Mitchell County 911 Job Application

Legal Name of Applicant *

First Name Last Name

Email *

example@example.com

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Please enter a valid phone number.

Driver's License Number and State *

Have you ever filed an application with us before? If yes, please answer below. *

Yes No

When did you last apply?

If you have previously employed with us before, please advise when.

Do any of your friends or relatives work for us here? *

Yes No

Are you currently employed? *

Yes No

May we contact your current employer? *

Yes No

Are you prevented from lawfully becoming employed in his country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employement *

Yes No

Date available to start working *

What is your desired pay range? *

Are you available to work Full Time 12 hour shifts? *

Yes No

Any restrictions on availability? *

Are you currently on "lay-off" status and subject to recall? *

Yes No

Are you able to travel if the job requires it? *

Yes No

Have you ever been convicted of a crime? *

Yes No

If yes, please describe

If you are selected for employment could you pass a multi-tasking test for typing, listening, and decision making? *

Yes No unsure

Can you work 12 hour shifts 6 AM- 6 PM? *

Yes No

Name and address of highest level of education completed. *

Describe any specialty training, apprenticeship, skills and extra-curricular activities. *

Name of last job location *

Name contact of last Employer *

First Name Last Name

Phone Number *

Please enter a valid phone number.

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Dates of employment *

Hourly Salary rate *

Type of work performed *

Reason for leaving *

Name of last job location *

Name contact of last Employer *

First Name Last Name

Phone Number *

Please enter a valid phone number.

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Dates of employment *

Hourly Salary rate *

Type of work performed *

Reason for leaving *

Name of last job location *

Name contact of last Employer *

First Name Last Name

Phone Number *

Please enter a valid phone number.

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Dates of employment *

Hourly Salary rate *

Type of work performed *

Reason for leaving *

State any additional information you feel may be helpful to us in considering your application.

Name of Reference #1 *

First Name Last Name

Phone Number *

Please enter a valid phone number.

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Name of Reference #2 *

First Name Last Name

Phone Number *

Please enter a valid phone number.

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Name of reference #3 *

First Name Last Name

Phone Number *

Please enter a valid phone number.

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

APPLICANT'S STATEMENT

I certify that answers given herein are true and complete.I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer:

Signature *

Clear

Date *

Date

FOR PURPOSES OF BACKGROUND CHECK YOU MUST PROVIDE A DRIVERS LICENSE NUMBER OR LEGAL NAME AND DATE OF BIRTH. BACKGROUND CHECKS INCLUDE LOCAL, STATE AND FEDERAL AGENCIES. DRUG TESTING MAY BE REQUESTED BEFORE EMPLOYMENT OFFERED. YOU WILL NOT BE CONSIDERED
FOR EMPLOYMENT IF YOU HAVE ANY SERIOUS MISDEMEANOR OR FELONY CONVICTIONS.

Mitchell County 911 Job Application

Employment Experience

References not related to you.