Application Form

We are an Equal Opportunity Employer and fully subscribe to the principles of Equal Employment Opportunity. Applicants and/or employees are considered for hire, promotion and job status, without regard to race, color, religion, creed, sex, marital status, national origin, age, physical or mental disability.

When Completeing This Application Make Sure You :
  • Complete the section for equal opportunity information.
  • 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.
  • Check for accuracy, sign and date your application.

Equal Opportunity Information :
  • State Government prohibits discrimination based on race, sex, origin, crood, age or disability. Sex, age or absence of disability is bonafide occupational qualification in a small number of state jobs. The information requested below will in no where affect you as applicant. Its sole use will be how well our recuritment are reaching all segments of the population.

Disability : Disability means with respect to individuals
  • Physical or Mental impairment that substantially limits one or more major life activities of such individuals.
  • A record of such impairment or being regarded as such an impairment ( Americans with disabilities Act of 1990 ) . Persons without disability should check item A.
  • The reporting of disability is strictly VOLUNTERY. Person who DOES NOT WISH to report their disability should check item A.
  • Information reported on this form will be kept confidiential as by State Law.
  • Public disclosure of this information without your consent would be violation of G.S .
  • Gender

Ethnic Group :

  • Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accomodation?

  • Have you been convicted of any felonies other than minor traffic violations during the past seven years? (A criminal record or a conviction will not automatically bar employment, but will be considered only as it reasonably relates to your fitness to perform in the position for which you are applying.) If YES please explain.

  • Last grade completed :

  • College :


Please list any skills you have that are appropriate for the position you are applying for:

  • If asked, will you work?

    • Rotating shifts

    • Overtime

    • Saturdays

    • Sundays

Salary Requirements :
  • Per Hour

  • Per Month

  • Starting with your PRESENT or MOST RECENT EMPLOYER list in consecutive order ALL EMPLOYMENT for at least the past FOUR employers. If currently employed, may we contact your employer?


READ CAREFULLY : I certify that the information contained in this application is correct to the best of my knowledge and understand that any misstatement or omission of information may result in denial of employment or discharge. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.