you have that you have not listed above: MILITARY SERVICE North Carolina General Statutes 143B-421.1 prohibits local governments from employing any male who has not Yes No complied with Selective Service Registration regulations. Are you in compliance? 1) Have you ever served in the U. S. Armed Services? 2) Are you a member of the U. S. Military Reserves? 3) If yes to questions 1 or 2, which branch of service did you serve in? 4) What were your dates of service? 5) What was your rank upon your separation/discharge/retirement? 6) What type of discharge/separation? PLEASE ANSWER THE FOLLOWING QUESTIONS: Were you ever discharged or forced to resign from employment due to misconduct or unsatisfactory services? If yes, Yes No explain in the section below. Prior discharges or forced resignations will not necessarily disqualify you “comments” from employment. Comments: Beginning with your current or most recent position, list all time periods of employment, unemployment, or volunteer experience over the past 10 years showing changes in title or promotions separately. Attach additional sheets if needed. Please fill out all the information requested on this form. "See Resume" is not acceptable. Incomplete information will result in the disqualification of your application. WORK EXPERIENCE From To #Employees Name of Employer Current or Last Position Title Supervised Mo Yr Mo Yr Prior Employment Status Address City State Zip State Full Time Part Time Current or Most Recent Supervisor Name Starting Salary May We Contact Employer? Phone City
Driver’s License Number State CDL (A, B, or C?) Number State Car for use at work Sign Language Braille Adding Machine/calculator Medical transcription Foreign language (specify) Typing (specify WPM) Shorthand/speedwriting (specify WPM) transcription Other Other Specialized Skills - List in the appropriate blanks below the specialized skills you are proficient in or have received training in: Building/grounds maintenance Construction/heavy equipment Trades (carpentry, welding, plumbing, etc.) Computers (software, hardware, networking) Other Skills - Describe any job-related skills, knowledge, special training, or licenses you have that you have not listed above: MILITARY SERVICE North Carolina General Statutes 143B-421.1 prohibits local governments from employing any male who has not complied with Selective Service Registration regulations. Are you in compliance? Yes No 1) Have you ever served in the U. S. Armed Services? 2) Are you a member of the U. S. Military Reserves? 3) If yes to questions 1 or 2, which branch of service did you serve in? 4) What were your dates of service? 5) What was your rank upon your separation/discharge/retirement? 6) What type of discharge/separation? PLEASE ANSWER THE FOLLOWING QUESTIONS: Were you ever discharged or forced to resign from employment due to misconduct or unsatisfactory services? If yes, explain in the “comments” section below. Prior discharges or forced resignations will not necessarily disqualify you from employment. Yes No Comments: WORK EXPERIENCE Beginning with your current or most recent position, list all time periods of employment, unemployment, or volunteer experience over the past 10 years showing changes in title or promotions separately. Attach additional sheets if needed. Please fill out all the information requested on this form. "See Resume" is not acceptable. Incomplete information will result in the disqualification of your application. From To Name of Employer Current or Last Position Title #Employees Supervised Mo Yr Mo Yr Prior Employment Status Address State City State Zip Full Time Part Time Starting Salary Current or Most Recent Supervisor Name City May We Contact Employer? Phone