Please enable JavaScript in your browser to complete this form.Name *FirstLastAddressEmail *PhonePosition Applying ForSalary DesiredHow were you referred to the City of Holly Springs?Are you available to work Weekends and HolidaysYesNoAre you available to work evenings?YesNoHave you worked for the City of Holly Springs before? YesNoIf Yes, when?Do you have any relatives working for the City of Holly Springs?YesNo If yes, please list, with relationships.Are you legally able to work in the U.S?YesNoAre you 18 years of age or older?YesNoHave you ever been convicted of a felony? YesNoIf Yes, please submit additional page with explanation, including dates charged, penalty assessed or disposition. Applicant is not required to disclose any erased records, charges or convictions. (Conviction is not necessarily a disqualification for employment.) Did you graduate from high school or have you passed a G.E.D. Test? YesNoSelect the last grade completed: 6789101112131415161718If a college degree is a requirement for this position, you must provide the City with a certified transcript within 90 days of hire.EDUCATION: High School Name/Address City State ZipNumber of Years HSNumber of YearsHS GPAGPADEGREE EARNED or NUMBER CREDITSDEGREE EARNED or NUMBER CREDITS Technical CollegeTechnicalNumber of Years TechNumber of YearsTech GPAGPADEGREE EARNED or NUMBER CREDITS TECHDEGREE EARNED or NUMBER CREDITS CollegeCollegeNumber of Years CollegeNumber of YearsCollege GPAGPADEGREE EARNED or NUMBER CREDITS COLLEGEDEGREE EARNED or NUMBER CREDITS OtherOtherNumber of Years OtherNumber of YearsOther GPAGPADEGREE EARNED or NUMBER CREDITS OTHERDEGREE EARNED or NUMBER CREDITS Please list all Specialized Certificates or Degrees you have earned (i.e., LCSW, CPA, GED, etc.)Degree/Certificate l Subject l School l City/StatePlease list all Specialized Certificates or Degrees you have earned (i.e., LCSW, CPA, GED, etc.) (copy)Degree/Certificate l Subject l School l City/StatePlease list all Specialized Certificates or Degrees you have earned (i.e., LCSW, CPA, GED, etc.) (copy) (copy)Degree/Certificate l Subject l School l City/StatePlease list all Specialized Certificates or Degrees you have earned (i.e., LCSW, CPA, GED, etc.) (copy) (copy) (copy)Degree/Certificate l Subject l School l City/StateOptional: Do you speak, read, or write a language other than English?YesNoLanguage: SpeakReadWriteLanguage 2: SpeakReadWriteSPECIAL JOB QUALIFICATIONS: Drivers LicenseYesNoIf you are applying for a job which will entail transporting clients and/or driving an agency vehicle, please answer the following:State & License Number:SPECIAL JOB QUALIFICATIONS: Drivers License 2YesNoIf you are applying for a job which will entail transporting clients and/or driving an agency vehicle, please answer the following:State & License Number: 2SPECIAL JOB QUALIFICATIONS: Drivers License 3YesNoIf you are applying for a job which will entail transporting clients and/or driving an agency vehicle, please answer the following:State & License Number: 3If you are applying for a clerical position, please indicate your skill level in the following areas:NoneFamiliarComfortableExpertComputer (specify type) Software (please list according to type)NoneFamiliarComfortableExpertWord Processing: Software (please list according to type) (copy)NoneFamiliarComfortableExpertSpreadsheet: Software (please list according to type) (copy) (copy)NoneFamiliarComfortableExpertDatabase: Software (please list according to type) (copy) (copy) (copy)NoneFamiliarComfortableExpertOther:EMPLOYMENT HISTORYEmployer 1:Dates of EmploymentFrom:Dates Of Employment To:SalaryStart / EndPositionType of OrganizationMailing Addressstreet/city/state/zipEmployer PhoneDutiesSupervisor NameMay we contact your supervisor?YesNoReason for leavingEMPLOYMENT HISTORY 2Employer 2:Dates of Employment FROM:From:Dates Of Employment TO:To:Salary 2Start / EndPositionType of OrganizationMailing Addressstreet/city/state/zipEmployer PhoneDuties Supervisor NameMay we contact your supervisor?YesNoReason for leavingEMPLOYMENT HISTORY 3Employer 3:Dates of Employment FROM: From:Dates Of Employment TO: To:Salary 3Start / EndPositionType of OrganizationMailing Address street/city/state/zipEmployer Phone Duties Supervisor NameMay we contact your supervisor? YesNoReason for leaving REFERENCE 1NamePhoneRelationshipHow many years known?REFERENCE 2NamePhoneRelationship How many years known? REFERENCE 3NamePhone Relationship How many years known? NameSubmit
