APPLICATION FOR EMPLOYMENT

Serving our community since 1965

2177 Asheville Rd., Waynesville. NC 28786

828 452 1447

154B Medical Park Loop. Sylva, NC 28779

828 586 2345

mountainprojects.org

Date

Mountain Projects, Inc. is an Equal Opportunity Employer where employment is based upon personal capabilities and qualifications without discrimination because of race. color. gender. religion. national origin. Other forms of discrimination as protected by law are not factors in employment, promotion, compensation or working conditions.

Name

First NameMiddle NameLast Name

Address

Address (Street number and name)

Street Address Line 2

City

County

State

Zip Code

Phone (Home or where you can be reached)

Business Phone

E Mail address

example@example.com

Yes Are you legally eligible to work in the United States? Yes Are you related to anyone currently employed at Mountain Projects? If yes, please give information.

Are you 18 years of age or older?

YesNo

Are you legally eligible to work in the United States?

YesNo

Are you related to anyone currently employed at Mountain Projects?

YesNo

Name

Dept.

To your knowledge, are you related to any member of the Board of Directors or anyone serving on an agency committee?

YesNo

If yes, please explain

Were you ever employed here?

YesNo

If yes, when?

Are you or any member of your household currently receiving any type of compensation from Mountain Projects, Inc.?

YesNo

If yes, please explain

How did you hear about us/this opening?

State briefly why you would like to work for Mountain Projects, Inc.

Please list all pending and prior criminal arrests including child and/or elderly abuse and neglect. List convictions related to other forms of child abuse and/or neglect/elderly abuse and all convictions of violent felonies.

Enter the specific title of the position for which you are applying

Date you can start

Date

Salary required

Are you employed now?

If so, may we contact your current employer?

Mountain Projects checks work references on each person we consider for employment. Please give a telephone number and contact name for each former employer. Those applications without these items will not be considered for a position with the agency.

Current or Last Employer

Address

Job Title

Supervisor's Name

Telephone Number

No. Supervised by you

Date Employed (mo/yr)

Date

Starting Salary: per

Ending Salary: per

Reason for Leaving

Date Separated (mo/yr)

Date

Full Time (years/months)

Part Time (years/months)

List major duties in order of their importance in the job

If part time, number of hours worked per week

May We Contact Your Current Employer

YesNo

Employer

Address

Job Title

Supervisor's Name

Telephone Number

No. Supervised by you

Date Employed (molyr)

Date

Starting Salary: per

Ending Salary: per

Reason for Leaving

Date Separated (mo/yr)

Date

Full Time (years/months)

Part Time (years/months)

If part time, number of hours worked per week

List major duties in order of their importance in the job

Employer

Address

Job Title

Supervisor's Name

Telephone Number

No. Supervised by you

Date Employed (mo/yr)

Date

Starting Salary: per

Ending Salary: per

Date Separated (mo/yr)

Date

Reason for Leaving

Full Time (years/months)

Part Time (years/months)

If part time, number of hours worked per week

List major duties in order of their importance in the job

References: Please Include one personal reference and two work references. Name

Address

Phone

Cell Phone

Years Known

Name

Address

Phone

Please enter a valid phone number.

Cell Phone

Please enter a valid phone number.

Years Known

Name

Address

Phone

Please enter a valid phone number.

Cell Phone

Please enter a valid phone number.

Years Known

Highest Grade Completed

Name and Location of High School Attended

Did you Graduate?

YesNoGED

College? If yes, number of years

1234

Graduate School? If yes, number of years

1234

College/University Name and Location

Dates Attended (mo/yr): From To

Did you Graduate?

YesNo

Major/Minor Course Work

Type of Degree Received

Graduate or Professional School Name and Location

Dates Attended (mo/yr): From blanks toblank

Did you Graduate?

YesNo

Major/Minor Course Work

Type of Degree Received

Other educational, vocational school internships. etc. Name and Location

Dates Attended (mo/yr): From to

Did you Graduate?

