McDowell County Application for Employment

McDowell County Application for Employment
INSTRUCTIONS TO APPLICANTS
THANK YOU FOR YOUR INTEREST IN MCDOWELL COUNTY EMPLOYMENT. IT IS OUR INTENT TO FIND THE BEST QUALIFIED PEOPLE AVAILABLE TO SERVE OUR CITIZENS; ALTHOUGH EVERYONE WHO APPLIES CANNOT BE HIRED, YOUR APPLICATION WILL BE GIVEN EVERY CONSIDERATION.

PLEASE ANSWER ALL QUESTIONS AND COMPLETE ALL SECTIONS OF THIS APPLICATION FORM.

MCDOWELL COUNTY EMPLOYS ONLY UNITED STATES CITIZENS OR ALIENS WHO CAN PROVIDE PROOF OF IDENTITY AND WORK AUTHORIZATION WITHIN 3 WORKING DAYS OF EMPLOYMENT.
WHEN COMPLETING THIS APPLICATION, PLEASE MAKE SURE YOU:
- COMPLETE THE SECTION FOR EQUAL OPPORTUNITY INFORMATION.
- APPLY FOR ONE VACANCY PER APPLICATION.
- GIVE COMPLETE INFORMATION ON YOUR EDUCATION AND WORK HISTORY (“SEE RESUME” IS NOT ACCEPTABLE)
- LIST SEPARATELY EACH JOB HELD AND YOUR DUTIES FOR EACH POSITION WHEN YOU WORKED FOR ONE EMPLOYER AND HELD MORE THAN ONE POSITION.
- AS YOU DESCRIBE YOUR WORK HISTORY, MAKE SURE YOU HIGHLIGHT YOUR COMPETENCIES (KNOWLEDGE, SKILLS, ABILITIES AND WORK BEHAVIORS) WHICH DEMONSTRATE YOUR QUALIFICATIONS FOR THE POSITION FOR WHICH YOU ARE APPLYING.
- PROVIDE ONLY THE LAST FOUR DIGITS OF YOUR SOCIAL SECURITY NUMBER.
- CHECK FOR ACCURACY, SIGN AND DATE YOUR APPLICATION.
(Based on PD 107, Rev 1/28/2022)
Equal Opportunity Information

Our policy prohibits discrimination based on race, sex, color, creed, national origin, age or disability. Sex, age or absence of disability is a bona fide occupational qualification in a small number of County jobs. The information requested below will in no way affect you as an applicant. Its sole use will be to see how well our recruitment efforts are reaching all segments of the population.
Email Address
example@example.com
Ethnic Group*

White (non-Hispanic)Black (non-Hispanic)Hispanic (Mexican, Puerto Rican, Cuban, Central or South American, other Spanish origin regardless of race)Asian (including Pacific Islander)American Indian (including Alaskan native)
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date

Personal Information
Date of Application*

MonthDayYear
Date
Last 4 Digits of Social Security No.*
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Home Number*
Please enter a valid phone number.
Cell Number*
Please enter a valid phone number.
Do you now work for McDowell County?*

YesNo
Are you related by blood or marriage to any person now working for McDowell County?*

YesNo
If yes, give name, relationship to you and the agency where employed.*

Availability
Check the types of work you will accept:*

Permanent full-timePermanent part-timeTemporary full-timeTemporary part-timeAny of the precedingWork involving travelShift or split shift work
If you are not available for work now, enter the earliest date you could begin work (mo/day/yr).
Job Applied For (Enter below the specific title for the job for which you are applying. *
Job Applied For (Enter below the specific title for the job for which you are applying.
Referral Source

Military Service
Have you served honorably in the Armed Forces of the United States on active duty for reasons other than training?*

YesNo
Do you wish to declare a service-connected disability?*

YesNo
At the time of this application, are you the surviving spouse or dependent of a deceased veteran who died from service-related reasons?*

YesNo
Do you wish to declare eligibility for veterans preference as the spouse of a disabled veteran?*

YesNo
Give dates of your (or spouse's) qualifying active military service:
Entered: Entered Separated: Separated
Branch: Branch Rank: Rank

Work History

(include volunteer experience) Use additional sections if necessary. As you describe your work history experiences, make sure you highlight your competencies which demonstrate your qualifications for the position for which you are applying.
Current or Last employer:
Address:
Job Title:
Supervisor's Name:
Phone Number
Please enter a valid phone number.
No. Supervised by you:
Date Employed (mo/yr):
Date Separated (mo/yr):
Starting Salary: blanks per blank .
Ending or Current Salary: blanks per blank .
Reason for Leaving:
May we contact employer?

