Washington County Consolidated Communications Agency
An Equal Opportunity Employer
Application for Employment


Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. Application must be dated and final acknowledgement must be checked, or it will be considered incomplete. All information given will be available only to persons who have a “need to know” or as required by law. This company will make reasonable accommodation in the application process, if needed.


Applying for
Today's Date Date Available for Employment
Name
Last, First MI
Email
Mail Address
Street City, State Zip
Home Phone Cell Phone
How did you hear about us?


Yes No Are you a citizen of the United States or, if not, are you legally authorized to work in the United States? ·If offered employment, you will be required to submit identification in accordance with INS rules and regulations.
Yes No As an adult have you ever been convicted of an offense other than a minor traffic violation? Due to the nature of law enforcement wrok conducted at WCCCA, state and federal law requires WCCCA to consider an applicant's criminal history.  Convictions are evaluated for each position, and are not necessarily disqualifying.

EDUCATION AND TRAINING:
EDUCATION AND TRAINING: Do you have a high school diploma, GED, or equivalent?

Yes No

Please list any colleges, universities, military, trade, business or other schools attended.
NAME AND LOCATION OF SCHOOL
MAJOR OR TYPE OF TRAINING
SEM.
CREDIT
HOURS
QTR.
CREDIT
HOURS
DEGREE OR CERTIFICATE
OBTAINED

LICENSES/CERTIFICATES: List driver’s license or other certificates you possess as required by the position applied for.
TITLE
NUMBER
ISSUING AGENCY
DATE ISSUED/DATE OF EXPIRATION

SKILLS/ABILITIES: List any skills/abilities you have which are pertinent to the position and to satisfy the minimum qualifications as noted in the job announcement.



EMPLOYMENT HISTORY: Beginning with your present or most recent job, list, in chronological order, your complete work experience, including paid and volunteer positions, military and intern experience. The information provided must be complete and accurate. A resume may be submitted but will not be accepted as a substitute for completing this section.
#1 - Name & Address of Employer
Supervisor's Name, Title, Phone Number
Your Title
From (MM/YY)
To (MM/YY)
Your Duties & Responsibilities
Reason for Leaving

#2 - Name & Address of Employer
Supervisor's Name, Title, Phone Number
Your Title
From (MM/YY)
To (MM/YY)
Your Duties & Responsibilities
Reason for Leaving

#3 - Name & Address of Employer
Supervisor's Name, Title, Phone Number
Your Title
From (MM/YY)
To (MM/YY)
Your Duties & Responsibilities
Reason for Leaving

#4 - Name & Address of Employer
Supervisor's Name, Title, Phone Number
Your Title
From (MM/YY)
To (MM/YY)
Your Duties & Responsibilities
Reason for Leaving

#5 - Name & Address of Employer
Supervisor's Name, Title, Phone Number
Your Title
From (MM/YY)
To (MM/YY)
Your Duties & Responsibilities
Reason for Leaving

#6 - Name & Address of Employer
Supervisor's Name, Title, Phone Number
Your Title
From (MM/YY)
To (MM/YY)
Your Duties & Responsibilities
Reason for Leaving

#7 - Name & Address of Employer
Supervisor's Name, Title, Phone Number
Your Title
From (MM/YY)
To (MM/YY)
Your Duties & Responsibilities
Reason for Leaving

#8 - Name & Address of Employer
Supervisor's Name, Title, Phone Number
Your Title
From (MM/YY)
To (MM/YY)
Your Duties & Responsibilities
Reason for Leaving

Supplemental Questionnaire for all Dispatch Applicants

1. Are you able to work in an organization whose structure is based on “chain of command” with work closely monitored and work productivity frequently evaluated and critiqued?
Yes No

2. Are you able to work at a rapid pace over which you have little control?
Yes No

3. Are you able and willing to work any shift assigned in a 24-hour a day operation?
Yes No

4. Describe your understanding of what working shift work means.


5. Are you willing to submit to a thorough criminal, personal and employment background investigation?
Yes No

6. Have you ever been convicted of a felony?
Due to the nature of law enforcement wrok conducted at WCCCA, state and federal law requires WCCCA to consider an applicant's criminal history.
Yes No
If yes, please list the date and explain the nature of the conviction.


