Contact Information

Page 1 of 11  Please enter or review your Contact Information below and modify as necessary. When finished, click Next to continue and generate the email with your login information for the Self Service module if this is your first time applying. Then answer the Application Questions on the next page or update as needed.  Click Save Changes when done.  You must complete all pages of this online application to be considered for a position.
First Name*
Middle Name*
Last Name
Nickname
Home Street 1*
Home Street 2
Home City*
Home State/Province*	Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota North West Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
Home Zip/Postal Code*
Home Phone Number*
Work Phone Number
Cell Phone
Best number to reach you	Home Phone Number Work Phone Number Cell Phone
Primary email address*
Confirm email address*
Referral Category	Job Boards Newspapers Other Schools Social Media Website
How did you hear about this position?*	College Career Posting Craigslist DiscoverPolicing.org Employee Referral Employment Security Commission Facebook Indeed.com Job Fair Kernersville Chamber of Commerce Kernersville News LinkedIn Came to Municipal Building Other Town of Kernersville Website Winston Salem Chronicle
Source Detail
Please provide the URL to your LinkedIn Profile if available: