Accepting Applications for a 911 Emergency Dispatcher Job Description Name* First Middle Last Other Names UsedAddress* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Email Address* Have you ever been employed by C.C.E. Central Dispatch Authority?YesNoStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY As aAre you legally eligible for employment in the United States?YesNo(Proof of U.S. Citizenship or immigration status will be required upon employment)Will you work overtime if required?YesNoDate available for work Date Format: MM slash DD slash YYYY Do you have a valid driver’s license?YesNoHave you ever had your driver’s license suspended or revoked?YesNoIf yes, please explain. Include dates, places, and nature of offenses.Have you ever been convicted, or entered a guilty plea or no-contest for any felony?YesNoNote: a “yes” answer will not automatically disqualify you from employment with C.C.E. Central DispatchIf yes, please explain. Incude dates, places, and nature of offenses.Are you presently under indictment for any felony offense?YesNoIf yes, please explain. Include dates, places, and nature of offenses. Do not include information for any charges that have been dismissed or are no longer pending.Have you ever been dismissed from any job?YesNoIf yes, please explain.Educational BackgroundCheck highest grade completed:High School:9101112GEDCollege:1234Graduate Work:YesNoSecondary EducationCollege/University/Trade SchoolCity/StateCertificate/DegreeMajor If you are fluent in any languages other than English, please list:Employment History List your complete employment history for the past ten years, starting with your most recent employer. List all positions held, including military experience, part-time summer and/or volunteer work periods of employment; do not omit any employers. Explain any gaps in employment in comment section. If you are submitting a resume, you are still required to summarize your job responsibilities in the space provided. Current EmployerCompany NameAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Job TitleDates EmployedFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Hourly RateContact for employment verification:Employer Contact Information First Last TelephoneMay we contact current employer?YesNoSummarize your job responsibilitiesReason for LeavingPrevious EmployerCompany NameAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Job TitleDates EmployedFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Hourly RateContact for employment verification:Employer Contact Information First Last TelephoneMay we contact previous employer?YesNoSummarize your job responsibilitiesReason for LeavingPrevious EmployerCompany NameAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Job TitleDates EmployedFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Hourly RateContact for employment verification:Employer Contact Information First Last TelephoneMay we contact previous employer?YesNoSummarize your job responsibilitiesReason for LeavingProfessional/Work References: List name and telephone number of three professional/work references who are not related to you. Please include one previous supervisorProfessional/Work ReferencesName, Company, AddressTelephone Special Skills and QualificationsTypingWPMList any PC applications you have used: Job-Related CertificatesDate AcquiredStatus: Current/Void List special accomplishments, publications, awards and the names of professional groups of which you are or have been a member: List any relative(s) working for C.C.E. Central Dispatch Authority: List any additional comments and/or information you would like us to consider:Where did you hear about us? Check all that apply CCE Website APCO/NENA Website Friend/Relative Employee Referral Newspaper Other Employee Name First Last Newspaper:Other:I certify that all information on this application form is complete and accurate. I understand that any omissions or misstatements of facts are cause for rejecting my application or, if I am hired, termination of employment. I also authorize C.C.E. Central Dispatch Authority to make all necessary and appropriate investigations to verify the appropriate information provided in this application and to secure additional job-related information about me. I understand that this application is not an employment contract. Any applicant requiring accommodation for a disability should advise the Human Resources Department.Signature*EmailThis field is for validation purposes and should be left unchanged. By alie|2021-03-11T10:11:22-05:00December 9th, 2020|General|