Submit an application online

Email: *

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Former Complete Address

Starting Salary # 1

Employer Phone # 1

Ending Salary # 2

I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships, and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

Yes

No

Have you Served in the Military?

Yes

No

Full Name # 1

Starting Salary # 2

Employer Name #1

Are you handicap?

Yes

No

May we contract this employer? # 3

Yes

No

Job Title # 1

Are you a disabled veteran?

Yes

No

How did you hear about us?

Upload Resume

Employer Address # 2

Reference Type # 3

Personal

Professional

If you did not graduate have you received your GED?

Yes

No

Dates Employed # 1

To

Phone # 3

Check Diploma or Degree?

Diploma

Degree

Reason for leaving # 3

Can you work weekends? (includes Saturday and Sunday)

Yes

No

Address # 2

Race / Ethnic Origin: (check only one box)

White - (All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East, and not, specifically included in a another group.)

Black - (All persons having origins in any of the black racial groups.)

Asian or Pacific Islanders - (All persons having origins in any of the original peoples of the Far East, Southeast, Asia, the Pacific Pacific Islands, or Indian subcontinent. This area includes, for example, China, Japan, Korea, India.)

Hispanic - (All persons of Spanish, Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.)

American Indian or Alaskan Natives - (All persons having origins in any of the original peoples of North American.)

Please submit submit any certification paperwork

Cell Phone

Dates ALPST - 1 Certified

Position applying for:

Nature of duties and any Special Training and Honors received:

Social Security Number

State Driver's License was issued in

Please submit submit any certification paperwork

Is there anything else that you would like us to know?

Date GED Completed?

Present Complete Address

Date and time

To

Dates Employed # 3

To

Reference Type # 1

Personal

Professional

Gender

Male

Female

Employer Name # 3

List all current licenses and/or areas of certification. List all equipment (office, trade, or technical) that you operate proficiently. List any training, skills, aptitudes, qualifications or other information which you feel is relevant to the type of employment you are seeking.

First Name: *

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

Yes

No

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Conviction does not guarantee employment disqualification.)

Yes

No

How long at former address?

Full Name # 3

Are you ALPST-1 Certified?

Yes

No

Reason for leaving #1

Please submit submit any certification paperwork

Employer Address # 3

Maiden or other name used: *

List any days of the week you are unable to work

Primary Phone

Profession # 1

Job Title # 2

Can you work overtime?

Yes

No

Date of Birthday *

Employer Address # 1

High School attended

Did you graduate?

Yes

No

Dates Employed # 2

To

High School Address

Last Name: *

Check last year completed

1

2

3

4

Was separation from military service anything other than an honorable discharge?

Yes

No

Phone Number # 3

Middle Name:

Address # 1

Address # 3

Can you work a rotating schedule of days and nights?

Yes

No

Cell Phone

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodations?

Desired Status

Full -time

Part - time

Temporary

Seasonal

Reference Type # 2

Personal

Professional

May we contract this employer? # 1

Yes

No

Job Title # 3

Years Known # 2

Can you work a rotating schedule of days and nights?

Yes

No

If declaring handicap or disabled status, in what way(s) is your ability to perform the job(s) you seek limited?

Phone Number # 1

Desired Pay

Employer Phone # 2

How were you ALPST-1 Certified

Took Competency Test online

Took 40 hour certification class

Profession # 3

Explain if separation from military service was anything other than a honorable discharge.

Please submit submit any certification paperwork

Reason for leaving # 2

Starting Salary # 3

May we contract this employer? # 2

Yes

No

Number of CEU's you hold for the current year?

Full Name # 2

Do you use Virtual Academy?

Yes

No

How long at present address?

Driver's License Number

Years Known # 3

Ending Salary # 1

List any skills you acquired in the service that you think might relate to the position for which you are applying.

I understand that employment at the Marengo E-911 is “at will”, which means that either I or 911 Board. can terminate the employment relationship at any time, with or without prior notice, and for any Reason not prohibited by stature. I also understand that all employment is continued on the “at will” basis, and that if I am employed, only the E-911 Board, has the authority to alter the “at will” employment relationship.

Yes

No

Is your license valid?

Yes

No

Have you applied here before?

Yes

No

Course of study

List any upcoming dates you can not work.

Profession # 2

Please submit submit any certification paperwork

Ending Salary # 3

Please submit submit any certification paperwork

Date Driver's License Expires

Years Known # 1

Employer Name # 2

Marengo County E-911 BACKGROUND INVESTIGATION CONSENT I, hereby authorize, the Marengo County E-911, and/or its agents to make an independent investigation of my background, social security number, documents presented for employment eligibility, references, character, past employment, education, credit history, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications for employment now and, if applicable, during the tenure of my employment with the Marengo County E-911. I release the Marengo County E-911 and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used. The following is my true and complete legal name and all information is true and correct to the best of my knowledge:

Describe nature of crime(s) and where and when convicted and disposition

On what date are you available to start work?

Phone Number # 2

Marengo County E-911
Application for Employment
Personal and Confidential

Military

ALPST - 1

Reference

Please fill in as much information as possible.

Education

Work History

To view job responsibilities, requirements, and benefits

Job Suitability

Additional Information

Work History

Reference

Work History

Reference

Release

Personal

Information

Marengo County E-911 Application for Employment Personal and Confidential

Military

ALPST - 1

Reference

Please fill in as much information as possible.

Education

Work History

To view job responsibilities, requirements, and benefits

Job Suitability

Additional Information

Work History

Reference

Work History

Reference

Release

​Personal

Information

Marengo County E-911
Application for Employment
Personal and Confidential

Personal