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2. WARREN COUNTY

    

3. 9-1-1 Telecommunicator Job Application
5. First Name
6. Last Name
8. Driver License Number and State
9. Phone Number
11. Date of Birth
12. Email Address
14. Address
15. City
17. State
18. Zip Code
20. HIGH SCHOOL OR GED INFORMATION
22. Education 1
24. School Name & Location
26. Years Completed & Course of Study
27. Diploma
29. Specialized Training / Honors / Awards
31. Education 2
34. School Name & Location
36. Years Completed & Course of Study
37. Diploma
39. Specialized Training / Honors / Awards
41. Education 3
43. School Name & Location
45. Years Completed & Course of Study
46. Diploma
48. Specialized Training / Honors / Awards
50. EXPERIENCE & EMPLOYMENT HISTORY
52. Employment 1
54. Employer's Name & Address
56. Dates Employed & Title (s)
58. Name of Supervisor or Employer Contact
60. Brief Description of Duties
62. Reason for Leaving
64. Miscellaneous Comments
66. Employer 2
68. Employer Name and Address
70. Dates Employed and Title(s)
72. Name of Supervisor or Employer Contact
74. Brief Description of Duties
76. Reason for Leaving
78. Miscellaneous Comments
80. Employer 3
82. Employer Name and Address
84. Dates Employed and Title(s)
86. Name of Supervisor or Employer Contact
88. Brief Description of Duties
90. Reason for Leaving
92. Miscellaneous Comments
94. Employment 4
96. Employer Name and Address
98. Dates Employed and Title(s)
100. Name of Supervisor or Employer Contact
102. Brief Description of Duties
104. Reason for Leaving
106. Miscellaneous Comments
108. RERERENCES
110. List four professional references who are not related to you
112. Reference 1 - Name, Address, Telephone Number, Years Known
114. Reference 2 - Name, Address, Telephone Number, Years Known
116. Reference 3 - Name, Address, Telephone Number, Years Known
118. Reference 4 - Name, Address, Telephone Number, Years Known
120. Miscellaneous Reference Comments (correspond by listed number)
122. AGENCY / JOB APPLIED TO:

     Warren County 9-1-1 Telecommunicator

124. EMPLOYMENT AND BACKGROUND QUESTIONS:
126. Number of years at your current address:
127. Are you a US citizen?

     1. Yes
     2. No
128. Are you legally authorized to work in the US?

     1. Yes
     2. No
130. Have you ever been convicted of a felony?

     1. Yes

     1. No
132. Please list all non-traffic crimes you have been convicted of, below

     **List offense, arresting agency, and date of arrest** (Conviction will not necessarily disqualify an applicant from employment)

134. Have you ever served in the military?

     1. Yes
     2. No
135. Discharge Status and Date
137. Have you been previously employed by the County of Warren?

     1. Yes
     2. No
138. Position, Year(s)
140. This position requires a valid driver's license with an acceptable driving record. Please list any traffic violations below:
142. Summarize any special job skills or qualifications pertinent to employment below. List any applicable license(s), certification(s), or registration(s) that you may possess.
144. Are you related to anyone who currently works for Warren County?

     1. Yes

     1. No
146. Who are you related to?
148. Name / Relationship
150. Name / Relationship
152. How did you hear about this job?

     1. Newspaper
     2. Social Media

     1. Indeed
     2. County Website

     1. From Another Employee
     2. Job Fair or Other In-Person Event
154. I heard about this job from a source that isn't listed above (please describe)
156. APPLICANT STATEMENT

     I certified that the answers given herein are true and complete to the best of my knowledge, information, and belief. I authorize investigation of all statements contained in the application for employment as may be necessary in arriving at an employment decision.

     I understand that this application is not intended as a contract for employment. I hereby authorize the County of Warren to thoroughly investigate my work references, work records, education, criminal history, credit, and all other matters related to my suitability for employment and furthermore authorize my current and former employers to disclose any/all letters, reports, or other information pertaining to my employment with them, without notice of disclosure. In addition, I hereby release the County of Warren from all claims, demands, liabilities, arising out of or in any way related to current or former employers, all persons, corporations, partnerships or associations within investigation or disclosure. 

     In the event of employment, I understand that false and misleading information given in my application ofr interview(s) will result in discharge. I understand also that I am required to abide by all rules and regulations of the County of Warren. 

     I understand that if offered employment, the offer is contingent on my passing a pre-employment alcohol and drug screen and any pre-employment testing. 

     Warren County is an equal opportunity employer and will consider applications for employment regardless of race, color, religion, sex, national origin, age, marital or veteran status, presence of a non-job-related medical condition or handicap, or any other legally protected status. 

158. Applicant Signature
159. Date
Leave This Blank:


161. 1. Receive an email copy of this form.
162. Email address

     This field is not part of the form submission.

163. Submit Submit and Print

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