TOWN OF TAYLORSVILLE
67 Main Avenue Drive - Taylorsville, NC 28681 - 828-632-2218
APPLICATION FOR EMPLOYMENT
Pre-Employment Questionnaire - An "At Will" Equal Opportunity Employer

 
Personal Information
Date:     
Name:     
Present Address:       
    
Permanent Address :       
    
Phone Number:     
Are you 18 years or older? Yes..........No............
Are you prevented from lawfully becoming employed in this country because of VISA or immigration status? Yes.............No.............
 
Employment Desired 
Position     
Date You Can Start:     
Salary Desired:     
Are you employed now? Yes..........No.......... If so may be inquire of your present employer? Yes..........No..........
Ever applied with the Town before?  Yes..........No.......... When? 
Referred by:     
 
Education
 
Name & Location
of School
# of Years Attended
Did you graduate?
Subjects Studied
Grammar School

       
High School

       
College

        
Trade, Business or Correspondence School        
 
General Information  
Subjects of Special Study or Research Work:     
Special Skills:
    

Activities (Civic, Athletic, Etc.) Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, disability, color, or nation of origin of its members.

 
US Military or Naval Service:    Rank 
Present Membership in National Guard or Reserves:     
 
Former Employers  
List last three employers, starting with last one first.
Date
(Month & Year)
Name & Address
of Employer
Salary
Position
Reason for Leaving

From:
To:

       
From:
To: 		       
From:
To: 		       
 
References 
Give the names of 3 persons not related to you, whom you have known at least 1 year.
Name
Address
Business
Years Acquainted
        
        
        
 
In case of Emergency Notify     
Name:     
Address:     
Phone:  
 

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and if I am employed, my employment may be terminated at any time. If employed, I agree to conform to the Town's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the Town's option. I also understand and agree that the Town may change the terms and conditions of my employment with or without cause and with or without notice at any time. I understand that no Town representative, other than the Town Manager, and then only when in writing and signed by the Town Manager, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

 

Date:

Signature:

 
This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.