CITY OF SHELBY
APPLICATION FOR EMPLOYMENT
Current Information
Date 1/14/14
Position applied for Customer Service Respresentative
When will you be available for employment? with in a two week notice
Are you seeking: Full-time Part-time Summer Work
Alexis Janay
Henderson
NAME
Last First Middle
NC 28150
309-l Howell St Shelby
ADDRESS
Street & No. or P.O. Box City State Zip
**************@*****.***
PHONE
Home Secondary Phone E-mail Address
General Information
a. Have you ever been employed with the City of Shelby? Yes No
If yes, what department and when
b. Are you related by blood or marriage to any City employee? Yes No
If yes, give name, relationship, and department
c. Were/Are you a member of the U. S. Armed Forces? Yes No
If yes, give the branch and dates of service
d. Have you ever been convicted of or plead guilty to a crime? Yes No
If yes, please explain each conviction, nature of offense, date(s) of conviction, sentence, and type(s) of rehabilitation, if any.
Please include any major traffic violations.
NOTE: A conviction will not automatically bar you from employment.
P. O. Box 207, Shelby, NC 28151-0207
Telephone: 704-***-**** Internet Address: www.cityofshelby.com
Education
(GIVE COMPLETE EDUCATIONAL HISTORY BELOW)
High School: Name Garner High Location Garner, NC
Select highest school year completed: 1 2 3 4 5 6 7 8 9 10 11 12
If you did not graduate, do you have a High School Equivalency (GED)? Yes No
Education beyond Name and Select No. Years Degree Major
High school Location Completed Certificate Subject
n/a
College or
1 2 3 4
University
n/a
Graduate or Professional 1 2 3 4
Certifica Business and
Lyndon B. Johnson Job Corps
Office
Center te
Other Education 1 2 3 4
Administration
Skills and Certifications
Professional License Equipment Computer or
and/or Skills Other Skills
Certifications Special Training
OSHA Training Microsoft Excel Knowledge
Mircosoft Word cerification
Microsoft Powerpoint Cerification
Employment
Record your complete work history in the spaces below. Begin with your current or most recent employer first. Attach as
many sheets as is necessary to account for your full record. Be sure to account for gaps in your employment history.
Please complete the employment history information even if a resume is attached. Related volunteer experience should also
be listed.
A. CURRENT OR MOST RECENT EMPLOYMENT
Job title Beauty Advisor and Customer service Rep. Starting Salary $ 7.50 Last Salary $ 7.65
Name and title of supervisor Stacey Hall No. of employees you supervise 0
Employer or company Walgreens
Address 231 East Dixon blvd
Date Employed 10/25/12 Date Separated Telephone 704-***-****
Main Duties
handling money, cleaning, helping all customers
Full-time Years 1 Months 3 Part-time Years Months
Reason for leaving still employed at this time
If part-time, number of hours worked per week
If currently employed, may we inquire of this employer about your qualifications and character? Yes No
B. NEXT MOST RECENT EMPLOYMENT
Job title Office Clerk Starting Salary $ 0.00 Last Salary $ 0.00
Name and title of supervisor Rhonda Stephens No. of employees you supervise
Employer or company Lyndon B Johnson Job Corps center
Address
Date Employed 10/6/11 Date Separated 6/6/12 Telephone
Main Duties
answering and direct calls to correct parties, filing, coping
Full-time Years Months Part-time Years Months 8
Reason for leaving finished program
If part-time, number of hours worked per week
C. NEXT RECENT EMPLOYMENT
Job title office clerk Starting Salary $ 0.00 Last Salary $ 0.00
Name and title of supervisor Rhonda Stephens No. of employees you supervise
Employer or company Franklin unemployment service commissions
Address
Date Employed 4/1/12 Date Separated 5/1/12 Telephone
Main Duties
answering phones, helping customer, filing, coping
Full-time Years Months Part-time Years Months 1
Reason for leaving finished trainning program
If part-time, number of hours worked per week
References
List three (3) persons who are not related to you and who have a definite knowledge of your ability
to perform the job for which you are applying. DO NOT REPEAT NAMES OF SUPERVISORS.
(1) Name James Parham Address
Telephone 828-***-****
(2) Name Mary Livingston Address
Telephone 828-***-****
(3) Name Jewel Dunn Address
Telephone 919-***-****
Read Carefully before submitting
I certify that all answers and statements on this application are true and complete. I understand that any falsification, omission, or
misrepresentation of facts in this application, in connection with my pre-employment physical examination or in connection with
any aspect of the hiring process, will be cause for either the rejection of this application or for my discharge if I have been hired.
I understand that my employment will be contingent upon my passing a physical examination. I also understand that future
examinations may be required by the City of Shelby. I am aware that the City of Shelby requires screening for drugs and alcohol
as part of its pre-employment testing and that I may be required to take future examinations.
I authorize the City of Shelby to make any inquiry or investigation deemed necessary to consider my employment application. This
may include contacting former employers and criminal records check. I understand that conviction of a crime will not
automatically bar my employment. I may still be eligible for employment if the City of Shelby determines my conviction could
have no bearing to the job for which I am applying.
I authorize former employers and schools to release all information the City of Shelby requests from them concerning my academic
records, job performance, attendance, personal evaluation, or other related information. I release from liability and /or damages
all parties which may give information regarding my application.
If my employment with the City of Shelby terminates for any reason, I authorize the City of Shelby to release all information and to
answer any inquiries regarding my employment, performance, and the reasons for my termination.
I understand that if I am employed my employment will be on a trial basis for 6 months. Before and after the probationary period
my employment is “at will;” It can be terminated at anytime by me or the City of Shelby. I also understand that the terms, policies,
procedures, and rules of employment are not guaranteed. They are subject to change at any time by the City of Shelby.
Although I may be employed for a specific work schedule, I understand the City of Shelby does not guarantee my work schedule
and may alter it as necessary.
I understand this application is current for only the specified job I am applying for. I will complete a new application should I not
be hired for the applied for position if future job opportunities become available that I may be interested in.
Signature Date