TOWN OF BURGAW EMPLOYMENT APPLICATION

TEST – Applicant Portal Validation

Administration · Full-time

Important: Fill out all sections completely. Unsigned or incomplete applications will not be considered. Once submitted, application materials become the property of the Town. Your application is part of the examination process and should represent your best effort.

Personal Information

Last name:

First name:

Middle name:

Home phone:

Other names:

Maiden name or any other name under which you may have worked or received education.

Address:

Mobile phone:

City:

State:

Zip code:

Email:

Are you legally authorized to work in the U.S.?

Employment Information

Position Applying For

Employment Type

Date available:

Have you ever applied for the Town before?

Previous application details:

Current base salary:

Compensation expectations:

Currently employed:

May we contact your current employer?

Are you related to a Town employee?

Relative name department:

Referral source:

Education

Enter the schools that apply to you.

TypeSchoolYearsDegree / EquivalentMajor / Subjects

Driver's License

A valid NC driver's license is required before hire under the current Town application.

Driver license number:

Driver license type:

Driver license state:

Driver license expiration:

Prior driver license number:

Prior driver license state:

Prior driver license expiration:

General Information

The questions below reproduce the current Town employment application. Access to this section should be limited appropriately in the staff system.

Have you ever been convicted of a felony under the name used on this application or another name?

Felony explanation:

The existence of a criminal record does not automatically eliminate you from employment consideration.

Have you ever been charged with any type of criminal offense?

Criminal charge explanation:

Registrations, Licenses, Certifications

License / CertificationStateNumberExpiration Date

Knowledge, Skills, and Abilities

List knowledge, skills, or abilities applicable to the position, including equipment, machines, computer knowledge, and software skills. "See attached resume" is not acceptable on the current application.

Employment History

List your most recent position first, account for gaps, and complete each applicable item. The current application states that "See attached resume" is not acceptable.

Employer 1

Company Name

From

Street / City / State / Zip

Telephone

Supervisor

Last Position

Starting Salary

Last Salary

Reason for Leaving

Job Responsibilities

Employer 2

Company Name

From

Street / City / State / Zip

Telephone

Supervisor

Last Position

Starting Salary

Last Salary

Reason for Leaving

Job Responsibilities

Employer 3

Company Name

From

Street / City / State / Zip

Telephone

Supervisor

Last Position

Starting Salary

Last Salary

Reason for Leaving

Job Responsibilities

Employer 4

Company Name

From

Street / City / State / Zip

Telephone

Supervisor

Last Position

Starting Salary

Last Salary

Reason for Leaving

Job Responsibilities

Employer 5

Company Name

From

Street / City / State / Zip

Telephone

Supervisor

Last Position

Starting Salary

Last Salary

Reason for Leaving

Job Responsibilities

Employer 6

Company Name

From

Street / City / State / Zip

Telephone

Supervisor

Last Position

Starting Salary

Last Salary

Reason for Leaving

Job Responsibilities

Military Experience

Military served:

Military branch:

Military dates:

Military obligation:

Veteran widow or disabled veteran spouse:

Current application language - males age 18 through 25 only: The current form states that males age 18 through 25 are required to register with the Federal Government in accordance with the Military Selective Act and asks whether the applicant has registered for Selective Service.

Selective service registered:

References

Do not list family relatives. The current application recommends coworkers, teachers, or others who know your qualifications.

Attachments

Resume:

Optional. PDF or Word document, maximum 10 MB.

Other attachment:

Optional certification, transcript, or supporting document.

Authorization and Electronic Signature

Please read and sign the statement below. We will not check a reference with your current employer unless you have given us permission.

I certify that, to the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly misrepresented or falsified any of the application information, I may be disqualified for employment consideration or dismissed from employment with the Town.

It is the policy of the Town of Burgaw to ensure that its employees are free from the effects of alcohol and drugs. All applicants selected must satisfactorily pass a drug-screening test. Those applicants with a confirmed positive test for drugs/alcohol will not be hired.

I authorize my current and former employers to give any information regarding my employment, together with any information regarding me whether or not it is on their records. I hereby release them from any damage whatsoever for issuing same. I also permit the Town of Burgaw to conduct a Police and Court Records investigation of my background.

I also authorize schools and other educational institutions that I may have attended to reveal my scholastic ratings to the Town of Burgaw representatives who are investigating my educational background.

I have read the authorization and agree to sign this application electronically.

Type your full legal name as your electronic signature:

For additional signature evidence, you may also sign in the box below. The typed name and electronic transaction record are retained with the signed PDF.

Submitting will lock this application. A signed PDF and audit record will be created at submission.