Cape Fear Public Utility Authority Official Site

CFPUA Application for Employment

Equal Opportunity Information
CFPUA policy prohibits discrimination based on race, sex, color, creed, national origin, age or disability. Sex, age, or absence of disability is a bona fide occupational qualification in a small number of CFPUA jobs. The information requested below is provided voluntarily and will in no way affect you as an applicant. Its sole use will be for Equal Opportunity recruitment tracking purposes.
At the time of submission, this page will be detached and kept separate from the application form. Please only complete the following fields and do not write anything else on this page.
Date of Birth
Date of Birth
Gender*
1. Male
1. Female
1. Prefer Not to Answer
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
5. Native Hawaiian or Other Pacific Islander
6. American Indian (including Alaskan Native)
7. Two or more races
8. Prefer Not to Answer
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CFPUA Application for Employment

CFPUA Application for Employment - Page 2

Employment History
Current or Last Employer:*
Address:*
Position Title:*
Supervisor's Name:*
Phone Number*
Date - From:*
To:*
Type*
1. Full Time
2. Part Time
Number supervised by you:
Starting Salary:
Ending/Current Salary
Reason for Leaving:
May we contact?*
1. Yes
2. No
List major duties which demonstrate your competencies related to the position for which you are applying for: *
Previous Employer #1:
Address:
Position Title:
Supervisor's Name:
Phone Number
Date - From:
To:
Type:
1. Full Time
2. Part Time
Number supervised by you:
Starting Salary:
Ending Salary:
Reason for Leaving:
May we contact?
1. Yes
2. No
List major duties which demonstrate your competencies related to the position for which you are applying for:
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CFPUA Application for Employment - Page 3

Previous Employer #2:
Address
Position Title:
Supervisor's Name:
Phone Number:
Date - From:
To:
Type:
1. Full Time
2. Part Time
Number supervised by you:
Starting Salary:
Ending Salary:
Reason for Leaving:
May we contact?
1. Yes
2. No
List major duties which demonstrate your competencies related to the position for which you are applying for:
Previous Employer #3:
Address:
Position Title:
Supervisor's Name:
Phone Number:
Date - From:
To:
Type:
1. Full Time
2. Part Time
Number supervised by you:
Starting Salary:
Ending Salary:
Reason for Leaving:
May we contact?
1. Yes
2. No
List major duties which demonstrate your competencies related to the position for which you are applying for:
Upload Resume
Upload Cover Letter
Upload Required Certificattions
Upload Miscellaneous Information
I certify that I have given true, accurate and complete information on this form to the best of my knowledge, If confirmation is needed about my information, I authorize educational institutions, associations, registrations and licensing boards, and others to furnish the details concerning my qualifications. I authorize the investigation of all statements made in the application and understand that false information or documentation, or a failure to disclose relevant information may be grounds for the rejections of my application, disciplinary action, or dismissal if I am employed, and/or criminal action. I further understand that dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet the position qualifications.
I certify that I have given true, accurate and complete information on this form to the best of my knowledge, If confirmation is needed about my information, I authorize educational institutions, associations, registrations and licensing boards, and others to furnish the details concerning my qualifications. I authorize the investigation of all statements made in the application and understand that false information or documentation, or a failure to disclose relevant information may be grounds for the rejections of my application, disciplinary action, or dismissal if I am employed, and/or criminal action. I further understand that dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet the position qualifications.
Signature of Applicant*
Date:*
Date:

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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