TOWN OF TOPSAIL BEACH EMPLOYMENT APPLICATION

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EMPLOYMENT APPLICATION
An Equal Opportunity/Affirmative Action Employer

Town of Topsail Beach
820 South Anderson Blvd.
Topsail Beach, NC 28445
topsailbeachnc.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. Once submitted, application materials become the property of the Town. An application must be received in Town Hall by 5 pm on the closing date posted to ensure consideration. The Town does not accept FAXED, emailed or handwritten applications. If a position is posted as "may close without notice," you should APPLY IMMEDIATELY.
Town of Topsail Beach*

EDUCATION
Indicate the highest school year completed: (i.e. 8, 12, 16)*
High School Information*

High School Name

Street Address Line 2

CityState

Zip Code
Have you received a high school diploma or equivalent?*

YesNo

Education Beyond High School (If nothing for any category below, type "N/A" in bottom row)*

	Name and Location	Dates Attended (From MM/YY to MM/YY)	Did You Graduate?	Credit Hours	Degree, Diploma, Certificate Earned or # of Years	Major/Minor
College(s)/ University(ies)
College(s)/ University(ies)
College(s)/ University(ies)
Graduate or Professional Schools
Graduate or Professional Schools
Technical Institutes, Internship, Other

KNOWLEDGE, SKILLS & ABILITIES

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. If you wish consideration for a secretarial/clerical position, indicate typing speed and word processing software packages known and/or used.*

	Knowledge, Skills, or Abilities
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)

REGISTRATIONS, LICENSES, CERTIFICATIONS

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

	Type	State	ID Number	Expiration Date
Registration or License #1
Registration or License #2
Other

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 blanks spaces.*

DL Number State Issued

Drivers License
Is your driver's license a Commercial Driver's License?*

YesNo
What class is your Commercial Driver's License?*

	DL Number	State Issued
Drivers License

	Current or most recent employment(or explain gap in employment)
Job Title
Starting Salary
Last Salary
Date Employed
Date Separated
Employer or Company
Telephone #
Employer or Company Address
Name of most recent supervisor
Title of most recent supervisor
Full-Time (Years and Months)
Part-Time (Years and Months)
If part-time - # of hours per week
# of employees supervised by you
Duties in order of importance
Reason for leaving or desiring a change

	Next most recent employment(or explain gap in employment)
Job Title
Starting Salary
Last Salary
Date Employed
Date Separated
Employer or Company
Telephone #
Employer or Company Address
Name of most recent supervisor
Title of most recent supervisor
Full-Time (Years and Months)
Part-Time (Years and Months)
If part-time - # of hours per week
# of employees supervised by you
Duties in order of importance
Reason for leaving or desiring a change

	Next most recent employment(or explain gap in employment)
Job Title
Starting Salary
Last Salary
Date Employed
Date Separated
Employer or Company
Telephone #
Employer or Company Address
Name of most recent supervisor
Title of most recent supervisor
Full-Time (Years and Months)
Part-Time (Years and Months)
If part-time - # of hours per week
# of employees supervised by you
Duties in order of importance
Reason for leaving or desiring a change

	Next most recent employment(or explain gap in employment)
Job Title
Starting Salary
Last Salary
Date Employed
Date Separated
Employer or Company
Telephone #
Employer or Company Address
Name of most recent supervisor
Title of most recent supervisor
Full-Time (Years and Months)
Part-Time (Years and Months)
If part-time - # of hours per week
# of employees supervised by you
Duties in order of importance
Reason for leaving or desiring a change

	Next most recent employment(or explain gap in employment)
Job Title
Starting Salary
Last Salary
Date Employed
Date Separated
Employer or Company
Telephone #
Employer or Company Address
Name of most recent supervisor
Title of most recent supervisor
Full-Time (Years and Months)
Part-Time (Years and Months)
If part-time - # of hours per week
# of employees supervised by you
Duties in order of importance
Reason for leaving or desiring a change

	Next most recent employment(or explain gap in employment)
Job Title
Starting Salary
Last Salary
Date Employed
Date Separated
Employer or Company
Telephone #
Employer or Company Address
Name of most recent supervisor
Title of most recent supervisor
Full-Time (Years and Months)
Part-Time (Years and Months)
If part-time - # of hours per week
# of employees supervised by you
Duties in order of importance
Reason for leaving or desiring a change

	Next most recent employment(or explain gap in employment)
Job Title
Starting Salary
Last Salary
Date Employed
Date Separated
Employer or Company
Telephone #
Employer or Company Address
Name of most recent supervisor
Title of most recent supervisor
Full-Time (Years and Months)
Part-Time (Years and Months)
If part-time - # of hours per week
# of employees supervised by you
Duties in order of importance
Reason for leaving or desiring a change

	Next most recent employment(or explain gap in employment)
Job Title
Starting Salary
Last Salary
Date Employed
Date Separated
Employer or Company
Telephone #
Employer or Company Address
Name of most recent supervisor
Title of most recent supervisor
Full-Time (Years and Months)
Part-Time (Years and Months)
If part-time - # of hours per week
# of employees supervised by you
Duties in order of importance
Reason for leaving or desiring a change

	Next most recent employment(or explain gap in employment)
Job Title
Starting Salary
Last Salary
Date Employed
Date Separated
Employer or Company
Telephone #
Employer or Company Address
Name of most recent supervisor
Title of most recent supervisor
Full-Time (Years and Months)
Part-Time (Years and Months)
If part-time - # of hours per week
# of employees supervised by you
Duties in order of importance
Reason for leaving or desiring a change

If you wish to upload supporting documentation (such as a cover letter, resume, or certifications), you may do that here. (PDF only please). However, you are limited to one attachment.

Cancelof
Have you had a physical within the past 12 months?*

YesNo
Please upload a copy of your physical.*

Cancelof

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 Town.*

I understand
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 agree
I also authorize educational institutions which I attended to reveal my scholastic ratings, as well as degrees or certificates earned, to the Town of Topsail Beach; 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 Town receives from an employer or educational institution under a promise of confidentiality.*

I agree
I also permit the Town of Topsail Beach 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.*

I agree
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.*

I understand
I understand and acknowledge that should I be employed by the Town of Topsail Beach, 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 or by conduct unless such change is specifically approved by the Town Manager.*

I understand
SIGNATURE*

Clear
Should be Empty:

	Night work	Weekend Work	Overtime	Rotating Shifts	"On-Call"
Occasional
Regular
Frequent

	Name	Title	Company	Relationship	Email	Phone #
Reference # 1
Reference # 2
Reference # 3

EMPLOYMENT APPLICATION

CURRENT INFORMATION

GENERAL INFORMATION

EDUCATION

KNOWLEDGE, SKILLS & ABILITIES

REGISTRATIONS, LICENSES, CERTIFICATIONS

EMPLOYMENT

Work History