Application For Employment Pre Employment Questionnaire-PDF Free Download

APPLICATION FOR EMPLOYMENT Pre employment Questionnaire
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Application for Employment, Office of the Clerk MDNC. City State Zip, 9 Phone Numbers include area code Daytime. 10 Are you 18 years or older Yes No, 11 In case of. emergency notify, Name Address Phone No, 12 Do you have any relatives who are employees of the U S Courts Yes No. If yes give name relationship and position, 13 Are you employed now.
14 Have you ever applied to this office before When. 15 Have you ever worked for the government before Where. Reason for leaving government employment, Name of last government supervisor. 16 Who referred you to this office Employment Agency Newspaper advertisement. State Employment Office, College Placement Service. Walked In Friend Other, 17 Lowest Pay Acceptable, WORK EXPERIENCE. MDNC 8 96 2, Application for Employment, Office of the Clerk MDNC. 18 Describe your current or most recent job in block a and work backwards describing each. job you held during the past 10 years, If you were unemployed for longer than 3 months within the past 10 years list the dates and.
your addresses in an experience block You may sum up in one block work that you did. more than 10 years ago but if that work is related to the type of job you are applying for. describe each related job in a separate block Include non paid work if the work is like the. job you are applying for, If you need more experience blocks use a sheet of paper include your name Social. Security Number and item number on each sheet, FORMER EMPLOYERS List below past employers starting with last one first. a Name and address of present or last employer, Starting Date Leaving Date. Month Year Month Year, Weekly Starting Salary Weekly Final Salary. If not currently employed, Job Title may we contact supervisor.
Name and title of supervisor Phone No, Nature of Work. Reason for leaving, Describe duties and accomplishments. MDNC 8 96 3, Application for Employment, Office of the Clerk MDNC. b Name and address of employer, Starting Date Leaving Date. Month Year Month Year, Weekly Starting Salary Weekly Final Salary.
Job Title May we contact supervisor, Name and title of supervisor Phone No. Nature of Work, Reason for leaving, Describe duties and accomplishments. c Name and address of employer, Starting Date Leaving Date. Month Year Month Year, Weekly Starting Salary Weekly Final Salary. Job Title May we contact supervisor, MDNC 8 96 4, Application for Employment.
Office of the Clerk MDNC, Name and title of supervisor Phone No. Nature of Work, Reason for leaving, Describe duties and accomplishments. 19 May we contact your current supervisor We will not contact. current supervisor without your permission, 20 Mark highest level completed some HS Bachelor. HS GED Master, Associate Doctoral, 21 Last High School or GED School. City State Zip if Zip known, Year diploma or GED received.
22 Colleges and Universities Attended Do not attach a copy of your transcript unless. City State Zip, Semester Credits Earned Major s, Quarter Credits Earned. MDNC 8 96 5, Application for Employment, Office of the Clerk MDNC. Degree if any Year Received, City State Zip, Semester Credits Earned Major s. Quarter Credits Earned, Degree if any Year Received. City State Zip, Semester Credits Earned Major s, Quarter Credits Earned.
Degree if any Year Received, 23 Subjects of special study or research work. Special training, Special skills including automated equipment. Do you type Yes No If yes what is your typing speed. 24 Job related training courses give title and year Job related skills other languages. computer software hardware tools machinery typing speed etc Job related. MDNC 8 96 6, Application for Employment, Office of the Clerk MDNC. certificates and licenses current only Job related honors awards and special. accomplishments publications memberships in professional honor societies leader. ship activities public speaking and performance awards Give dates but do not send. documents unless requested, 25 In addition to your work experience what other experience skills or qualifications. especially qualify you for work with the U S District Courts. REFERENCES, 26 List three people who are not related to you and are not supervisors you listed under.
item 1 who know your qualifications and fitness for the kind of job for which you are. applying At least one should know you well on a personal basis. a Name of Reference, Years Acquainted, b Name of Reference. Years Acquainted, MDNC 8 96 7, Application for Employment. Office of the Clerk MDNC, c Name of Reference, Years Acquainted. BACKGROUND, 27 Are you a U S Citizen Yes No, 28 Have you ever served in the United States Military Service If your only active duty was. training in the Reserves or National Guard answer NO Yes No. If you answered YES provide the following information. Branch From mm dd yy To mm dd yy, Type of Discharge.
29 Have you been convicted by a military court martial If no. military service answer NO If YES use item 39 to provide the date. explanation of the violation place of occurrence and the name and address of. the military authority or court involved Yes No, 30 Have you been convicted been imprisoned been on probation or been on parole include. felonies firearms or explosives violations misdemeanors and all other offenses If YES. use item 39 to provide the date explanation of the violation place of occurrence and the name and. address of the police department or court involved. 31 Are you now under charges for any violation of law If YES use item 39 to. provide the date explanation of the violation place of occurrence and the name. MDNC 8 96 8, Application for Employment, Office of the Clerk MDNC. and address of the police department or court involved Yes No. 32 During the last 15 years were you fired from any job for any reason did you quit after. being told that you would be fired did you leave any job by mutual agreement because. of specific problems or were you debarred from Federal employment by the Office of. Personnel Management If YES use item 39 to provide the date an explanation of. the problem and reason for leaving and the employer s name and address. 33 Are you delinquent on any Federal debt Includes delinquencies arising from. Federal taxes loans overpayment of benefits and other debts to the U S Government. plus defaults of Federally guaranteed or insured loans such as student and home mortgage. guaranteed or insured loans such as student and home mortgage loans If YES use. item 39 to provide the type length and amount of the delinquency or default and steps. that you are taking to correct the error or repay the debt Yes No. 34 Do you receive or have you ever applied for retirement pay pension or other pay. based on military Federal civilian or District of Columbia Government Service. MDNC 8 96 9, Application for Employment, Office of the Clerk MDNC. 35 Have you ever been treated for drug or alcohol abuse. If YES please use item 39 to provide date length type and place of treatment. 36 Do you have any physical and or mental impairment s that would interfere or prevent you. from performing duties as assigned to you in the clerk s office If YES please use item 39. to provide a description of any physical mental limitation Yes No. 37 Why do you think you would like to work for the Federal Court. 38 Why should you be selected above other applicants. MDNC 8 96 10, Application for Employment, Office of the Clerk MDNC. CONTINUATION SPACE, 39 Provide details requested in items 29 through 39 in the continuation space.
below or on attached sheets Be sure to identify attached sheets with your name. Social Security Number and item number and to include ZIP codes in all addresses. APPLICANT CERTIFICATION, AUTHORIZATION, I certify that the facts contained in this application are true and complete to the best of my knowledge. and understand that if employed falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and 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, I understand and agree that if hired my employment is for no definite period and may be terminated at. the pleasure of the Court, Date Signature, MDNC 8 96 11. APPLICATION FOR EMPLOYMENT Pre employment Questionnaire OFFICE OF THE CLERK UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF NORTH CAROLINA AN EQUAL OPPORTUNITY EMPLOYER Date Type or Print all the information If your application does not provide all information requested on this form and in the job vacancy announcement you may lose consideration for a job 1 Job Title in

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