Full Text
10-2017 David Dyer UNION COUNTY E-911/Mapping John Pickelsimer Director 76 D HUNT MARTIN ST. E-911 Coordinator BLAIRSVILLE, GEORGIA 30512 [PHONE REDACTED] Phone(706) 439-6061 [EMAIL REDACTED] Fax (706) 745-4399__ PRE-EMPLOYMENT INQUIRY THIS APPLICATION SHALL REMAIN ACTIVE FOR 90 DAYS. IF YOU WISH TO RENEW YOUR APPLICATION, YOU SHOULD NOTIFY THIS OFFICE AT (706) 439-6056 PRIOR TO THE 90 DAY EXPIRATION DATE. I understand that this inquiry will be reviewed and my qualifications considered for possible job openings in the near future. If the County finds that my qualifications and employment background match a current opening, I will be contacted for further information. NAME: Address: State: Phone Position Desired: Wage Email AVAILABILITY: Check all that apply: Seasonal___ Temporary___ Full Time Part Time____ Hours/Shift Available_________________Days I am willing to work 12 hour ---PAGE BREAK--- 10-2017 EMPLOYMENT EXPERIENCE: Present or most recent Employer name and contact number: Dates Employed: From to Describe your position and primary Duties: Reason For Prior Employer/Position name and contact number: Dates Employed: From to Reason for leaving Prior Employer Position name and contact number: Dates Employed: From to Reason for leaving Prior Employer/Position name and contact number: Dates Employed: From to Reason for leaving ---PAGE BREAK--- 10-2017 CIRCLE THE NUMBER OF YEARS COMPLETED FOR EACH OF THE FOLLOWING: High School 1 2 3 4 Vo-Tech 1 2 3 4 College 1 2 3 4 Post Graduation 1 2 3 4 List your Major or Primary area of study: List any professional, vocational, or other training/skills relevant to the type of employment sought: I agree to participate in any testing administered by the 911 Center that relates to my application. (Initials) I agree to take a pre-employment drug screen test at the direction of Union County Personnel. (Initials) ---PAGE BREAK--- 10-2017 Have you ever been arrested for a: Misdemeanor_____ Felony________ Have you ever been convicted of a: Misdemeanor____ Felony________ Have you ever been arrested, convicted, or plead NOLO to If you answered yes to either of the above questions, explain the charges and circumstances below: Do you have any relatives working for Union Do you have any friends or close relatives that have been convicted of any felony or ---PAGE BREAK--- 10-2017 References: Please list five references below: Name: Address: Phone#: Relationship: Name: Address: Phone#: Relationship: Name: Address: Phone#: Relationship: Name: Address: Phone#: Relationship: Name: Address: Phone#: Relationship: ---PAGE BREAK--- 10-2017 BACKGROUND CHECKS: Consent Form I hereby give my consent for the (Union County 911 Center) to receive any Georgia or III criminal history record information pertaining to me, as authorized under state and federal law for individuals seeking employment with a criminal justice agency. Full Name (print) Address Sex Race Date of Birth Social Security Number Signature Date Special employment provisions (check if applicable): Employment with criminal justice agency – civilian (Purpose code Employment with criminal justice agency – P.O.S.T. certified (Purpose code One of the following must be checked: This authorization is valid for 90/180/_____ (circle one) days from date of signature. I, give consent to the above named Agency to perform periodic criminal history background checks for the duration of my employment with this agency. I hereby declare that all the information furnished in this application is true, accurate, and complete to the best of my knowledge. Signature Date All individuals considered for employment are evaluated without regard to race, color, religion, gender, national origin, age, marital or veteran status, the presence of a disability, or any other legally protected status.