Application for Employment - Town of Louisburg

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Application for Employment

The Town of Louisburg is an Equal Opportunity Employer. The Town of Louisburg considers applications for all positions without regard to race, color, religion, sex (including pregnancy, sexual orientation and gender identity), national origin, age, disability, citizenship status, genetic information or any other legally protected status.

Position applying for(Required)

Date

How Did You Learn About Us?

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Employment Agency

Relative

Friend

Inquiry

Other

Name

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number(s)

Additional Telephone Number(s)

Email

Best time to contact you at home is:

:

If you are under 18 years of age, can you provide required proof of your eligibility to work

Yes

No

Does Not Apply To Me

Have you ever filed an application with us before?

Yes

No

Have you ever been employed with us before?

Yes

No

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 lawfully authorized to work in the United States?

Yes

No

Date available to work

What is your desired salary range?(Required)

Are you available to work (select from drop down):

If you are available to work full-time please indicate shift:

If you are available to work part-time please indicate time of day:

If you are available to work temporarily please indicate dates available:

From

To

Are you currently on "lay-off" status and subject to recall?

Can you travel if a job requires it?

Education

High School

Name of School

Address

Address of School

Course of Study

Diploma/Degree

Start Date

Start

End Date

End

Undergraduate College

Name of School

Address

Address of School

Course of Study

Diploma/Degree

Start Date

Start

End Date

End

Graduate Professional

Name of School

Address

Address of School

Course of Study

Diploma/Degree

Start Date

Start

End Date

End

Other (Specify)

Name of School

Address

Address of School

Course of Study

Diploma/Degree

Start Date

Start

End Date

End

Describe any specialized training, apprenticeship, skills and extr-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, sex (including pregnancy, sexual orientation and gender identity), national origin, age, disability, citizenship status, genetic information or any other legally protected status.

Employer

Employer Name

Telephone Number(s)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Employee

Job Title Supervisor Reason for Leaving Work Perfomed

Dates Employed

From

Dates Employed

To

Employer

Employer Name

Telephone Number(s)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Employee

Job Title Supervisor Reason for Leaving Work Perfomed

Dates Employed

To

Dates Employed

From

Employer

Employer Name

Telephone Number(s)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Employee

Job Title Supervisor Reason for Leaving Work Perfomed

Dates Employed

From

Dates Employed

To

Employer

Employer Name

Telephone Number(s)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Employee

Job Title Supervisor Reason for Leaving Work Perfomed

Dates Employed

From

Dates Employed

To

If you need additional space for employer information, please continue here. List professional, trade, business or civic activities and offices held.

You may exclude memberships which would reveal sex (including pregnancy, sexual orientation and gender identity), national origin, age, disability, citizenship status, genetic information or any other legally protected status.

Additional Information

Other Qualifications

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

Specialized Skills (Check Skills/Equipment Operated)

For Example: Terminal, Word Processing, Spreadsheet, Shorthand, Production/Mobile Machinery (list)

State any additional information you feel may be 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.

Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?

Reference(s)

Reference

Name

Phone

Address

Reference

Name

Phone

Address

Reference

Name

Phone

Address

Reference

Name

Phone

Address

Applicant's Signature(Required)

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

Date