EmailMe Form - NC811 Application for Employment

Upload your Pipes Plus Certificate *

Because of the special nature of what we do, we ask that all interested applicants complete the online (free) Pipe Plus training. The training teaches you all about who we are, the public we serve and how the whole process works to protect the public. Upon completion you will have a certificate which is your “golden ticket” to receive an interview. Want to serve? Your journey starts here with Pipes Plus Training! ncpipesplus.org.

Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Home Phone *

### - ### - ####

Cell Phone

### - ### - ####

Email *

AVAILABILITY *

FULL TIME

PART TIME

TEMP

DATE AVAILABLE TO START *

MM / DD / YYYY

ARE YOU UNDER AGE 18? *

YES

NO

IF HIRED, CAN YOU FURNISH PROOF OF ELIGIBILITY TO WORK IN U.S.? *

YES

NO

REFERRED BY:

JOB POSTING

NC 811 WEBSITE

FRIEND/RELATIVE

OTHER

DO YOU HAVE ANY FRIENDS OR RELATIVES WORKING HERE? *

YES

NO

IF YOU ANSWERED YES ABOVE PLEASE STATE THEIR NAME.

First Last

OTHER NAME(S) BY WHICH YOU HAVE BEEN KNOWN

HAVE YOU EVER BEEN FIRED FROM A JOB OR ASKED TO RESIGN? *

YES

NO

IF YOU ANSWERED YES ABOVE PLEASE EXPLAIN

HAVE YOU EVER BEEN CONVICTED OF A FELONY? *

YES

NO

A conviction does not automatically exclude you from consideration for employment.

EDUCATION

CERTIFICATION - Read carefully before completing form

I certify that the information I have provided on this Application for Employment is true and complete. I have had an opportunity to review/discuss the job requirements for this position and I can perform the essential functions of the job, with or without reasonable accommodation. I understand and agree that employment with North Carolina 811, if offered, may be immediately discontinued if misrepresentation, false statements or material omissions are found to have been made. I hereby authorize educational institutions, former employers and former supervisors to provide any and all information pertinent to my being considered for employment and hereby release those providing such information from any liability for doing so. I understand that employment, if offered, will be contingent upon negative drug screening results and acceptable background check. Proof of identity and employment eligibility for completion of a Form I-9 will be required, as well as additional information necessary for employee record purposes. I understand that, if employed, the Company or I may terminate the employment relationship at any time, with or without cause, with or without notice, and that, if employed, employment does not constitute a contract of employment between myself and North Carolina 811. If employed, I will abide by and conform to all Company policies, rules and procedures as may be in effect from time to time. I understand that this application will become inactive in sixty days unless reactivated by me in person or in writing. I understand that, upon request, I will be provided a copy of my signed Application for Employment. I have read the above, understand its content and meaning, and agree to all of its provisions.