Applications

Name*

First Middle Last

Address

Street Address City State ZIP Code

SOCIAL SECURITY NUMBER

DRIVER LICENSE #

TELEPHONE NUMBER: (H)

(CELL)

POSITION :

DATE AVAILABLE

WILL YOU ACCEPT

TEMPORARY WORK

YES
NO

PART-TIME WORK

YES
NO

Acceptance or refusal of temporary or part-time work will not affect your consideration of other appointments.

Have you ever been convicted against the law or are you now under charges for any offenses against the law? You may omit (1) traffic violation for which you paid a fine of $30.00 or less and (2) any offense committed before your 21st birthday which was finally adjudicated in a juvenile court or under a Youth Offender Law

YES
NO

If your answer is yes, give details

A conviction does not automatically mean you cannot be appointed. What you where convicted of and how recently will be evaluated in relation to the position.

May inquiry be made of your employers listed below regarding your character, qualifications and records of employment?

YES
NO

May inquiry be made of other sources as to credit, personal reference, criminal records, etc...for the town of Cheraw personnel records? This information is kept for the Personnel Department's records only and will be kept confidential. Signature ___________________________

PHYSICAL EXAMINATIONS AND DRUG SCREENING TESTS ARE REQUIRED BEFORE BEING EMPLOYED BY THE TOWN OF CHERAW.

EMPLOYMENT HISTORY

Start with your present job or last job.

DATES OF EMPLOYMENT

FROM

TO

Employer

Address

Street Address City State ZIP Code

Phone :

AVERAGE HRS. PER WEEK

: HH

MM

SUPERVISOR NAME

REASON FOR LEAVING

JOB TITLE

DUTIES AND RESPONSIBILITIES

EDUCATION

Schools/Colleges Attended

# Years

Year Grad.

Degree

REFERENCES

LIST THREE PERSONS WHO ARE NOT RELATED TO YOU AND HAVE KNOWLEDGE OF YOUR QUALIFICATIONS FOR THE POSITION YOU ARE APPLYING. DO NOT REPEAT NAMES OF SUPERVISORS LISTED UNDER EMPLOYMENT HISTORY.

Name

First Last

Address

Street Address City State ZIP Code

CREDIT REFERENCES

NAME

BUSINESS NAME

ADDRESS

I certify that answer given herein are true and complete to the best of my knowledge. I authorized investigations of all statements contained in this application foe employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination.
Signature ___________________________

Date

VOLUNTARY INFORMATION

The following information is requested on a voluntary basis. The information will be used for research and analysis purposes only and will not be used in making an employment decision.

DATE

Name

First Last

Sex

Male
Female

Date of birth

Race

Applications

TOWN OF CHERAW

If your answer is yes, give details

May inquiry be made of your employers listed below regarding your character, qualifications and records of employment?

EMPLOYMENT HISTORY

EDUCATION

REFERENCES

CREDIT REFERENCES

VOLUNTARY INFORMATION

Location

Phone/Email

Social Media