YesNo

Major/Minor Course Work

Type of Degree Received

Please check the following skill, experience, etc which you have that are relevant for the position for which you are applying:

Foreign language (specify)

List Computer Program Skills:

Driver's License Number and State

Do you have any other experience, training, qualifications or skills that you feel make you especially suited for work at Mountain Projects, Inc.? If so, explain in detail below

Mountain Projects, Inc. Application for Employment. Page 4 Please Read and Initial Each Paragraph Below (if there is any part of this page you do not understand, please ask the Human Resource Manager about it before signing

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I. the undersigned applicant, have personally completed this application. I understand that any omission or misstatement on this application or on any documents used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Mountain Projects, Inc. to thoroughly investigate my references, work records, education and other matters related to my suitability for employment and, further. authorize my current and former employers to disclose to the company any and all letters, reports and other information pertaining to my employment with them, without giving me prior notice of such disclosure. In addition. I hereby release Mountain Projects, Inc., my current and former employers, and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that if offered employment. the offer is contingent on a negative pre employment criminal background check and on a negative alcohol and drug screen. By signing this application, I voluntarily agree to have my criminal background checked and to take a pre employment alcohol/drug screen. I further understand that a positive result in either of these screenings will result in withdrawal of the employment offer. I acknowledge that if hired I will be subject to random, reasonable suspicion. and post accident drug tests, and that failure to comply with these tests will be considered automatic termination. Employment may also be terminated should criminal record checks warrant, misrepresenting information relevant to checks, and in case of future convictions.

If hired, I also agree to submit to random alcohol or drug testing as a condition of employment. I agree that Mountain Projects, Inc. may conduct alcohol or drug screening at its sole discretion with or without notice, with or without cause or reason. I also understand that refusal to submit to a random alcohol/drug screen will be considered a voluntary resignation of employment.

If hired for Haywood Public Transit, I agree to submit at anytime to random alcohol and or drug testing as required by the US Department of Transportation (DOT) 49 CFR Part 40 as amended for safety sensitive positions. Testing can occur during the beginning, middle or end of an employee's schedule.

I understand and agree that any future changes in my title. duties. compensation, working conditions, and/or Mountain Projects, Inc. benefits, policies and procedures will not alter our at will or any other agreements.

I understand that nothing contained in the application or conveyed to me during any interview which may be granted is intended to create an employment contract, implied or explicit, between me and Mountain Projects, Inc. In addition, I understand and agree that if I am employed, my employment relationship with Mountain Projects, Inc. is strictly voluntary and at our mutual will. I understand that if employed. my employment is for no definite period and may be terminated at any time, with or without prior notice. with or without cause or reason. at the option of either myself or Mountain Projects. Inc., and that nopromises or representations contrary to the forgoing are binding on Mountain Projects, Inc. unless made in writing and signed jointly by the Executive Director and myself.

I understand that if offered employment, I will. as a condition of employment. be required to submit proof of my identity and legal right to work in the United States on my first day of employment.

My signature below certifies that I have read and understand this complete page, and agree to the terms and conditions outlined in this document.

Clear

I have not tested positive for Drugs or Alcohol within the last two (2) years.

Applicant's Signature

Clear

Date

Mountain Projects, Inc. Application for Employment. Page 5

Mountain Projects, Inc. policy prohibits discrimination in hiring, promotion, or termination based on race, sex, color, creed, national origin, age, disability, or veteran status. However, the Equal Employment Opportunity Commission (EEOC) requires that we keep a record of the gender and race of all applicants. This information will NOT remain with your application and in NO WAY affects you as an applicant. Its sole purpose is to comply with the requirements of the EEOC. Completion of this form is voluntary.

Sex

MaleFemale

Ethnic Group

White (non-hispanic)Black (non-hispanic)Hispanic (Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish Origin)Asian (including Pacific Islander)American Indian

Veteran Status

Not a VeteranVeteranVietnam Era Veteran

APPLICATION FOR EMPLOYMENT

Work History

Education