ADDENDUM TO APPLICATION
Social Workers
Upload the completed addendum form as an attachment to the online application or submit completed form by mail or fax and submit official academic transcripts by mail.
FOR DEPARTMENT OF SOCIAL SERVICES, DSS, POSITIONS ONLY TO:
Mecklenburg County Department of Social Services
Attention: Human Resources
301 Billingsley Road
Charlotte, NC 28211
Or by fax to:
877-235-9684
FOR COMMUNITY SUPPORT SERVICES, CSS, POSITIONS ONLY TO:
Mecklenburg County Community Support Services
700 North Tryon St. Suite. 206
Charlotte, NC 28202
Or by fax to:
704-336-4198
Date ______
Name ______
Address______
City ______State______Zip______
Phone ______
Email ______
POSITIONS APPLIED FOR (Job Title and ID number):
______
______
______
List and describe (below) all related Social Worker positions. For each position, list the duties performed and the percentage of time each month you performed this duty.
Name of Employer #1______
Position Held______
Were you an hourly or salaried employee?______
From______To ______
Length of Full Time Service (yrs/mths)___/___
From______To ______
Length of Part Time Service (yrs/mths)___/___
List Duties and % of time performed each month (must total 100%)
Position #1
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Name of Employer #2______
Position Held______
Were you an hourly or salaried employee?______
From______To ______
Length of Full Time Service (yrs/mths)___/___
From______To ______
Length of Part Time Service (yrs/mths)___/___
List Duties and % of time performed each month (must total 100%)
Position #2
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Name of Employer #3______
Position Held______
Were you an hourly or salaried employee?______
From______To ______
Length of Full Time Service (yrs/mths)___/___
From______To ______
Length of Part Time Service (yrs/mths)___/___
List Duties and % of time performed each month (must total 100%)
Position #3
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Name of Employer #4______
Position Held______
Were you an hourly or salaried employee?______
From______To ______
Length of Full Time Service (yrs/mths)___/___
From______To ______
Length of Part Time Service (yrs/mths)___/___
List Duties and % of time performed each month (must total 100%)
Position #4
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Name of Employer #5______
Position Held______
Were you an hourly or salaried employee?______
From______To ______
Length of Full Time Service (yrs/mths)___/___
From______To ______
Length of Part Time Service (yrs/mths)___/___
List Duties and % of time performed each month (must total 100%)
Position #5
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
Duty______% of time performed each month______
If Bachelor’s/Master’s degree is in related field please list 15 hours of Social Work/Counseling courses.
______
______
______
______
______
______
Revised 10/25/2012