JASCO Application for Employment

  • Application for Employment

  • Personal Information

  • Today's Date
     - -
  • Format: (000) 000-0000.
  • Date of Birth*
     - -
  • Have you ever filed an application with us before?*
  • Have you ever been employed with us before?*
  • Will you work overtime, if required?*
  • Can you travel for training, if the job requires it?*
  • Date you can start*
     - -
  • Type of work desired*
  • Are you currently on “lay-off” status and subject to recall?*
  • Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*
  • Have you ever pled guilty to or been convicted of any criminal offense, including those for which imposition of sentence was suspended? (590.080.1(2), RSMo )*
  • Have you ever been discharged or asked to resign from employment?*
  • Are you a United States Veteran?*
  • Are you a member of the Reserves National Guard?*
  • Would you be willing to take a truth verification test over the statements made in this application?*
  • Have you been informed about the requirements of the job for which you are applying?*
  • Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you are applying?

  • Education

  • Did you attend high school?*
  • Did you graduate?
  • Have you completed any college?*
  • Did you graduate?
  • Have you completed a trade, business or correspondence school?*
  • Did you graduate?

  • Employment Experience

  • Begin with your present or most recent job. List all jobs, paid or volunteer, civilian and military over the past ten years. A resume may be attached to provide additional or more detailed information, but will not be accepted in lieu of completing this section. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. DO NOT WRITE “SEE RESUME” IN SPACES BELOW. Any break for more than 1 month in employment with in the last 10 years must have a written explanation for verification.
  • Do you have additional employment experience to add?
  • Do you have additional employment experience to add?
  • Do you have additional employment experience to add?
  • Do you have additional employment experience to add?
  • Do you have additional employment experience to add?
  • Do you have additional employment experience to add?
  • Do you have additional employment experience to add?
  • Do you have additional employment experience to add?
  • Do you have additional employment experience to add?

  • References

  • Give the names of 3 people not related to you, whom you have known for at least 1 year.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Acceptance and Signature

  • I certify that answers given herein are true and complete to the best of my knowledge. They are made voluntarily upon application for employment, and as inducement therefore. In the event that any information on this application is found to be untrue, the applicant may become disqualified from the process or if employed, may be dismissed from employment immediately.

    I authorize Jasper County Emergency Services to investigate all statements contained in this application for employment as they 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 the Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such charge is specifically acknowledged in writing by an authorized executive of this organization.

    I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

    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.

    After completing this application, you will receive an email with instructions to complete. Failure to complete the steps listed in the email may result in the dismissal of your application. 

    I do hereby release all parties and individuals connected therewith from all liabilities for any damage whatsoever incurred in furnishing such information.

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