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Town of Hillsborough
Human Resources Department
(Mail) PO Box 429, Hillsborough, NC 27278
(Office) 101 E. Orange Street, Hillsborough, NC 27278
Office (919)-732-1270; FAX (919)-732-3921
Internet: Hwww.ci.hillsborough.nc.us
Application Date
(mm/dd/yy)
Position Title
 
 
It is the policy of the Town of Hillsborough to hire and promote the best-qualified individual(s) available. To this end, no person shall be refused employment, denied promotion or assignment, discharged or otherwise discriminated against or given preference in any aspect of the employment relationship on the basis of race, gender, religion, age, political affiliation, national origin, sexual orientation, physical or mental disability, or any other non-job related factor, except when certain physical and mental requirements are bona-fide occupational qualifications.
testing
last Name First Name Initial Phone(Day) Evening E-mail Address
Mailing Address Street City State Zip
Immigration Reform & Control Act Drivers License Information
After employment, you will be required to submit verification of your legal right to work in the United States. The Town of Hillsborough employs only United States citizens or aliens who can provide proof of identity and work authorization within 3 working days of employment.
Does the position you are applying for require a driver's license?
   Yes    No If YES, you MUST. provide the information below.
License # State Issued Class or Type Expiration Date
(mm/dd/yy)
job
Name of School School Address
(City & State)
Dates Attended
From To
Type of Degree
or Diploma Received		 Major Subjects Studied
High School (Includes GED equivalency) Mo Yr Mo Yr (N/A if not complete)  
General Studies
Colleges or Universities Mo Yr Mo Yr (N/A if not complete)  
Technical, Vocational, or Military Training Mo Yr Mo Yr (N/A if not complete)  
Describe job-related skills, knowledge, special training, or licenses you have pertaining to the position. Please identify skills using computer software such as Word, Excel, PowerPoint, Access, or other specialized computer software:
1. Are you now, or have you ever been, employed by the Town of Hillsbrough? If YES, identify most recent employment dates, job title, department assigned, and / or reason for leaving in the "comments" section below.
Yes No
2. Do you have any relatives currently employed by the Town of Hillsborough? If YES, list their name(s), position, title, department assigned, and their relationship to you in the "comments" section below
Yes No
3. Were you ever discharged or forced to resign from employment due to misconduct or unsatisactory services? If YES, explain in the "comments" section below. Prior discharges or orced resignations will not necessarily disqualify you from employment.
Yes No
4. This question if for Males 18 through 25 Only - Federal law requires males age 18 through 25 to register with the Federal government to comply with the Military Selective Service Act. North Carolina GS 143B-421.1 prohibits local governments from employing any males who have not complied with the federal Selective Service Registration regulations. If this requirement pertains to you, have you complied with the Federal law? (check the appropriate box to the right).
Yes No
Comments (for any YES answer from above, give number and explain):
 
Have you EVER been convicted of a civil or criminal violation of the law, other than a minor traffic violation? (Exclude juvenile offenses if records legally sealed). Convictions will not necesarily disqualify you from employment.
Yes No
Have you EVER been convicted of reckless driving or driving under the influence of alcohol or other drugs, OR has your driver's license ever been suspended or revoked as a result of a conviction(s) o a driving violation(s)? Convictions will not necessarily disqualiy you from employment.
Yes No
experience
Beginning with your current or most recent position, list all time periods of employment, unemployment, or volunteer experience over the past 10 years sowing changes in title or promotions separately. Attach additional sheets or resume if needed; however, a resume will not substitute for the information required in this section.
From To
Mo Yr Mo Yr
Name of Employer Current or Last Position Title Employees
Supervised
Prior Employment Status Address City ST ZIP Supervisor Name Phone
Full Time Part Time
Reason for wanting to leave? Salary; and Duties
From To
Mo Yr Mo Yr
Name of Employer Current or Last Position Title Employees
Supervised
Prior Employment Status Address City ST ZIP Supervisor Name Phone
Full Time Part Time
Reason for wanting to leave? Salary; and Duties
From To
Mo Yr Mo Yr
Name of Employer Current or Last Position Title Employees
Supervised
Prior Employment Status Address City ST ZIP Supervisor Name Phone
Full Time Part Time
Reason for wanting to leave? Salary; and Duties
From To
Mo Yr Mo Yr
Name of Employer Current or Last Position Title Employees
Supervised
Prior Employment Status Address City ST ZIP Supervisor Name Phone
Full Time Part Time
Reason for wanting to leave? Salary; and Duties
certification
I certify that all statements made in this application are true, complete and correct to the best of my knowledge and belief, and that any alse statements or major omissions shall be considered sufficient cause for employment disqualification or dismissal. I further acknowledge that any or all information provided by me is subject to verification and hereby autorize te Town of Hillsborough to conduct a personal background investigation of me including any current or prior criminal arrests, convictions, and driving history. By my signature below, I authorize the Town of Hillsborough to contact my current and / or all former employers, as well as schools or other educational institutions that I may have attended, and obtain any information about my qualifications for employment including current or prior work history, scholastic ratings and records, and any other information they may have regarding me, whether or not it is on their records. I also authorize my current and / or former employers and educational institutions to release any information requested by the Town of Hillsborough.
   
Applicant Signature Signature Date

Town of Hillsborough
Equal Opportunity Employer Questionnaire

PLEASE COMPLETE THIS FORM - IT WILL BE REMOVED PRIOR TO PROCESSING

In order to comply with United States Government Equal Employment Opportunity requirements, all applicants for employment are requested to complete this form. Data collected will be used for statistical reporting purposes and to measure the effectiveness of recruitment efforts and selection procedures. This information is requested on a voluntary basis, will be kept confidential, and is not available to hiring authorities. Refusing to provide the information will not result in any adverse treatment with respect to the employment or selection process.

The Town of Hillsborough is an equal opportunity employer. In accordance with applicable laws and regulations, the Town does not discriminate on the basis of disability or other prohibited criteria. If you believe you have been treated unfairly or discriminated against on the basis of race, color, national origin, gender, age, religion, political affiliation, sexual orientation, or disability, please contact the Human Resources Department at (919) 732-1270 Ext. 71.

Effective Date(mm/dd/yy)
Job Title
Applicant Name
  Female Male
Are you a veteran of the United States Armed Forces? Yes       No   
If "Yes" - Branch of Service Type of Discharge
Ethnic Origin (Check One)
White (not of Hispanic origin): All persons with origins in any of the peoples of Europe, North Africa or the Middle East
Black (not of Hispanic origin): All persons with origins in any of the black racial groups of Africa.
Hispanic: all persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
Asian or Pacific Islander: All persons with origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes for example, China, India, Japan, Korea and Samoa
American Indian or Alaskan Native: All persons with origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

To help us ensure our recruitment efforts are targeted to and reaching all segments of our recruitment area and community, please identify how you first learned of this job opening (check only one box).

A Friend or Relative Cable or other TV/Radio (which channel):
A City Employee Newspaper (name):
Internet (identify web site): Other means (identify):
If you are disabled and would like to request testing accomodations, please describe:

Thank you for making an application for this position and in your decision to select the Town of Hillsborough as a possible employer. If you need clarification of information on this form, please contact the Human Resources Department at (919)- 732-1270 Ext. 71.