7. Have you ever been convicted of a misdemeanor?
Due to the nature of law enforcement wrok conducted at WCCCA, state and federal law requires WCCCA to consider an applicant's criminal history.
Yes No
If yes, please list the date and explain the nature of the conviction.


8. Are you willing and able to treat all people with respect and dignity?
Yes No

9. Can you speak English clearly and concisely?
Yes No

10. Can you write in English clearly, accurately, concisely, legibly and correctly?
Yes No

11. Are you willing and able to be courteous to callers who scream or direct obscene language at you; or callers who are drunk, irrational or confused?
Yes No



I understand and agree that information may be developed through an Agency review of background history records, personal interviews with third parties such as family members, neighbors, friends, associates, former employers, educational institutions, custodians of official records or other sources. Only job-related information developed from such a report will be considered in evaluating my employment application or continued employment. I hereby authorize such persons, companies, organizations or corporations to answer all questions or release any information regarding me for purposes of my application for employment. I hereby release them and WCCCA from any liability and hold them harmless from any claim for releasing any information within their knowledge and/or records.

I certify that the answers given by me to the foregoing questions and during any interviews are true and correct without consequential omissions, and understand that my failure to do so will result in the rejection of my application and, if employed, omissions and/or false statements on this application or during any interviews may result in dismissal. I understand and acknowledge that this employment application does not constitute an employment contract. I have had an opportunity to have my questions about this statement's content and intent answered and understand its terms.

In consideration of my employment, I agree to conform to the instructions, rules and policies of WCCCA. Further, I hereby affirm that I am able to perform the essential functions of this job, with or without reasonable accommodation, as outlined in the attached job description and/or announcement.

I understand, certify, agree to and acknowlege the above content.

***Review Veterans Preference information and scroll to bottom to submit form.***



Veterans’ Preference Form (ORS 408.230)


Veterans who meet the minimum qualifications for a position open for recruitment may be eligible for preference in employment under Oregon law. If you are a Qualified Veteran or Qualified Disabled Veteran as defined below, and would like to be granted preference in the selection and hiring process for a specific posted job, please provide proof of eligibility by submitting a copy of form DD-214 or 215 (copy 4). The required supporting documentation must be submitted with your application by the application deadline to be considered for Veterans’ Preference.

Qualified Veteran: Veterans’ preference may be claimed if you meet at least one of the items below and provide proof via form DD-214 or 215 (Copy 4)

RS 408.225(f) – I served on active duty with the Armed Forces of the United States:
  • For a period of more than 90 consecutive days beginning on or before January 31, 1955, and was discharged or released under honorable conditions
  • For a period of more than 178 consecutive days beginning after January 31, 1955, and was discharged or released from active duty under honorable conditions
  • For a period of 178 days or less and was discharged or released from active duty under honorable conditions because of a service due to a service related disability
  • For a period of 178 days or less and was discharged or released from active duty under honorable conditions and have a disability rating from the United States Department of Veterans Affairs
  • For at least one day in a combat zone and was discharged or released from active duty under honorable conditions
  • And received a combat or campaign ribbon or an expeditionary medal for service in the Armed Forces of the United States and was discharged or released from active duty under honorable conditions
  • And am receiving a nonservice – connected pension from the United States Department of Veterans Affairs  

Qualified Disabled Veteran: Additional preference may be claimed if you meet at least one of the items below and provide proof of eligibility via a copy of DD-214 or 215 (Copy 4), and a public employment preference letter from the nited States Department of Veteran’s Affairs (letter may be requested by calling 800-827-1000)
  • I am entitled to disability compensation under laws administered by the United States Department of Veterans Affairs; or
  • I was discharged or released from active duty for a disability incurred or aggravated in the line of duty; or
  • I was awarded the Purple Heart for wounds received in combat.

Preference will not be awarded without the appropriate documentation. You must submit your DD-214 or 215 in all cases at the time of your application by the application deadline. If you are claiming disabled veterans preference, you must also submit the public employment preference letter from the Department of Veterans Affairs unless the information is included in the federal DD-215 or 215 form. You will not receive preference without these accompanying documents.