McDowell County Commission on Aging Employment Application Step 1 of 4 25% Personal InformationDate* MM slash DD slash YYYY Name* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Are you 18 years or older?* Yes No Are you either a U.S. citizen or an alien authorized to work in the United States?* Yes No Employment DesiredLocation applying to:Welch Senior Center FacilityBradshaw Senior Center FacilityPosition* Date you can start?* MM slash DD slash YYYY Salary desired* Are you employed now?* Yes No May we inquire of your present employer?* Yes No Ever applied to this company before?* Yes No Where?* Yes No When?* Yes No Referred by EducationName of High School: Location of High School: Number of years attended - High School: Did you graduate High School? Yes No High School subjects studied: Name of college or trade/business school: Location of college or trade/business school: Number of Years Attended - college or trade/business school: Did you graduate college or trade/business school? Yes No College or trade/business school subjects studied: GeneralSubjects of special study or research work?Special skills?Activities (Civic, athletic, etc.)?Do not include organizations which indicate race, religion, sex, age, marital status or nation of origin of its members.Military service? Yes No Rank? Active? Yes No Discharge date? MM slash DD slash YYYY Δ