YesNo
Full Time: (Years, months)
Part Time: (Years, months)
If part time, number of hours worked per week:
List major duties that demonstrate your competencies related to the position for which you are applying in order of their important in the job:

Additional Work History
Employer:
Address:
Job Title:
Supervisor's Name:
Phone Number
Please enter a valid phone number.
No. Supervised by you:
Date Employed (mo/yr):
Date Separated (mo/yr):
Starting Salary: blanks per blank .
Ending or Current Salary: blanks per blank .
Reason for Leaving:
Full Time: (Years, months)
Part Time: (Years, months)
If part time, number of hours worked per week:
List major duties that demonstrate your competencies related to the position for which you are applying in order of their important in the job:

Additional Work History
Employer:
Address:
Job Title:
Supervisor's Name:
Phone Number
Please enter a valid phone number.
No. Supervised by you:
Date Employed (mo/yr):
Date Separated (mo/yr):
Starting Salary: blanks per blank .
Ending or Current Salary: blanks per blank .
Reason for Leaving:
Full Time: (Years, months)
Part Time: (Years, months)
If part time, number of hours worked per week:
List major duties that demonstrate your competencies related to the position for which you are applying in order of their important in the job:

I certify that I have given true, accurate and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigation of all statements made in this application and understand that false information or documentation, or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action or dismissal if I am employed, and (or) criminal action. I further understand that dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet position qualifications (Authority: G.S. 126-30, G.S. 14-122.1

Unsigned applications will not be processed
Signature*

Clear
Date of Application*

MonthDayYear
Date

Drug Screening Consent Through Urinalysis
I, Full Legal Name*understand that as part of the preemployment process I am required to submit to a urinalysis drug screening. This is in accordance with the policy of McDowell County to maintain a workforce that is free of illegal drug abuse.

I do hereby voluntarily consent to the sampling and submission for testing of my urine for the purpose of screening for the presence of illegal drugs and/or an abusive level of prescribed medication. I understand that a positive result from this screening may be a condition of employment and may bar me from employment with McDowell County for a period of one year.

I authorize disclosure of the drug screen results by and between the testing
laboratory, Medical Review Officer and the employing agency.
Full Legal Name*
Social Security Number*
Signature*

Clear
Date*

MonthDayYear
Date

Background Check Consent Form

Wolfe Reality Check Consumer Report and Investigative Consumer Report Disclosure (For Employment Purposes)
Part 1 - Authorization for release of information (for employment purposes)

I hearby authorize Agency to receive information and disclose such information to its customers for the purpose of making a determination as to my eligibility for employment, promotion, retention or other lawful purpose. If hired or contracted, I authorize Agency and to retain this document on file to as as ongoing authorization for the procurement and possession of Reports at any time during my employment or contact period. I full release Agency and Suppliers from all claims of damages related to the investigation of my background and provision of information as set forth in this disclosure and authorization. I agree that information in Agency's possession may be supplied by Agency for legally permissible purposes; provided, such information will not include the Drug and Alcohol information set forth above, unless I have given a separated specific consent for Agency to share such information.

By signing below, I certify that: (i) all information provided herein is complete and accurate; (ii) I have read and fully understand this disclosure and authorization for release; (iii) prior to signing, I was given an opportunity to ask questions and to have those questions answered to my satisfaction; (iv) I execute the authorization voluntarily and with the knowledge that the informatio nobtained pursuant to this authorization could affect my eligibility for employment, promotion, retention or other lawful purpose; (v) I understand I may review this document with legal counsel prior to signing; (vi) I authorize Agency and any person or entity contacted by Agency to furnish the above mentioned information; and (vii) facsimile or photographic copies of this authorization are as valid as the original.

