Housing Authority of The City of High Point Application for Employment


An Equal Opportunity/Affirmative Action Employer
The Housing Authority is a Drug-Free Workplace

Please complete carefully and completely. Answer all questions that are relevant to you.

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You are applying for: Quality Control Coordinator
Contact Information
Date Available
(mm/dd/yyyy)		 Present Salary Salary Desired    
     
First Name Middle Name Last Name Last 4 of SSAN Area Code + Phone # Email Address
Current Address City State Zip Code Years At This Address  
 
List all previous addresses for the past seven (7) years:
  Address City State Zip Code Years At This Address
Previous Address ›
  Address City State Zip Code Years At This Address
Next Previous Address ›
  Address City State Zip Code Years At This Address
Next Previous Address ›
  Full Name Address Area Code + Phone #    
Emergency Contact ›    

Have you ever applied here before? Yes No        If yes, when?

Were you ever employed here? Yes No        If yes, when?         If yes, what position?

Do you have a valid driver's license? Yes No        If yes, State and License #

Have you ever worked or attended school under any other names? Yes No        If yes, give names:

Do you have the legal right to work and be employed in the United States? Yes No

Please note: Proof of identity and legal work authority in the United States is a condition of employment with the Housing Authority of The City of High Point.

Education History

Select highest grade completed:

  Name of School & Location Course of Study Dates (From/To) Day or Night Years Completed Did You Graduate? Degree Received
High School ›
College or University ›
Graduate School ›
Military School ›
Other ›
Other ›
Any affiliations or professional societies? If so, please list. Exclude those whose titles indicate race, creed, color or national origin.
Military Service
Branch of Service Length of Service Final Rank Service Number

Schools or special experience acquired during service which are pertinent to position being applied for

Work History

List all previous employment, including military service, during the past ten (10) year. Do not state "see resume" for any responses. Include any additional previous employment details in the space provided below.

Present or Recent Position

May we contact this employer for reference?   Yes  No

Employer Your Title Name/Title Of Supervisor Dates Employed (From/To) Full/Part Time?
Employer Address Area Code + Telephone Starting Salary/Pay Final Salary/Pay Reason For Leaving
Description of Your Work Duties

Previous Position

May we contact this employer for reference?   Yes  No

Employer Your Title Name/Title Of Supervisor Dates Employed (From/To) Full/Part Time?
Employer Address Area Code + Telephone Starting Salary/Pay Final Salary/Pay Reason For Leaving
Description of Your Work Duties

Previous Position

May we contact this employer for reference?   Yes  No

Employer Your Title Name/Title Of Supervisor Dates Employed (From/To) Full/Part Time?
Employer Address Area Code + Telephone Starting Salary/Pay Final Salary/Pay Reason For Leaving
Description of Your Work Duties

Previous Position

May we contact this employer for reference?   Yes  No

Employer Your Title Name/Title Of Supervisor Dates Employed (From/To) Full/Part Time?
Employer Address Area Code + Telephone Starting Salary/Pay Final Salary/Pay Reason For Leaving
Description of Your Work Duties

Other Qualifications & Sillls

Self-Employment Information
Complete only if you were self-employed at any time during the past ten years.

Business Name Business Type Dates of Operation (From/To) Your Title & Duties Tax ID #
Names & Phone Numbers of Two (2) Business Customers

Unemployment Information
Complete only if you were unemployed and not attending school at any time during the past ten years.

Dates of Unemployment (From/To)
Reasons for Unemployment

The following section is applicable to any person who will regularly drive a vehicle during the course of their employment.

How many years have you driven commercially?
Can you drive a standard transmission vehicle?
Identify each commercial vehicle you have driven and the hours per month and number of months experience you have driving that commercial vehicle.
Commercial, personal or chaffeur's license, permit restrictions
List any licenses or permits ever held. Include type, state & number and expiration date for each.
Has any license, privilege or permit you've held ever been suspended? Yes  No
Has any license, privilege or permit you've held ever been revoked? Yes  No
Has any license, privilege or permit you've held ever been denied? Yes  No
If you've had a license, privilege or permit suspended, revoked or denied, please list the reason why and in what state(s)?
Have you any other driving experience? Yes  No
If yes, what size vehicle? 
List all traffic violations, other than parking, for which you have been convicted or forfeited bond or collateral.
Have you ever been convicted, cited or forfeited bond or collateral for driving while intoxicated or under the influence? Yes  No
If yes, when? 

List all accidents in which you, as the driver, have been involved, regardless of severity.

Last Accident Date City & State Brief Description Injuries? Fatalities? At Fault?

References

Provide three (3) references, not relatives or employers.

Name Years Known Address Telephone Number
Have you ever been convicted of a crime? Yes  No
Date Place Offense Disposition

(A "Yes" answer does not automatically disqualify you from employment, since the nature of the offense, date and the job for which you are applying is considered.)

Please list any relatives who work for the Housing Authority and relationship to you
List any friends who work for the Housing Authority.

Certification of Submission

Please read below before submitting this application.

I hereby certify that the information contained in this application for employment is true and correct to the best of my knowledge and hereby agree to have any of the statements verified by the Housing Authority of the City of High Point (“the Authority”) unless I have indicated to the contrary. I authorize the references listed above, as well as other individuals whom the Authority contacts, to provide the Authority with all information concerning my previous employment and any other pertinent information that they may have. Further, I release all parties and persons from any liability for any damages that may result from furnishing such information to be the Authority as well as from the use of disclosure of such information by the Authority or any to its agents, employees, or representatives. I understand and agree that misrepresentation, falsification or material omission of information on this application may result in my failure to receive an offer; or, if I am hired, my dismissal from employment. I understand and agree that the Authority shall not be liable in any respect if my employment is terminated because of misrepresentation, falsification or material omission of information on this application for employment. I understand and agree that any information provided to the Authority shall become the exclusive property of the Authority.

As required by the Authority prior to employment, I consent to taking urinalysis to determine the presence of controlled substances in the body. I understand that I am required to successfully pass a drug screening examination.

It is agreed and understood that this application in no way obligates the Authority to employ me. I have the right to resign my employment at any time, for any reason or no reason, with or without notice. I further understand that neither this application nor any written or oral communication by management representatives made at the time of hire or during the course of my employment will be considered as creating an employment contract between the Authority and me.

By my signature below, I certify that I understand these conditions of employment and that all entries on this application are true and complete to the best of my knowledge.

I understand that if employed, either the Authority or I may terminate the employment relationship at any time for any reason. I understand that this application or subsequent employment does not create a contract of employment with the Authority nor guarantee employment for any definite period of time.

Employment application effective for 90 days of application signature. Applicant must complete an application if reapplying after 90 days.

STATE AND FEDERAL LAWS PROHIBIT DISCRIMINATION BECAUSE OF RACE, COLOR, RELIGION, SEX, AGE MARITAL STATUS, NATIONAL ORIGIN, DISABILITY, DISABLED VETERAN OR VETERAN OF THE VIETNAM ERA.

 I have read and understood the above statement

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