APPLICANT QUESTIONS (CONTINUED) Have you lived and/or worked in Orange County, NC for the past 12 months? Yes____ No____ are you connected to Orange County (family, Senior Center, volunteer, etc.)? If no, Yes____ No____ Please describe your connection to Orange County: Do you smoke? Yes_______ No_______ Do you have pets? Yes______ No_______ If yes, what kind and how many? ___________________________________________ Employment Information for the past 2 years for the Applicant Current Employer Address Start Date Hourly Wage & (City, State, Zip) Number of Hours Previous Employer Address Start Date End Date (City, State, Zip)
APPLICANT QUESTIONS (CONTINUED) Have you lived and/or worked in Orange County, NC for the past 12 months? Yes____ No____ If no, are you connected to Orange County (family, Senior Center, volunteer, etc.)? Yes____ No____ Please describe your connection to Orange County: Do you smoke? Yes_______ No_______ Do you have pets? Yes______ No_______ If yes, what kind and how many? ___________________________________________ Employment Information for the past 2 years for the Applicant Current Employer Address (City, State, Zip) Start Date Hourly Wage & Number of Hours Previous Employer Address (City, State, Zip) Start Date End Date
Crescent-Magnolia-Application.docx