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EMPLOYMENT APPLICATION

2. City of Lowell EMPLOYMENT APPLICATION

4. An Equal Opportunity/Affirmative Action Employer

6. Applications will be accepted only for positions for which the City is recruiting and may be hand delivered or mailed to 101 W. First Street, Lowell, NC 28098. www.lowellnc.com

8. Fill out all sections COMPLETELY and to the best of your ability. Your application will be used as part of the examination process and, therefore, should represent your best effort. Unsigned, or incomplete applications will not be considered. Once submitted, application materials become the property of the City. An application must be received by 5 pm on the closing date posted to ensure consideration. Photocopied applications must have an original signature and current date. If a position is posted as "may close without notice", APPLY IMMEDIATELY.

10. First Name*

11. Last Name*

13. Address*

15. City*

16. State*

17. Zip Code*

19. Phone Number*

20. Email Address

22. Are you 18 or older?*

    1. Yes
    2. No

23. If no, what is your birth date.

25. CURRENT INFORMATION

27. DATE:*
    DATE:

28. Are you seeking:*

    1. Full-Time
    2. Part-Time
    3. Temporary

29. Position Title Applying For*

33. Apart from absences for religious observances, check conditions below that you are willing to accept.

35. Check All That Apply

    Occasional

    1. Night Work
    2. Weekend Work
    3. Overtime
    4. Rotating Shifts
    5. On-Call
36. Check All That Apply

    Regular

    1. Night Work
    2. Weekend Work
    3. Overtime
    4. Rotating Shifts
    5. On-Call
37. Check All That Apply

    Frequent

    1. Night Work
    2. Weekend Work
    3. Overtime
    4. Rotating Shifts
    5. On-Call
41. GENERAL INFORMATION

43. Have you ever been employed with the City of Lowell?*

    1. Yes
    2. No
44. If "YES", what department and when:

46. Are you willing to accept a salary within the advertised normal starting salary range?*

    1. Yes
    2. No
48. Are you now or were you previously related in any way to a City employee?*

    1. Yes
    2. No
49. If "YES", give name, relationship, and department.

51. Are you able to perform all of the duties of the job you have applied for?*

    1. Yes
    2. No
52. Are you an American citizen or do you currently have authorization to work in the U.S.?*

    1. Yes
    2. No
54. Did you receive any of your education or employment experience under another name? *

    1. Yes
    2. No
55. If "YES"please explain under EXPLANATIONS.

59. BASIC EDUCATION

61. Indicate highest school year completed: (i.e. 8, 12, 16)*

62. Name of high school. City/State.*

64. Have you received a high school diploma or equivalent?*

    1. Yes
    2. No
68. EDUCATION BEYOND HIGH SCHOOL

70. College? (List name and Location)

71. University? (List name and Location)

73. Attended (Month/Year to Month/Year)

74. Did you graduate?

    1. Yes
    2. No
75. Attended (Month/Year to Month/Year)

76. Did you graduate?

    1. Yes
    2. No
78. Major/Minor

79. Major/Minor

83. Graduate or Professional School? (Name/Location)

84. Technical Institutes, Internships, Other?

86. Attended (Month/Year to Month/Year)

87. Did you graduate?

    1. Yes
    2. No
88. Attended (Month/Year to Month/Year)

89. Did you graduate?

    1. Yes
    2. No
91. Major/Minor

92. Major/Minor

96. KNOWLEDGE, SKILLS & ABILITIES

98. Please list any knowledge, skills, or abilities you have that you feel are applicable to the position for which you are applying. Include skills with equipment or machines you can operate. Also indicate any software applications with which you have skill.

102. REGISTRATIONS, LICENSES, CERTIFICATIONS

104. List fields of work for which you have been registered, licensed or certified:

106. Registration

107. State

108. No.:

109. Exp Date

111. Registration

112. State

113. No.:

114. Exp Date

116. Please list your VALID DRIVER'S LICENSE NUMBER and the state in which it was issued. If you do not have a driver's license, please put NONE in the blank.

