Madison County, NC Local Government
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Generic Application
Equal Opportunity Information
State Government policy prohibits discrimination based on race, sex, color, creed, national origin, age, genetic information or disability. Sex, age or absence of disability is a bona fide occupational qualification in a small number of State jobs. The information requested below will in no way affect you as an applicant. Its sole use will be to see how well our recruitment efforts are reaching all segments of the population.
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Indicates required field
Date of Birth
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Gender
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Male
Female
Ethnic Group
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White (non-Hispanic)
Black (non-Hispanic)
Hispanic (Mexican, Puerto Rican, Cuban, Central or South American, Spanish origin regardless of race)
Asian (including Pacific Islander)
American Indian (including Alaskan native)
Last 4 digits of SSN
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Last Name
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First Name
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Middle Name
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Address (Street number and name)
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City
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County
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State
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Zip Code
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Phone
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Alternate Phone
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Do you now work for the State of NC?
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Yes
No
If subject to Military Selective Service registration, certify compliance by initialing below
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Are you a layoff candidate with the State of N.C. eligible for RIF priority reemployment consideration as described by GS 126:
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Yes
No
Notification Date
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Are you related by blood or marriage to any person now working for the State
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Yes
No
If yes, give name, relationship to you and the agency where employed.
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Military Service
Have you served honorably in the Armed Forces of the United States on active duty for reasons other than training?
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Yes
No
Do you wish to declare a service-connected disability?
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Yes
No
At the time of this application, are you the surviving spouse or dependent of a deceased veteran who died from service-related reasons?
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Yes
No
Do you wish to declare eligibility for veterans preference as the spouse of a disabled veteran?
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Yes
No
Entered
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Separated
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Branch
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Rank
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Check the types of work you will accept:
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Permanent full-time
Permanent part-time
Temporary full-time
Temporary part-time
Work involving Travel
Shift or Split Shift Work
If you are not available for work now, enter the earliest date you could begin work (mo/day/yr.)
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Will you accept work anywhere in N.C.?
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Yes
No
(If no, list below the counties in which you would be willing to work.)
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Job Applied For
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Please indicate your referral source
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If you were referred by the Employment Security Commission (Job Service) please indicate which local office:
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Education
Highest Grade Completed
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Some High School
Completed High School
GED
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
PHD
High School
Name and Location
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Date Began
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Date Finished
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Grad?
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Yes
No
College or University
Name and Location
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Date Began
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Date Finished
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Grad?
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Yes
No
S/Q Hours
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Major/Minor Course Work
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Type of Degree Received
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Graduate or Professional
Name and Location
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Date Began
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Date Finished
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Grad?
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Yes
No
S/Q Hours
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Major/Minor Course Work
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Type of Degree Received
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Other educational, vocational school, internships, etc.
Name and Location
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Date Began
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Date Finished
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Grad
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Yes
No
S/Q Hours
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Major/Minor Course Work
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Type of Degree Received
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Special training programs and seminars you have completed in the last five years (list):
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If the job(s) applied for calls for specific courses, indicate those courses taken and credits received:
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Current professional status: (List fields of work for which you have been registered)
Registration
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Registration
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State
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State
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No.
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No.
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Membership in professional, honorary, or technical societies (list):
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Licenses and certifications (List, giving dates and sources of issuance):
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Skills
Driver's License No.
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State
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Chauffeur's License
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State
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Car for use at work?
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Yes
No
Choose Any
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Sign Language
Adding Machine/Calculator
Legal Transcription
Medical Transcription
Braille
Word Processing
Foreign Language (list)
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Typing (WPM)
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Shorthand (WPM)
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Other (list)
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Have you ever been convicted of an offense against the law other than a minor traffic violation? (A conviction does not mean you cannot be hired. The offense and how recently you were convicted will be evaluated in relation to the job for which you are applying.)
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Yes
No
(If yes, explain fully below)
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Work History
Current or Last Employer
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Street Address
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City
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State
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Zip Code
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Job Title
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Supervisor's Name
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Telephone Number
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No. Supervised by you
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Date Employed (mo/yr)
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Date Seperated (mo/yr)
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Starting Salary
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Ending or Current Salary
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If part time, number of hours worked per week:
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Reason for Leaving
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May We Contact Employer
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Yes
No
List major duties that demonstrate your competencies related to the position for which you are applying in order of their importance in the job
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Employer
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Street Address
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City
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State
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Zip Code
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Job Title
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Supervisor's Name
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Telephone Number
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No. Supervised by you
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Date Employed (mo/yr)
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Date Seperated (mo/yr)
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Starting Salary
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Ending Salary
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If part time, number of hours worked per week:
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Reason for Leaving
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May We Contact Employer
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Yes
No
List major duties that demonstrate your competencies related to the position for which you are applying in order of their importance in the job
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Resume
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Max file size: 5MB
Optional Supplementation
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Max file size: 5MB
Cover Letter
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Max file size: 5MB
Optional Supplementation
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Max file size: 5MB
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