I understand that if I do not consent, any offer of my employment or contract will be withdrawn. If hired failure to cooperate with you or Agency regarding a current or future report will be cause to terminate my employment or contract.
Legal Printed Name*
Address*
Social Security Number*
Date of birth*

MonthDayYear
Date
Driver's License State and Number*
Signature*

Clear
Today's Date*

MonthDayYear
Date

McDowell County Pre-Hire Job Reference Requirements

If you are one of our finalists for a position, Human Resources will require professional and qualitative references from your current employer, direct supervisor or previous employers before an offer may be extended. Employers often require current/former employees to sign releases to allow references to be given. It is your responsibility to ensure you have completed the required steps to allow employer(s), to provide reference to McDowell County.
APPLICANT'S PERMISSION TO REQUEST PERFORMANCE INFORMATION FROM CURRENT AND PREVIOUS EMPLOYERS
I, Full Legal Name*authorize McDowell County to request job performance information from the organizations and individuals listed below. This information may include my suitability for re-employment with the agency; my skills, abilities, and traits as they may relate to my suitability for future employment; and the reason for my separation. I understand that I am responsible for completing any paperwork/process necessary to allow this information to be provided to McDowell County.
Employer #1
Direct Supervisor
Phone Number
Please enter a valid phone number.
Employer #2
Direct Supervisor
Phone Number
Please enter a valid phone number.
Employer #3
Direct Supervisor
Phone Number
Please enter a valid phone number.
Please contact me prior to requesting references from the agencies/persons listed above...

YesNo
Signature

Clear
Date

MonthDayYear
Date
Applicants who are local or state government employees should be aware that North Carolina law allows their employers to release certain information about their job history and job performance to a prospective employer.

153A-98. Privacy of employee personnel records.
(a) Notwithstanding the provision of G.S. 132-6 or any other general law or local act concerning access to public records, personnel files of employees, former employees, or applicants for employment maintained by a county subject to inspection and may be disclosed only as provided by this section. For purposes of
this section employee’s personnel file consists of any information in any form gathered by the county with respect to the employee and, by way of illustration by not limitation, relating to their application, selection or non-selection, performance, promotions, demotions, transfers suspension and other disciplinary actions,
evaluation forms, leave, salary, and termination of employment. As used in this section, “employee” includes former employees of the county.

(b) The following information with respect to each county employee is a matter of public record.
(i) Name.
(ii) Age.
(iii) Date of original employment or appointment to the county service.
(iv) The terms of any contract by which the employee is employed whether written, oral, past and current, to the extent that the county has the written contract or a record of the oral contract in its possession.
(v) Current position.
(vi) Title.
(vii) Current salary.
(viii) Date and amount of each increase or decrease in salary with that county.
(ix) Date and type of each promotion, demotion, transfer, suspension, separation or other change in position or classification with that county.
(x) Date and general description of the reasons for each promotion within that county.
(xi) Date and type of each dismissal, suspension, or demotion for disciplinary reasons taken by the county. If disciplinary action was a dismissal, a copy of the written notice of the final decision of the county setting forth the specific acts or omissions that are the bases of the dismissal.

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Please upload any necessary documents you would like provide alongside your completed Application for Employment. This may include resumes, transcripts, certifications, etc.
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	Name & Location	Dates Attended (mo/yr) From: To:	Grad? Y/N	S/Q Hrs.	Major/Minor Course Work	Type of Degree Received
High School
College
Graduate
Other Educational, vocational school, internships, etc.

McDowell County Application for Employment

INSTRUCTIONS TO APPLICANTS

Equal Opportunity Information

Personal Information

Availability

Military Service

Education

Skills

Work History

Additional Work History

Additional Work History

Drug Screening Consent Through Urinalysis

Background Check Consent Form

McDowell County Pre-Hire Job Reference Requirements

Document Upload