Camden County Employment Application

PO Box 190
Camden, NC 27921                                An Equal Opportunity Employer
(252) 338-6363  ext 315
Office Hours: 8 am - 5 pm                           www.camdencountync.gov

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. Incomplete applications wil not be considered. Once submitted, application materials become property of the County. An application must be received by the County by 5 pm on the closing date posted to ensure consideration. The County does not accept FAXED applications. Photocopied application must have original signature and current date. If a position is posted as "open until filled," APPLY IMMEDIATELY. Applications will need to be signed if an interview is offered and accepted. The signature will be taken at the time of interview.

CURRENT INFORMATION

Position Applying for

Date of Application

Where did you hear about this position? *

When will you be available for employment? (i.e. immediately, 2 weeks notice)

Are you seeking

E-mail Address *

Last Name

First Name

Middle Name

Mailing Address

City

State

Zip Code

Phone Number

Cell Number

Business Number

GENERAL INFORMATION
If you need to explain any answer, use the spaces under explanations near the end of this application.

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

Have you ever been employed with the County of Camden?
If yes, indicate what department and when:

No

Yes Yes

Have you ever applied to the County of Camden before?
If yes, indicate what department and when:

No

Yes Yes

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

No

Yes

Are you now or were you previously related in any way to a County employee?
If yes, please list name and relationship:

No

Yes Yes

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

No

Yes

Are you an American citizen or do you currently have authorization to work in the US?

No

Yes

Did you receive any of your education or employment experience under another name?
If yes, please explain under EXPLANATIONS.

No

Yes

EDUCATION

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

Name of High School, County & State

Have you received a high school diploma or equivalent?

No

Yes

Education beyond High School

College(s)/University(ies)

Name and Location, Dates Attended, Certificate Earned, Major/Minor

Graduate or Professional Schools

Name and Location, Dates Attended, Certificate Earned, Major/Minor

Technical Institutes, Internships, Other

Name and Location, Dates Attended, Certificate Earned, Major/Minor

KNOWLEDGE, SKILLS & ABILITIES

Please list any knowledge, skills, or abilities you have you feel are applicable to the positon for which you are applying. Include skills with equipment or machines you can operate. If you wish consideration for a secreterial/clerical position, indicate typing speed and word processing software packages known and/or used.

List of fields of work for which you have been registered, licensed or certified:
Registration, State, Number & Expiration Date:

Do you have a valid driver's license? If so, please list which state issued and number.

No

Yes Yes

Is your driver's license a Commerical Driver's License?
If yes, indicate which class:

No

Yes Yes

EMPLOYMENT

Record your complete history. BEGIN with your current or most recent position. Include military and related volunteer experience. Be sure to account for gaps in your employment history. ALL SPACES MUST BE COMPLETED OR MARKED N/A(not applicable). "See attached resume" is NOT acceptable in the duties space.

Position

Salary

Employer

Address

City

State

Phone

From (MM/YYYY)

To (MM/YYYY)

Name and Title of Most Current Supervisor

If you worked part-time, the number
of hours worked per week

# of employees supervised by you

DUTIES IN ORDER OF IMPORTANCE

Reason for Leaving

Position

Salary

Employer

Address

City

State

Phone

From (MM/YYYY)

To (MM/YYYY)

Name and Title of Most Current Supervisor

If you worked part-time, the number
of hours worked per week

# of employees supervised by you

DUTIES IN ORDER OF IMPORTANCE

Reason for Leaving

Position

Salary

Employer

Address

City

State

Phone

From (MM/YYYY)

To (MM/YYYY)

Name and Title of Most Current Supervisor

If you worked part-time, the number
of hours worked per week

# of employees supervised by you

DUTIES IN ORDER OF IMPORTANCE

Reason for Leaving

Position

Salary

Employer

Address

City

State

Phone

From (MM/YYYY)

To (MM/YYYY)

Name and Title of Most Current Supervisor

If you worked part-time, the number
of hours worked per week

# of employees supervised by you

DUTIES IN ORDER OF IMPORTANCE

Reason for Leaving

EXPLANATIONS

ITEM # & Explanation

Have you had disciplinary action taken against you in the past 12 months?
If yes, explain under EXPLANATIONS. (A yes will not automatically disqualify you.)

No

Yes

Have you ever been dismissed or forced to resign from any job held?

No

Yes

Were you dismissed or forced to resign for disciplinary reasons?

No

Yes

May we contact your present employer for reference prior to an interview(if granted)?
If NO, explain under EXPLANATIONS.

No

Yes

Please list 3 persons, not related to you, who have knowledge of your qualifications and have known you for at least two years. Please provide complete names, phone numbers and relationship.

1.

2.

3.

Attach additional employment on Word Document or a Resume.

Certification and Release

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 County. I authorize my current and former employers to give any information regarding me or my employment, whether or not it is on their records. I hereby release them from any damage whatsoever for issuing same. I also authorize educational institutions which I attended to reveal my scholastic ratings, as well as degrees or certificates earned, to the County of Camden; and associations, registration and licensing boards and to others to furnish whatever detail is available concerning my qualifications. Not withstanding any provision of State or Federal law, I expressly waive any right I have to review information the County receives from an employer or educational institution under a promise of confidentiality. I also permit the County of Camden to conduct a Court, Credit and/or Motor Vehicle Records Investigation of my background. I understand that if I apply or have applied for certain jobs, may be tested for drug and alcohol use to determine if I am currently abusing these substances. I consent to the testing and understand that the results could preclude my appointment. I understand and acknowledge that should I be employed by the County of Camden, then I serve “at will.” This means that I may be terminated at any time or without cause. I further understand that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically approved by the County Manager.

I certify that I have given true, accurate and complete information on this form to the best of my knowledge.

Applicant Signature *

clear

Ocassional Night work	Ocassional Weekend work	Occassional Overtime
Occassional rotating shifts	Occassional "on-call"	Regular Night work
Regular Weekend work	Regular Overtime	Regular rotating shifts
Regular "on-call"	Frequent Night work	Frequent Weekend work
Frequent Overtime	Frequent rotating shifts	Frequent "on-call"