April 14, 2017 administrator Employment 1Contact Information2Record of Education3Prior Work History4Legal History5Skills6Personal References7Optional Resume Upload8Disclaimer & Digital Consent Contact InformationPosition(Required)Select PositionTelecommunicatorSupport Desk TechnicianName(Required) First Middle Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Enter Email Confirm Email This will be used as the primary means of contact.Are you a citizen of the United States(Required) Yes No Please explain citizen ship Record of EducationSchool(Required) Course of study(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code Number of Years Completed(Required)Please enter a number greater than or equal to 0.Did you graduate(Required) Yes No Diploma or degree received(Required) Yes No School Address Street Address City State / Province / Region ZIP / Postal Code Number of Years CompletedPlease enter a number greater than or equal to 0.Did you graduate Yes No Diploma or degree received Yes No School Address Street Address City State / Province / Region ZIP / Postal Code Number of Years CompletedPlease enter a number greater than or equal to 0.Did you graduate Yes No Diploma or degree received Yes No Prior Work HistoryEmployer Name(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code Job Title(Required) Job Duties(Required)Employment Start Date(Required) MM slash DD slash YYYY Employment End Date(Required) MM slash DD slash YYYY Hourly rate of pay start(Required)Please enter a number greater than or equal to 0.Hourly rate of pay finish(Required)Please enter a number greater than or equal to 0.Reason for leaving(Required) Employer Name Address Street Address City State / Province / Region ZIP / Postal Code Job Title Job DutiesEmployment Start Date MM slash DD slash YYYY Employment End Date MM slash DD slash YYYY Hourly rate of pay startPlease enter a number greater than or equal to 0.Hourly rate of pay finishPlease enter a number greater than or equal to 0.Reason for leaving Employer Name Address Street Address City State / Province / Region ZIP / Postal Code Job Title Job DutiesEmployment Start Date MM slash DD slash YYYY Employment End Date MM slash DD slash YYYY Hourly rate of pay startPlease enter a number greater than or equal to 0.Hourly rate of pay finishPlease enter a number greater than or equal to 0.Reason for leaving Legal HistoryFull transparency is required, a criminal history does not automatically disqualify an individual from the process.Have you ever been charged with a crime(Required) Yes No State the nature of the offence, when, where and disposition Certifications & SkillsTyping words per minute(Required)Please enter a number greater than or equal to 0.Certifications(Required) Add RemoveSkills(Required) Add Remove Personal ReferencesName(Required) First Last Occupation(Required) Phone(Required)Date Known(Required) MM slash DD slash YYYY Address(Required) Street Address City State / Province / Region ZIP / Postal Code Email(Required) Name(Required) First Last Occupation(Required) Phone(Required)Date Known(Required) MM slash DD slash YYYY Address(Required) Street Address City State / Province / Region ZIP / Postal Code Email(Required) Name(Required) First Last Occupation(Required) Phone(Required)Date Known(Required) MM slash DD slash YYYY Address(Required) Street Address City State / Province / Region ZIP / Postal Code Email(Required) Resume UploadAccepted file types: pdf, doc, docx, Max. file size: 30 MB. Disclaimer & Digital Consent I certify that my answers are true and complete. I authorize investigation of all statements, including references, contained in this application for employment as may be necessary in arriving at an employment decision. I also specifically waive any written notice requirements of Section 67 of 1978 PA 397 pertaining to disciplinary reports, letters of reprimand or other disciplinary actions. I also waive any claim against the Muskegon Central Dispatch 9-1-1 and all current or former employers arising from such investigation or disclosure, including, but not limited to, slander and libel, that may result from furnishing any information to the Muskegon Central Dispatch 9-1-1. This application for employment shall be considered active for a period of time not to exceed 365 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, in the absence of an express written contract or agreement to the contrary; any employment relationship with the Muskegon Central Dispatch 9-1-1 is of an “at will” nature, which means that the employee may resign at any time and the Employer may discharge employee at any time with or without cause. The undersigned applicant agrees, authorizes and consents to the procurement of a Consumer Report and/or an Investigate Consumer Report and understands that it may contain information about the applicant’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. I certify that the Muskegon Central Dispatch 9-1-1 has provided a separate notice of my rights under the Fair Credit Reporting Act. In the event of employment, I understand that false or misleading information given in my application or interview(s) would be grounds for discharge. I understand, also, that I am required to abide by all rules and regulations of the Muskegon Central Dispatch 9-1-1. I further understand that if I am offered employment, a physical which may include drug testing (at the Muskegon Central Dispatch 9-1-1’s expense) may be required, proof of educational and licensing attainment must be submitted, and if any driving will be done for the Muskegon Central Dispatch 9-1-1 purposes, I must be both eligible to drive and be qualified for insurance coverage. Employment by Muskegon Central Dispatch 9-1-1 is conditioned upon such results being satisfactory to the Muskegon Central Dispatch 9-1-1.Consent(Required) I agree to the privacy policy.By submitting this application and signing electronically, I agree my electronic signature is the legal equivalent of my manual signature on the application. I understand my electronic signature is as valid as if I signed the document in writing and on certification authority or other third party verification is necessary to validate my signature.Date of Consent(Required) MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
