Fill and Sign the Judicial Employment Form

JUDICIAL BRANCH OF GOVERNMENT APPLICATION FOR EMPLOYMENT NOTICE: 1. The State employs only U.S. citizens or aliens who can provide proof of identity and work authorization within three working days of employment. 2. Persons subject to military selective service registration must certify compliance to be eligible for state employment (G.S. 143B-421.1). See availability block. WHEN COMPLETING THIS APPLICATION, PLEASE MAKE SURE YOU: 1. Print or type. 2. Give complete information on your education and work history. (“See Resume” is not acceptable.) 3. List separately each job held and your duties for each position. 4. Check for accuracy. Sign and date your application. NOTE: If you forget to complete some part of this application or do not include requested information (except the Equal Opportunity Information which is voluntary), your application may not be considered . Thank you for your interest in the Judicial Branch of Government. The Judicial System of North Carolina wants to attract the best qualified people available to serve its citizens. Filling out an application does not imply that you will be interviewed or hired, but that you will be considered for vacancies based upon the stated job(s) for which you have applied. District Job Title Equal Opportunity NOTE TO EMPLOYMENT SECURITY COMMISSION EMPLOYEES OR JUDICIAL BRANCH OF GOVERNMENT HIRING AUTHORITIES: Please ensure all blanks are completed and mail to: Administrative Ofce of the Courts, Attn: Stafng Coordinator, Courier Box 5 -!"10"-0, Raleigh, NC, OR if courier is not available, mail to P.O. Box 5 2446, Raleigh, NC 27!02. State Government policy prohibits discrimination based on race, sex 5, color, creed, national origin, age or disability. Sex 5, age or absence of disability is a bona fde occupational qualifcation in a small number of Judicial Department jobs. NOTE TO APPLICANT: The information requested below is strictly voluntary and will in no way afect you as an applicant. Its sole use will be to see how well our recruitment eforts are reaching all segments of the population. Date of Birth (mo.) (day) (year) Check One SEX M F (male) (female) DISABILITY: “Disability means, with respect to an individual: (1) a physical or mental impairment that substantially limits one or more major life activities of such individual; (2) a record of such an impairment; or (3) being regarded as having such impairment.” (Americans with Disabilities Act of 1990). Persons without a disability should check item A. ETHNIC GROUP 1. White (non-Hispanic) 2. Black or African-American (non-Hispanic) 3. Hispanic or Latino (Mexican, Puerto Rican, Cuban, Central or South American, other Spanish origin regardless of race) 4 .Asian (native Hawaiian or Pacific Islander) 5. American Indian (including Alaskan native) The reporting of a disability is strictly VOLUNTARY. Persons with disabilities who DO NOT WISH to report their disabilities should check item A. Information reported on this form will be kept confidential as required by State law. Public disclosure of this information without your consent would be a violation of G.S. 126-27. A None/Prefer not to report B Blind or severely visually impaired C Deaf or severely hearing impaired D Loss or limited use of arms and/or hands E Non-ambulatory (must use wheelchair) F Other orthopedic impairment (including amputation, arthritis, back injury, cerebral palsy, spina bifida, etc.) G Respiratory impairment H Nervous system/Neurological disorder I Mental illness/Emotional disturbance J Mental retardation K Learning disability L Others (heart disease, diabetes, speech impairment, etc.) AOC A-133, Rev. 2/07 © 2007 Administrative Office of the Courts An Equal Opportunity Employer STATE OF NORTH CAROLINA Administrative Office Of The Courts Human Resources Division JUDICIAL BRANCH OF GOVERNMENT APPLICATION FOR EMPLOYMENT Please type or print. (SSN Voluntary, for Record-Keeping and Data Processing Only) Social Security Number (last four digits only) Last Name First Name Middle /Maiden Name Address (Street number and name) City County State Zip Code - Phone (Home or where you can be reached) ( ) - Business Phone ( ) - Availability Do you now work for the State of NC? YES NO Are you related by blood or marriage to any person now working for the State? YES NO (If yes, give name, relationship to you and the agency where employed.) If not a U.S. citizen, are you eligible to work in the U.S.? YES NO If subject to military selective service registration, certify compliance by initialing dotted line: Military Service Have you served honorably in the Armed Forces of the United States on active duty for reasons other than training? YES NO Do you wish to declare a service-connected disability? YES NO At the time of this application, are you the surviving spouse or dependent of a deceased veteran who died from service-related reasons? YES NO Do you wish to declare eligibility for veteran’s preference as the spouse of a disabled veteran? YES NO Give dates of your (or spouse’s) qualifying active military service: Entered: Separated: Branch: Rank: Are you a member of the Military Reserves? YES NO Branch: Rank: AGENCY USE ONLY ELIGIBLE FOR VETERAN’S PREFERENCE : YES NO Check the types of work you will accept: 1. Permanent full-time 2. Permanent part-time 3. Temporary full-time 4. Temporary part-time 5. Any of the preceding 6. Work involving travel 7. Shift or split shift work 8. Weekend work If you are not available for work now, enter the earliest date you could begin work (mo./day/yr.) Will you accept work anywhere in N.C.? YES NO (If no, list below the counties in which you would be willing to work.) 1. 