118. Is your driver's license a Commercial Driver's License?

     1. Yes
     2. No
119. If YES, indicate the class here:

123. EMPLOYMENT

125. Record your complete work history in the spaces below. If needed, additional sheets containing the same information and in the same format are acceptable. BEGIN with your current or most recent position. Include military and related volunteer experience. Be sure to account for gaps in your employment history.

127. A. CURRENT OR MOST RECENT EMPLOYMENT

129. Job Title

130. Starting Salary

131. Last Salary

133. Date Employed
     Date Employed

134. Date Separated
     Date Separated

135. Employer or Company

137. Telephone #

138. Employer or Company Address

140. Name and Title of most current Supervisor

142. Full-time: (# Yrs/Mos)

143. Part-time: (#Yrs/Mos)

144. If you worked part-time, # of hours worked per week:

146. # of employees supervised by you (if applicable)

148. Duties in order of importance:

150. Reason for leaving or desiring a change:

154. B. NEXT MOST RECENT EMPLOYMENT

156. Job Title

157. Starting Salary

158. Last Salary

160. Date Employed
     Date Employed

161. Date Separated
     Date Separated

162. Employer or Company

164. Name and Title of most current Supervisor

166. Full-time (# Yrs/Mos)

167. Part-time: (# Yrs/Mos)

168. If you worked part-time, # of hours worked per week:

170. # of employees supervised by you (if applicable):

172. Duties in order of importance:

174. Reason for leaving or desiring a change:

178. C. NEXT MOST RECENT EMPLOYMENT

180. Job Title

181. Starting Salary

182. Last Salary

184. Date Employed
     Date Employed

185. Date Separated
     Date Separated

186. Employer or Company

188. Telephone

189. Employer or Company Address

191. Name and Title of most current Supervisor

193. Full-time: (# Yrs/Mos)

194. Part-time: (# Yrs/Mos)

195. If you worked part-time, # of hours worked per week:

197. # of employees supervised by you (if applicable)

199. Duties in order of importance:

201. Reason for leaving or desiring a change:

205. Have you had disciplinary action taken against you in the past 12 months? If YES, explain below:*
     -- Select One --NoYes

207. Explanation (If YES above):

211. May we contact your present employer for a reference prior to an interview (if granted)?*
     -- Select One --NoYes

215. Certification and Releases

217. Acknowledgement #1:*

     To the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly or negligently misrepresented, falsified or omitted any information during the application process, or have made any changes to the format or wording of this application form, I may be disqualified for employment consideration or dismissed from employment with the City.

     1. I Agree.
     2. I Decline.
219. Acknowledgement #2:*

     I also authorize education institutions which I attended to reveal my scholastic ratings, as well as degrees or certificates earned, to the City; and associations, registration and licensing boards and to others to furnish whatever detail is available concerning my qualifications. Notwithstanding any provision of State or Federal law, I expressly waive any right I have to review information the City receives from an employer or educational institution under a promise of confidentiality.

     1. I Agree.
     2. I Decline.
221. Acknowledgement #3:*

     I also permit the City to conduct a Police, court, Credit and/or Motor Vehicle Records Investigation of my background where related to the job for which I am applying.

     1. I Agree.
     2. I Decline.
223. Acknowledgement #4:*

     I understand that if I apply or have applied for certain jobs, I may be tested for drug and alcohol use to determine if I am currently using or abusing these substances. I consent to the testing and understand that the results could preclude my appointment.

     1. I Agree.
     2. I Decline.
225. Acknowledgement #5:*

     I understand and acknowledge that should I be employed by the City, then I serve "at will". This means that I may be terminated at any time. I further understand that this "at will" employment relationship may not be changed by any written document unless such change is specifically approved by the City Manager.

     1. I Agree.
     2. I Decline.
227. UPLOAD RESUME*

     Please upload your resume. Applications in lieu of resumes will not be considered.

Leave This Blank:


228. 1. Receive an email copy of this form.
229. Email address

     This field is not part of the form submission.

230. Submit Submit and Print

* indicates a required field