2. Return application to:
   Physical Address
   116 W Sycamore Street
   Lincolnton, NC 28092
   
   Mailing Address
   P.O. Box 617
   Lincolnton, NC 28093
4. Qualified applicants are considered for positions without regard to race, color, religion, sex, nationality, age, marital status or disability.
6. Answer all question in ink. Please print or type your name.
8. Date
10. First Name
11. Last Name
13. Address1
15. Address2
17. City
18. State
19. Zip
21. Phone
23. How did you hear about this vacant position?

    1. From a city employee
    2. Advertisement
    3. From a friend or relative
25. Reasons for Applying
27. Have you previously applied for work with the City of Lincolnton?

    1. Yes
    2. No
29. If yes, approximate date and position
31. Criminal Offense Record and License Information
    A conviction does not necessarily bar you from becoming a volunteer. The offense and how recently you were convicted will be evaluated in relation to the job for which you are applying.
33. Have you ever been convicted of an offense against the law other than a minor traffic violation?

    1. Yes
    2. No
34. If yes, give dates and details
36. Do you possess a valid driver’s license?

    1. Yes
    2. No
37. Do you possess a CDL?

    1. Yes
    2. No
39. Was your license ever suspended or revoked?

    1. Yes
    2. No
40. When was your license revoked?
42. Highest level of education completed
44. Educational Background
46. Did you graduate high school?
47. High School Location
49. Did you graduate College?
50. College Location and Major
52. Graduate level education?
53. College Location and Area of Study
55. Other
57. Describe any certification, licenses, specialized training, or skills, giving dates of issuance and source issuance.
59. Employment Data
    In the space below, give your employment history beginning with your present or most recent employer and list all positions held, including military, part-time, summer, and significant volunteer work. Details on any period of unemployment must be included. If additional space is needed, please use a sheet of paper. All additional sheets of paper containing job history must be signed and dated by the applicant.
61. May we contact your present employer?

    1. Yes
    2. No
63. Employer
64. Address
65. Phone
67. Job Title
68. Supervisor's Name
69. Do you supervise anyone?
    (Number of people)
71. Date Employed (month/year)
72. Starting Salary
73. Ending Salary
75. Reason for leaving
76. Date Separated (Month/Year)
78. Duties
80. Full Time:
    Years/Months
81. Part Time
    Years/Months
83. Employer
84. Address
85. Phone
87. Job Title
88. Supervisor's Name
89. Did you supervise anyone?
    Number of people
91. Date Employed (Month/Year)
92. Starting Salary
93. Ending Salary
95. Reason for Leaving
96. Date Separated
98. Duties
100. Full Time
     Years/Months
101. Part Time
     Years/Months
103. Other Qualifications
     Summarize special job-related skills and qualifications acquired from employment or other experience.
105. References
     Please list 3 persons who are not related to you and have a definite knowledge of your work. Do not repeat the names of supervisors listed in the employment data section of this application.
107. First Name
108. Last Name
110. Address1
111. Phone
113. First Name
114. Last Name
116. Address1
117. Phone
119. First Name
120. Last Name
122. Address1
123. Phone
125. Please read carefully before signing.
     I hereby certify that each and every statement made on this form is true and complete. I authorize the City of Lincolnton to conduct whatever investigation it deems necessary to confirm the answers submitted on this application. I understand that any misstatement or omission of information will subject me to disqualification or dismissal.
     
     I authorize and understand a thorough background check, including a criminal record check, driving record check, and/or credit check may be conducted.
     
     This application is not an offer of employment, nor should it lead to an expectation of employment.
127. Signature in Full
128. Date
130. Printed Name
Leave This Blank:


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

     This field is not part of the form submission.

134. Submit

* indicates a required field