Application for Employment  We are an Equal through diversity.  Please print ort type. The considered.. Please complete eachs section, eveni ify you attacha resume.  Opportunity Employer and application must! bef fully committed to excellence completed to be  Town of Vanceboro Personal Information  Name Address  City  State  Zip  Phone number  Email address  Are you legally eligible to worki in the US?  Are you a veteran? Yes D  YesD YesD Position Position you are applying for Employment desired Education School name  NoDJ NoD  NoD  Ifselected for employment are youy willing to submit to al background check?  Available. start date Partt time  Desired pay  JFull time  Seasona/Temporary  Location  Years attended  Degree received  Major  References (business and professional only)  Name  Title  Company  Phone    Employment History Employer (1) Work phone Address  Jobt title  Dates employed Ending pay rate Zip  Starting pay rate City Jobt title  State  Employer (2) Work phone Address  Dates employed Ending pay rate Zip  Starting pay rate City Jobi title  State  Employer (3) Work phone Address  Dates employed Ending pay rate Zip  Starting pay rate City  State  Signature Disclaimer  Icertify thatr my answers are true and complete tot the best of my knowledge.  Ifthis application leads to employment, understand that false or misleading information in my application or interview may resulti in  my employment! being terminated. Name (please print)  Signature  Date    Town of Vanceboro Background Check Authorization Form  CAREFULLY READ EACH STATEMENT BEFORE SIGNING ATTHE BOTTOM  laffirm that all oft the information provided in this employment application is true and complete to the best of myl knowledge, and lauthorize investigation of all statements contained in this application, including a criminal background check. lunderstand that any false or incomplete information may disqualify me from further consideration fore employment and may result in immediate termination of lauthorize the investigation of any or all statements contained in this application and also authorize any person, educational institution, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. Irelease such persons and organizations from any legal liability in making such  my employment if discovered at a later date.  statements.  This information is provided solely for the purpose of conducting: a background check.  Last Name: Street Address:  First Name: City:  Middle Name: State:  Zip Code:  Social Security Number:  Driver's License State:  Driver's License Number:  Date of Birth (MM/DD/VYY): Race:  Gender: Male D Female  Other or Form Names:  Thave read and understand the above statements. laffirm the above statements to be true.  Signature:  Date: