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Warren County, Mississippi

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Employment Application

E911 Employment Application

Step 1 of 9 - Basic Information

11%

Warren County E911 - Employment Application
Name*
First Last
Address*
Street Address City State ZIP Code
How long at present address
Cell / Mobile Phone
Home Phone
Work Phone
Email*

Position Applying For*
Date Available for Work*
MM slash DD slash YYYY

When will you be able to work?
Over 21 years of Age*
- Yes
- No
Instructions Employment is subject to verification of minimum legal age.
Previous Applicant?*
- Yes
- No
Have you previously Applied for Employment with Us?
How did you hear about this position
Legal Employment Status*
- Yes
- No
Are you legally eligible for employment in the U.S.?
Current Employment Status*
- Yes
- No
Are You Currently Employed?

Disclosure We conduct criminal background checks on job applicants prior to employment. In response to the following questions, all convictions of or pleas of guilty or no contest to criminal offenses must be disclosed. A conviction does not automatically mean you will not be hired. However, criminal background history, non-disclosure or inaccurate or misleading disclosure may result in a decision not to hire.
Felony*
- Yes
- No
Have you ever been convicted of, or plead guilty or no contest (nolo contendre) to a felony?
Misdemeanor*
- Yes
- No
Have you been convicted of, or plead guilty or no contest (nolo contendre) to, a misdemeanor in the last 5 years, which resulted or could have resulted in incarceration?
Pending Criminal Charges*
- Yes
- No
Do you currently have any unresolved criminal charges pending (including DUI or DWI) but excluding minor traffic violations?
Explain
Please tell us about the pending criminal charges
Job Performance*
- Yes
- No
Are there any reasons for which you might not be able to perform the job duties (with a reasonable accommodation)?
Drivers License Number
What is your Drivers License Number
State issued
What state has issued this Drivers License
Violations
- Yes
- No
Have you received any moving violations

The following Questions relate to your educational experience
High School Attended
Name of School Year Completed Area of Study Graduate (yes or no) Degree / Diploma Obtained

College*
- Yes
- No
Did you attend College
Education
Name Year Completed Area of Study Graduate (yes or no) Degree Obtained

Note: To enter additional schools, select the plus symbol to add an additional row

U.S. Armed Services*
- Yes
- No
Have you served in the U.S. Armed Services
Military Service Record
Branch of Service Rank at Discharge Service From (Date) Service To (Date) Type Discharge (Honorable, Other Than Honorable) etc Duties

Tell us about your service

Work Experience #1
Employer*
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Supervisors Name
Phone
Start Date*
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY

Leave this blank if you are still working for this employer.
Starting hourly rate
Ending hourly rate
Description*

Please briefly describe your role at the company.
Reason for Leaving
Why did you leave this company
May we contact this employer
- Yes
- No
Additional Experience?*
- Yes
- No
Work Experience #2
Employer
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Supervisors Name
Phone
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY

Leave this blank if you are still working for this employer.
Starting hourly rate
Ending hourly rate
Reason for Leaving
Why did you leave this company
Description

Please briefly describe your role at the company.
May we contact this employer
- Yes
- No
Additional Experience?*
- Yes
- No
Work Experience #3
Employer
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Supervisors Name
Phone
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY

Leave this blank if you are still working for this employer.
Starting hourly rate
Ending hourly rate
Reason for Leaving
Why did you leave this company
Description

Please briefly describe your role at the company.
May we contact this employer
- Yes
- No

Enter the first reference below, then select the plus + symbol to the right of the field to enter the 2nd reference, repeat for 3rd reference.
3 References*
Name Relationship Phone Number

Give 3 References: Important - Select the + symbol to add references
Our employees are required to list any known immediate or close family members who are also employed with us. Failure to do so will result in disciplinary action up to and including termination. Immediate family members are defined as, Mom, Dad, Sister, Brother, in-laws, Step - relations or spouse
Disclosure of Relatives Employed with us*
Name Relationship Department

List all relatives employed with us

* Please Note that if you are selected for a position with Us, a backgrounds check as well as a drug / alcohol test will be done prior to employment. ** Please note that if you are selected for a position with us, Depending on the position you will be asked to provide information on your background and pertinent information regarding your employment and personal history. By signing this Application I am certifying that
- The Information provided in the application the Application for Employment is true, correct and complete. If employed and mis-statements or omissions of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.
- If you decide to engage in an investigative consumer reporting agency to report on my credit and personal history, I authorize you to do so.
- If a report is obtained you must provide, at my request the name and address of the agency so I may obtain from them the nature and substance of the information contained in the report.
Signature*
01/24/2025
Phone
This field is for validation purposes and should be left unchanged.

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