Employment Application

Thank you for your interest in employment with Putnam County 911 / Emergency Management.

Applications will not be accepted unless you have completed and signed the application in its entirety. Your resume and copies of applicable certifications must also be attached.

Applications will remain active for 6 months. After that time, those interested need to reapply.

We are located at 100 Emergency Lane Winfield WV 25213. If you choose, you may mail your application and the requested documents to the above address.

If you have any questions, please feel free to call the office of the Deputy Director Monday – Friday 7 am – 5 pm at (304) 586-4923.

Application For Employment

Step 1 of 7

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Application For Employment

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability, or national origin. Consistent with the Americans with Disabilities Act, applicants may request accommodations needed to participate in the application process.

Date(Required)

MM slash DD slash YYYY

Position for which you are applying:(Required)

Full Name(Required)

First Middle Last

Present Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Applicant Questionnaire

Are you currently employed?(Required)

Yes

If yes, may we inquire with your present employer?(Required)

Yes

If no, please provide an explanation

Have you ever applied with Putnam County 911/Emergency Management before?(Required)

Yes

If so, when?

Have you ever been employed with ANY 911/Emergency management agency?(Required)

Yes

If so, please list the agency name and your position:

If employment is offered, what date are you available to start?

Questions

Please check the appropriate box.

1. Are you legally authorized to work in the United States?(Required)

Yes

2. Do you have a valid driver's license?(Required)

Yes

3. Have you ever been convicted of a traffic violation?(Required)

Yes

4. Have you ever been convicted of a misdemeanor crime?(Required)

Yes

5. Have you ever been convicted of a felony?(Required)

Yes

6. Are you currently under any pending criminal charges?(Required)

Yes

If you have answered "yes" to any question numbered 3 through 6, please explain:

Are you willing to work the following?

12-Hour Shifts:(Required)

Yes

Night Shift:(Required)

Yes

Weekends:(Required)

Yes

Holidays:(Required)

Yes

Scheduled Overtime:(Required)

Yes

Unscheduled Overtime:(Required)

Yes

Day Shift:(Required)

Yes

Education

Name of High School(Required)

Did you graduate?(Required)

Yes

If no, what is the last year you completed?

Name of College

Did you graduate?

Yes

If no, what is the last year you completed?

Subjects Studied or Degree(s) Received

Technical or Vocational School

Did you graduate?

Yes

If no, what is the last year you completed?

Subjects Studied or Degree(s) Received

Other (Specify)

Specialized Skills

What skills or additional training do you have that are related to the job for which you are applying?(Required)

What machines or equipment can you operate that are related to the job for which you are applying (including dispatch systems)?(Required)

Please describe your experience and knowledge of computer systems (software and hardware), particularly dispatch systems.(Required)

State any additional information about your sklils which you feel may be helpful to us in considering your applicaiton.

Certifications

Do you currently possess a valid Emergency Medical Dispatch (EMD), or Public Safety Telecommunicator (PST) 1 certificates?(Required)

If yes, please attach a copy to the file upload section of the application when you reach it.

Do you currently possess a valid Cardio-Pulmonary Resuscitation (CPR) certificate?(Required)

If yes, please attach a copy to the file upload section of the application when you reach it.

Please list any other job-releated certifications you possess.(Required)

If yes, please attach a copy to the file upload section of the application when you reach it.

Military

List below your last four employers, starting with the most recent one.

Branch of Service

Rank

Dates of Service

Type of Discharge

Former Employers

List below your last four employers, starting with the most recent one.

Name & Address of Employer 1

Date Started

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Phone Number

Salary Upon Leaving

Position

Supervisor

Reason for Leaving

Name & Address of Employer 2

Date Started

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Phone Number

Salary Upon Leaving

Position

Supervisor

Reason for Leaving

Name & Address of Employer 3

Date Started

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Phone Number

Salary Upon Leaving

Position

Supervisor

Reason for Leaving

Name & Address of Employer 4

Date Started

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Phone Number

Position

Salary Upon Leaving

Supervisor

Reason for Leaving

References

List below three persons not related to you whom you have known for at least one year.

Reference 1 Name & Address

Phone Number

Relationship

Number of Years Acquainted

Reference 2 Name & Address

Phone Number

Relationship

Number of Years Acquainted

Reference 3 Name & Address

Phone Number

Relationship

Number of Years Acquainted

Certification & Authorization

Please read carefully, check each item, and sign that you are in agreement.

I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission or misrepresentation on this application may cause me not to be hired or, if hired, may cause my dismissal regardless of when discovered by the employer.(Required)

I Agree

If I am offered employment, I authorize the employer to conduct a thorough background check including, but not limited to, my criminal and driving history, and I authorize my references and former employers to disclose any information regarding my employment history, character and general reputation, without giving me prior notice of the disclosure. I release the employer, any former employers, all references listed above and any law enforcement or governmental agency that assists in conducting my background check from any and all claims, demands or liabilities arising out of or related to the investigation or disclosure.(Required)

I Agree

If I am offered employment, I agree to submit to a drug/alcohol test, and a medical examination if applicable, before starting work. If employed, I also agree to submit to medical examinations and drug/alcohol testing at any time deemed appropriate by the employer as permitted by law. I authorize and consent to the release of the test results of the examinations to the employer. I understand that my employment or continued employment is contingent upon satisfactory medical examinations and drug tests, to the extent permitted by law.(Required)

I Agree

I understand that completing this form does not create an employment contract and does not indicate that there is a position open. Further, I understand that if hired, I will be an at-will employee whose term of employment is not fixed and may be terminated at any time, with or without cause, at the option of myself or the employer.(Required)

I Agree

Signature(Required)

Date(Required)

MM slash DD slash YYYY

File Upload(Required)

Drop files here or

Max. file size: 15 MB.