Employment CURRENT JOB OPENINGS Police Officer (Continual Recruitment) Seasonal Emergency Medical Technician Public Safety Director Online Job Application 1Personal Information2Position Applying For3Work Experience4Prior Employment5Education6References7Disclaimer Name * Required First MI Last Social Security Number - Last 4 Digits * Required Email * Required Address * Required Street Address Address Line 2 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 * RequiredMobile Phone * RequiredAre you Entitled to Work in the United States? * Required Yes No Are you 18 or older? * Required Yes No Have you ever been convicted of a felony or been incarcerated in connection with a felony in the past 7 years? * Required Yes No If yes please explain: * RequiredMilitary Service? * Required Yes No Are you a veteran? * Required Yes No What position are you applying for? * Required How did you hear about this position? * RequiredExpected Hourly Rate Expected Weekly Earnings Date Available - must be mm/dd/yyyy format * Required MM slash DD slash YYYY CURRENT or PRIOR WORK EXPERIENCECURRENT or MOST RECENT EMPLOYER * Required Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone * RequiredName of Immediate Supervisor * Required First Last Dates of Employment FROM - must be mm/dd/yyyy format * Required MM slash DD slash YYYY Dates of Employment TO - must be mm/dd/yyyy format * Required MM slash DD slash YYYY Position/Job Title * Required Pay * Required Reason for Leaving? * RequiredMay We Contact? * Required Yes No PRIOR EMPLOYMENTPRIOR EMPLOYER * Required Prior Employer Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Prior Employer Telephone * RequiredPrior Employer Supervisor * Required First Last Prior Employer Dates of Employment FROM - must be mm/dd/yyyy format * Required MM slash DD slash YYYY Prior Employer Dates of Employment TO - must be mm/dd/yyyy format * Required MM slash DD slash YYYY Prior Employment Position/Job Title * Required Prior Employment Pay Reason for Leaving Prior Employer ? * RequiredMay We Contact Prior Employer? * Required Yes No EDUCATIONHigh School Name * Required Last Year Completed * Required 9th Grade 10th Grade 11th Grade 12th Grade Check the box of the year you last completed.Name of College or University Last Year Completed 1st Year 2nd Year 3rd Year 4th Year Graduate Check the box of the year you last completed.Other Education/Certifications/Endorsements List any applicable special skills, training, or proficiencies REFERENCESReference #1 * Required First Last Phone * RequiredReference #2 * Required First Last Phone * Required Signature * Required Disclaimer - By Typing my name (signing), I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired. I also provide consent for former employers to be contacted regarding work records.
