Employment Application

The County considers applicants for all positions without regard to age, race, color, religion, creed, sex, national origin, marital status, disability, veteran status, gender identity, sexual orientation, or any other legally protected status. Women, veterans, and persons of color are encouraged to apply.

Fields with asterisks* are required.

1. Date
2. First Name *
3. Middle Name
4. Last Name *
5. Current Address *
6. City *
7. State * Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
8. Zip *
9. Date of Birth *
10. Email *
11. Cell Phone *
12. Home Phone
13. Work Phone
14. How did you hear about this position? * Please list the specific publication, web site, friend, employee, etc.
15. Do you speak a language in addition to English? If so, please list the language(s) and your degree of fluency.
16. Do you live within Marshalltown city limits? * Please Select Yes No
If no, at normal driving speed, and under normal conditions, how long will it take you to reach the Public Safety Building from your residence?
17. Do you plan to relocate if offered employment? * Please Select Yes No
18. Have you been convicted of a violation of the law other than minor traffic offenses? * If you have a fugitive record, or record of a felony, aggravated misdemeanor, or serious misdemeanor you cannot be hired as a 911 Communications Specialist and should not apply. Please Select Yes No
If Yes, please explain.
19. If you are under 18 years of age, can you provide required proof of work eligibility? * Please Select Yes No
20. Do you have a valid driver's license? * Please Select Yes No
21. Are you currently addicted to drugs and/or alcohol? * Please Select Yes No
22. Have you ever used any drug not prescribed by your physician? * Please Select Yes No
If you answered yes, what were the circumstances?
23. Have you ever sold or furnished drugs to anyone? * Please Select Yes No
If you answered yes, explain in detail
24. After a conditional job offer, candidates must successfully pass pre-employment psychological, physical & drug tests. Do you believe that you can pass a basic pre-employment physical? * Please Select Yes No
25. Do you believe that you can pass a pre-employment drug test? * Please Select Yes No
If you answered no, or if you are unsure, please explain.
26. Do you know anyone who is employed by the Commission/911 Center? * Please Select Yes No
If yes, list names, and how you know them

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Veterans' Preference

Complete this section only if you are a US Military veteran and want to claim veterans’ preference points. Applicants wishing to have points awarded for military service must submit proof of service including dates of service and type of discharge prior to or at the time of interview.

Next Section

27. Please list your military service dates (from and to).
28. Do you have an honorable discharge? Please Select Yes No
29. Are you a United States citizen? Please Select Yes No
30. Are you currently a resident of Iowa? Please Select Yes No
31. Do you have a service-connected disability or are you receiving compensation, disability benefits, or pension under laws administered by the veterans’ administration (an honorably discharged veteran who has been awarded the Purple Heart for disabilities incurred in action shall be considered to have a service-connected disability)? Please Select Yes No

Education and Training

High School

1. Name *
2. City *
3. State * Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
4. Zip *
5. Course of Study
6. Highest Grade Completed
7. Did you graduate? * Please Select Yes No

College

1. Name
2. City
3. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
4. Zip
5. Course of Study
6. Highest year completed
7. Did you graduate? Please Select Yes No

Technical

1. Name
2. City
3. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
4. Zip
5. Course of Study
6. Highest year completed
7. Did you graduate? Please Select Yes No

Other

1. Name
2. City
3. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
4. Zip
5. Course of Study
6. Highest year completed
7. Did you graduate? Please Select Yes No

Employment History

Please provide your employment history for past ten years, starting with the most recent employer.

Employer 1

1. Employer Name *
2. City *
3. State * Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
4. Phone *
5. Dates Employed *
6. Most Recent Earnings *
7. Supervisor *
8. Position Title *
9. Job Duties *
10. Reason For Leaving *
11. May we contact current employer? * Please Select Yes No
Add Employer

Employer 2

1. Employer Name
2. City
3. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
4. Phone
5. Dates Employed
6. Most recent earnings
7. Supervisor
8. Position Title
9. Job Duties
10. Reason For Leaving
11. May we contact this employer? Please Select Yes No
Add Employer

Optional: Upload Resume

1. Resume
   only PDF files are allowed

1. If you are currently employed, may we contact your current employer, if given advance notice? Please Select Yes No
2. Have you ever been discharged from a job? * Please Select Yes No
If you answered yes, please explain the circumstances of the discharge(s).

References

Please list three personal references, other than prior employers or relatives, whom we can contact.

Reference 1

1. Name *
2. Working Relationship *
3. Years Known *
4. Email Address (if known)
5. Phone *

Reference 2

1. Name *
2. Working Relationship *
3. Years Known *
4. Email Address (if known)
5. Phone *

Reference 3

1. Name *
2. Working Relationship *
3. Years Known *
4. Email Address (if known)
5. Phone *

1. Have you ever worked in a job that involved working varying shifts, nights, weekends, and holidays? N/A Yes No
2. Please describe your ability and flexibility to work these hours
3. What experience do you have communicating over the telephone?
4. Explain how you would react in a crisis situation? Please give specific examples to support your answer
5. Elaborate on your computer experience; including types of software used, years of experience, and level of proficiency

Agreement: Before you sign this agreement, please read the following carefully

I have completed this application myself; no one else has completed any part of it for me.

I understand and agree that if I am hired by the Commission, I will have my paychecks directly deposited into a checking or savings account(s) rather than receiving paper checks.

The information provided on this application or on any information submitted with this application is true and complete to the best of my knowledge. I agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if later discovered.

In order to permit the Commission to make a thorough investigation of my background, personal habits, and character for the purpose of determining my fitness and suitability for employment, I hereby release from liability and promise to hold harmless from any liability under any and all possible causes of legal action, any and all persons or entities who shall furnish any information or opinions regarding my background, personal habits, and/or character, whether or not that individual is specifically listed as a reference on this application.

I hereby authorize any person or entity who may be contacted by the Commission, its agents, or employees to release to such agents or employees any information, data, or opinions they may have regarding my background, personal habits, character, qualifications, and/or job performance. I understand that the source of such information or opinions provided to the Commission shall be confidential and that the Commission shall not be required to reveal the content or source of any information or opinions.

I agree to hold harmless and release from liability under any and all possible causes of legal action, the Commission, its agents, and its employees, for any statements, acts, or omissions in the course of its investigation into my background, personal habits, and/or character.

I realize that it is necessary for the Commission to thoroughly investigate my personal background and qualifications and by applying for employment with the Commission, I expressly waive all my legal rights and causes of action to the extent that the Commission investigation (for purposes of evaluating my suitability for employment) may violate or infringe upon these aforementioned legal rights and causes of action of mine.

This release from liability given by me to the Commission, its employees, or agents, and all others as heretofore provided, shall apply to any right of action that might accrue to my self, my heirs, and/or my personal representatives.

Your Signature

1. Signature * Please type your full name to serve as an electronic signature.
2. Today's Date