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Current Information

Name
Last, First, Middle
Address
City
State
Zip Code
Primary Telephone Number
Secondary Telephone Number
Email Address*
Are you 18 years or older?
1. Yes
2. No
If 'No', what is your date of birth?
Applying for Position
Date
Date
When will you be available for employment?
Examples include: Immediately, 2 weeks notice, etc.
Are you seeking:
1. Full Time Regular
2. Part Time Regular
3. Temp./Prefer Regular
4. Temporary Only
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General Information

Education/Knowledge, Skills & Abilities

Provide your complete education history
Indicate highest school year completed (i.e. 8, 12, 16)
Name of High School
City
State
Have you received a high school diploma or equivalent?
1. Yes
2. No
Please list all college(s)/university(ies)
Name & Location, Attended from (Month/Year to Month/Year), Indicate if you graduated, Indicate how many credit hours received, Degree/Diploma/Certificate Earned or # of years and Major/Minor
Please list all graduate or professional school experience
Name & Location, Attended from (Month/Year to Month/Year), Indicate if you graduated, Indicate how many credit hours received, Degree/Diploma/Certificate Earned or # of years and Major/Minor
Please list all technical institutes, internships, other attended
Name & Location, Attended from (Month/Year to Month/Year), Indicate if you graduated, Indicate how many credit hours received, Degree/Diploma/Certificate Earned or # of years and Major/Minor
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 an administrative/clerical position, indicate typing speed and word processing software packages known and/or used
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Registrations, Licenses & Certifications

Please list fields of work for which you have been registered, licensed or certified
If possible, please upload file with registrations, licenses & certifications photocopied/scanned
Please upload your photocopied/scanned valid driver's license and the state in which it was issued. If you do not have a driver's license, please leave this section blank
Is your driver's license a Commercial Driver's License?
1. Yes
2. No
Please indicate class
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Employment

Record your complete work history in the spaces below. If needed, please upload an additional file containing the same information and in the same format. BEGIN with your current or most recent position. Include military and 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.
Current or Most Recent Employment (or explain gap in employment)
Job Title
Starting Salary
Ending Salary
Date employed and Date separated
Date employed and Date separated Start Date
—
Date employed and Date separated End Date
Employer/Company
Employer/Company Address
Telephone Number
Name & Title of most current supervisor
Full-Time for
Years and Months (answer N/A if not applicable)
Part Time for
Years and Months (answer N/A if not applicable)
Duties listed in order of importance
How many hours per week?
Number of employees supervised by you
Reason for leaving
Next Most Recent Employment (or explain gaps in employment)
Job Title
Starting Salary
Ending Salary
Date employed and date separated
Date employed and date separated Start Date
—
Date employed and date separated End Date
Employer/Company
Employer/Company Address
Telephone Number
Name & Title of Previous Supervisor
Full-Time for
Years and Months (answer N/A if not applicable)
Part-Time for
Years and Months (answer N/A if not applicable)
Duties listed in order of importance
How many hours per week?
Number of employees supervised by you
Reason for leaving
Next Most Recent Employment (or explain gap in employment)
Job Title
Starting Salary
Ending Salary
Date employed and date separated
Date employed and date separated Start Date
—
Date employed and date separated End Date
Employer/Company
Employer/Company Address
Telephone Number
Name & Title of Previous Supervisor
Full-Time for
Years and Months (answer N/A if not applicable)
Part-Time for
Years and months (answer N/A if not applicable)
Duties listed in order of importance
How many hours per week?
Numbers of employees supervised by you
Reason for leaving
Please upload additional employment information if applicable
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Disciplinary Action

Have you had any disciplinary action taken against you in the past 12 months?
1. Yes
2. No
Explain
Have you ever been dismissed or forced to resign from any job held?
1. Yes
2. No
Were you dismissed or forced to resign for disciplinary reasons?
1. Yes
2. No
Explain
This will NOT automatically disqualify you
May we contact your present employer or any employer identified in response to the questions in this section prior to an interview (if granted)?
1. Yes
2. No
3. N/A (if not currently employed)
Explain
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Certification and Release

Certification and Release (Must be Signed and Dated Below)
- 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 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 whatever 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 Town of Boone; 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 also permit the Town of Boone to conduct a Police, Court, Credit and/or Moter Vehicle Records Investigation of my background related to the job I am applying.
- 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 and acknowledge that should I be employed by the Town of Boone, 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 conduct unless such change is specifically approved by the Town Manager.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature
Date
Date
It is Required to Fill Out the Town of Boone's Equal Employment Opportunity Form
The Town of Boone's Equal Opportunity Employment Form can be found after submitting the Career Application

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Current Information

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