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    CLARK COUNTY INDIANA
    911 EMPLOYMENT APPLICATION
  • ANSWER EVERY QUESTION. IF A QUESTION DOES NOT APPLY TO YOU STATE WITH N/A.. DO NOT MISTATE OR OMIT MATERIAL FACTS. THE STATEMENTS MADE HEREIN ARE SUBJECT TO VERIFICATION TO DETERMINE YOUR QUALIFICATIONS. THE CLARK COUNTY OFFICE OF EMERGENCY COMMUNICATIONS IS AN EQUAL OPPORTUNITY EMPLOYER. ADHERING TO A POLICY OF MAKING EMPLOYMENT DECISIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, NATURAL ORIGIN, AGE OR DISABILITY.
  • GENERAL INFORMATION
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  • Please be aware:

    Clark County 911 operates on 12 hour shifts and due to the nature of the position we can not guarantee a specific shift to anyone. 

  • EDUCATION / TRAINING
  • LIST ALL ELEMENTARY, JUNIOR HIGH, HIGH SCHOOLS AND COLLEGE / TRADE SCHOOLS ATTENDED
  • DEGREES / SPECIAL TRAINING / CERTIFICATION / SKILLS
     
  • EMPLOYMENT HISTORY
  • REFERENCES
  • PROVIDE THE NAMES OF THREE PERSONS, TO WHICH YOU ARE NOT RELATED, AND YOU HAVE KNOWN FOR ATLEAST ONE YEAR
  • LIST ANY RELATIVES, FRIENDS, OR AQUAINTANCES THAT CURRENTY OR HAVE PREVIOUSLY WORKED FOR CLARK COUNTY 911
  • MILITARY SERVICE HISTORY
  • CIVIC / COMMUNITYPAST OR PRESENT MEMBERSHIP IN ORGANIZATIONS.
  • OPERATORS LICENSE
  • CRIMINAL HISTORY
  • IF YES, LIST ALL CHARGES AND COVICTIONS BELOW
  • CLARK COUNTY OFFICE OF EMERGENCY COMMUNICATIONSWaiver and Release for Background Investigation  I am presently applying for employment with the Clark County Office of Emergency Communications, which I acknowledge and understand must thoroughly investigate my employment background, criminal history, personal background, education and references in order to evaluate my qualifications. I understand that it is in the public’s interest that all relevant information in this regard, including my personal and employment history with my current and former employers, be disclosed to the Clark County Office of Emergency Communications. By this release, I hereby authorize any representative of all of my former employers, which have been fully disclosed and identified in my employment application, to divulge any information in its files pertaining to my employment records and history, and I further authorize the release of such information upon request to any representative of Clark County 911. Also authorize all former employers identified in my employment application to permit a review and full disclosure of all records, or any part thereof, concerning myself and my employment with those former employers, by and to any duly authorized agent of the Clark County Office of Emergency Communications, whether said records are of public, private or confidential nature. The intent of this authorization is to permit all former employers identified in my employment application to provide, and for the Clark County Office of Emergency Communications to obtain, full and free access to the background and history of my personal life and my employment history and performance, for the specific purpose of permitting the Clark County Office of Emergency Communications to conduct a thorough background investigation regarding me that will provide pertinent data for consideration by the Clark County Office of Emergency Communications in determining my suitability for employment. It is my specific intent to provide the Clark County Office of Emergency Communications with access to personnel information, however personal or confidential it may appear to be. I authorize all former employers, which have been fully disclosed and identified in my employment application, to release any and all public and private information that it may have concerning me, my work record, my background and reputation, my military service records, educational records, my financial status, my criminal history record, including my arrest record(s) and records compiled during or as the result of a criminal investigation(s) of me, efficiency ratings, complaints or grievances filed by or against me, the records or recollections of attorneys at law, or other counsel, whether representing me or another person in any case, either criminal or civil, in which I presently have, or have had, an interest, attendance records, polygraph examinations, and any internal affairs investigations and discipline, including any files which are deemed to be confidential and/or sealed. I hereby release all former employers identified in my employment application, and, if applicable, their elected and appointed officials, employees and agents and all others from liability of damages that may result from furnishing the information requested, including any liability or damage pursuant to any state or federal laws. I hereby release all former employers identified in my employment application, and, if applicable, its officers, employees, or related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family, or associates because of compliance with this authorization and request to release information, or any attempt to comply with it. I direct all former employers identified in my employment application to release such information upon request of the duly accredited representative of the Clark County Office of Emergency Communications, regardless of any agreement, written or oral, I may have made with the former employer to the contrary. In addition, I also give the Clark County Office of Emergency Communications the right to thoroughly investigate my background, previous employment, education and references in order to ascertain my suitability for service as a Clark County Office of Emergency Communications employee. I release and hold harmless the Clark County Government, its elected and appointed officials, agents and employees from and against any and all liability which might result from conducting such an investigation, including any damages of whatever kind which may at any time result to me, my heirs, family or associates because of such investigation. I recognize and understand my rights under Title 5, United States Code, Section 552a, the Privacy Act of 1974, with regard to access and disclosure of records, and I waive those rights with the understanding that information furnished by any former employer will be used by the Clark County Office of Emergency Communications in conjunction with employment procedures. I understand that if a former employer refuses to cooperate with this investigation by failing to provide full disclosure of any and all relevant information about me, then the Clark County Office of Emergency Communications may disqualify me from further consideration for employment.A photocopy or facsimile of this release form will be valid as an original thereof, even though the said photocopy or facsimile does not contain an original writing of my signature. This waiver is valid for a period of three years from the date of my signature. Should there be any questions as to the validity of this release, you may contact me at the address listed on my employment application. I agree to indemnify and hold harmless the person to whom this request is presented, as well as his agents and employees, from and against all claims, damages, losses and expenses including reasonable attorney’s fees, arising out of or by reason of complying with this request. 
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  • IMPORTANT:

    Please make sure you application is COMPLETE. If its determined that there have been omissions in any section of this application you will become ineligible for employment.
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