SHASCOM EMPLOYMENT APPLICATION
NOTE: Read the application carefully and answer ALL questions completely. Incorrect or incomplete applications will be rejected.
Position you are applying for:
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Public Safety Dispatcher
Acting Public Safety Dispatch Supervisor
Public Safety Dispatch Supervisor
Other
Where did you hear about this job posting?
Were you referred by a SHASCOM employee?
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Yes
No
Who?
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Personal Information
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Are you a US Citizen?
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Yes
No
If not, are you a legal resident?
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Yes
No
Have you ever been convicted of a felony?
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Yes
No
Explain
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Drivers License
Do you have a drivers license?
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Yes
No
Drivers License Number
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Class
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Expires
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 -
Month
 -
Day
Year
State Issued
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Prior SHASCOM Employment / Relatives
Were you previously employed by SHASCOM?
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Yes
No
When?
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Under what name(s)?
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Do you have any relatives that work for SHASCOM?
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Yes
No
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Typing and Computer Skills
Typing Skill
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WPM
Personal Computer Skills
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Please Select
Excellent
Good
Fair
Poor
None
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Education
Did you graduate from high school?
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Yes
No
High School
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Do you have a GED or equivalent?
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Yes
No
Did you attend college?
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Yes
No
College
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Do you have other education to list?
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Yes
No
Other Education
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Current and/or Prior Employment
In order for your application to be considered, the following section must be completed. List all present and past employers for the last TEN years, beginning with your most recent. If you have not been in the work force for the last 10 years, please explain why (i.e., school, family, etc.)
Have you been employed within the past 10 years?
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Yes
No
Explain
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Are you currently employed?
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Yes
No
Current Employment
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Do you have additional employment within the last ten years to add?
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Yes
No
Prior Employment
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Additional Employment / Resume
May we contact your current employer?
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Yes
No
I am currently unemployed
Have you ever been discharged or forced to resign?
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Yes
No
Explain
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Would you like to attach a resume?
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Yes
No
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Browse Files
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Certification and Submit
Certification
*
I hereby certify that my answers to the questions in this application and any required supplement are complete, accurate and true to the best of my knowledge. I agree and understand that any omissions or misstatement of material facts contained therein may cause me to forfeit all rights of employment. I understand that the information provided by me will be verified and that failure to completely answer any questions will result in my not being considered for employment. This application will be valid for 120 days.
Signature
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Submit
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