2 . 3. 4 . 5 . Jobs Applied For Enter below the specific title(s) of the job(s) for which you are applying. Please list no more than three on this application 1. 2. 3 . Referral Source Please indicate your referral source: If you were referred by the Employment Security Commission (Job Service), please indicate which local office : Education If you used a different name when enrolled at the college or university listed below, give name used and the institution involved. Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 GED College 1 2 3 4 Graduate School 1 2 3 4 Under S/Q Hrs., list the number of credit hours and if they were semester (S) or quarter (Q) hours. Schools Name and Location Dates Attended (mo/yr) From: To: Grad? S/Q Hrs. Major/Minor Course Work Type of Degree High School YES NO College(s) University (s) YES NO Graduate or Professional YES NO Other educational, voca tional school, intern ships, etc. YES NO List special training programs and seminars you have completed in the last five years: If the job(s) applied for calls for specific course(s), indicate the course(s) taken and credit(s) received: Current professional status: (list fields of work for which you have been registered) Registration: State: No.: Registration: State: No.: List membership in professional, honorary, or technical societies: FOR AOC USE ONLY Degrees And Professional Credentials Have been verified Will be verified within 90 days (G.S. 126-30) Person Responsible: AOC A-133, Rev. 2/07 © 2007 Administrative Office of the Courts An Equal Opportunity Employer Divison: District: Job Title: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Professional licenses and certifications (list, giving dates and sources of issuance): SKILLS CHECK the following skills, experiences, etc., which you have: Driver’s License # Chauffeur’s License # Car for use at work Word processing Typing (specify WPM) State State Sign language Foreign language (specify) Adding machine/calculator Typing (specify WPM) Shorthand/speedwriting (specify WPM) Legal transcription Braille Computer software (i.e., dBase, spreadsheets, et.c.) specify: Other Have you ever been convicted of an offense against the law other than a minor traffic violation? (A conviction does not mean you cannot be hired. The offense and how recently you were convicted will be evaluated in relation to the job for which you are applying.) YES NO (If yes, explain fully on an additional sheet.) WORK HISTORY (include volunteer experience) Use Additional Sheets If Necessary Employer Address Job Title Supervisor’s Name Telephone No. ( ) " No. Supervised by You: Date Employed (mo/yr) Starting Salary $ per Ending Salary $ per Reason for Leaving May We Contact Employer? YES NO Date Separated (mo/yr) Full Time Years Months Part Time Years Months If part time, no. hours per week: List major duties in order of their importance in the job: Current or Last Employer Address Job Title Supervisor’s Name Telephone No. ( ) " No. Supervised by You: Date Employed (mo/yr) Starting Salary $ per Ending Salary $ per Reason for Leaving May We Contact Employer? YES NO Date Separated (mo/yr) Full Time Years Months Part Time Years Months If part time, no. hours per week: List major duties in order of their importance in the job: I certify that I have given true, accurate and complete information on this form to the best of my knowledge. In the event confrmation is needed in connection with my work, I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifcations. I authorize investigation of all statements made in this application and understand that false information, false documentation, or failure to disclose relevant information may be grounds for rejection of my application, disciplinary action or dismissal if I am employed, and/or criminal action. I further understand that dismissal shall be mandatory if fraudulent information is given to meet position qualifcations. (Authority: G.S. 12!"30, G.S. 14"122.1). I understand that Judicial Branch employees are not subject to the State Personnel Act. Judicial Branch employees serve "at the pleasure" of their hiring authorities. This means that employment may be terminated with or without cause and/or advance notice by either the employer or the employee. However, termination by the employer may not occur due to discrimination prohibited by law. If I am employed by an independent hiring authority within the Judicial Branch of Government, such as a judge, clerk of superior court, district attorney or public defender, I understand that I will serve at the pleasure of that ofcial, that my employment may be terminated by that ofcial without cause or notice, neither I nor the judicial ofcial by whom I am employed is an employee of the Administrative Ofce of the Courts, and that the Administrative Ofce of the Courts has no authority over the hiring decisions or other employment practices of the judicial ofcial by whom I am employed. Signature of Applicant (unsigned application will not be processed) Date AOC A-133, Side Two, Rev, 2/07 © 2007 Administrative Office of the Courts An Equal Opportunity Employer