Dispatcher Application

Please download, scan, and submit with this application the Background Investigation Waiver

In order for your application to be taken into consideration please download the Background Investigation Waiver by clicking here and upload it using the form below.

Upload the completed Background Investigation Waiver document(Required)

Max. file size: 50 MB.

City of Quincy Employee Application

Complete this application in its entirety. Failure to provide complete and accurate information could cause rejection of your application. Information submitted on this application is subject to verification.

Personal Data

Name(Required)

First Middle Last

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Previous Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone Number(Required)

Alternate Phone Number(Required)

Email(Required)

Specify the POSITION for which you are applying for:(Required)

(Note: A separate application must be submitted for each vacancy.)

Rate of Pay Expected:(Required)

Have you ever worked for the City of Quincy before?(Required)

Yes

If yes, when?(Required)

What department?(Required)

Why did you leave the City's employment?(Required)

List any friends or relatives currently working for the City

Name

Relationship

Name

Relationship

Name

Relationship

Education

High School Diploma / GED

Print Name, Number and Street, City, State and Zip Code(Required)

No. of Years Complated(Required)

Degree(Required)

Major Course of Study(Required)

College

Print Name, Number and Street, City, State and Zip Code(Required)

No. of Years Complated(Required)

Degree(Required)

Major Course of Study(Required)

Graduate School

Print Name, Number and Street, City, State and Zip Code(Required)

No. of Years Complated(Required)

Degree(Required)

Major Course of Study(Required)

Trade, Business, Night or Corres.

Print Name, Number and Street, City, State and Zip Code(Required)

No. of Years Complated(Required)

Degree(Required)

Major Course of Study(Required)

Employment History

List present and past employment, beginning with your most recent, and limit it to the past ten years. Include any jobrelated military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or protected status. If any periods of unemployment exist, note that as well. Do not omit employers. Doing so may be cause for rejection of your application. Use additional pages if necessary.

May we contact the following employers?(Required)

Yes

If no, which employers should not contacted?(Required)

Employer Name(Required)

From(Required)

To(Required)

Title or Position(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Work Performed(Required)

Salary (starting&ending)(Required)

Phone(Required)

Name of Supervisor(Required)

Reason for Leaving(Required)

Employer Name

From

Title or Position

Address

Street Address Address Line 2 City State ZIP Code

Work Performed

Salary (starting&ending)

Phone

Name of Supervisor

Reason for Leaving

Office Skills (please indicate areas of competency)

OFFICE SKILLS (please indicate areas of competency)(Required)

Computer

Filling

Typying (wpm)(Required)

Software Applications Used(Required)

Trade Skills (please indicate areas of competency)

Trade Skills(Required)

Automotive Mechanic

Electrician

Custodial Work

Grounds keeping

Heavy Equipment Operator

Other Trade Skills

Job Task Analysis Information

Are you able to perform the essential functions of the job for which you applied?(Required)

Yes

If no, would you be able to perform these tasks with or without accommodation(s)?(Required)

Yes

If no, explain how you would perform these tasks with what accommodation(s):(Required)

Citizenship

Are you a citizen of the United States?(Required)

Yes

If no, do you possess an I-151 Card and I-551 Cards or an I-94 Card stamped “Employment Authorized?(Required)

Yes

Other Information

A. Criminal Record

Have you ever been convicted of a Felony?(Required)

Yes

A conviction will not necessarily disqualify you from employment

If yes, give dates and explain (attach separate paper if necessary)(Required)

B. Driver's License

Do you possess a valid Driver’s License?(Required)

Yes

Please specify State(Required)

C. Professional Certification Record - License, Registrations and Certification Numbers.(Required)

D. Professional References – Please list former supervisors and/or associates who are acquainted with your professional qualifications

Name(Required)

Address & Telephone(Required)

Name

Address & Telephone

Name

Address & Telephone

VETERAN’S PREFERENCE: A DD214 or comparable document which serves as a certificate of release or discharge must be furnished at the time of application.

Do you claim veteran’s preference?(Required)

Yes

Brand of Service(Required)

Date of Entry(Required)

Date of Discharge(Required)

Brand of Service

Date of Entry

Date of Discharge

Certification

I understand that any omissions, falsifications, misstatements or misrepresentations may disqualify me for employment consideration, and, if I am hired, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I consent to the release of information about my ability and fitness for employment by employers, schools, law enforcement agencies, and individuals. I certify that, to the best of my knowledge and belief, all the statements contained herein are true, correct and made in good faith. In compliance with the City of Quincy’s Alcohol/Drug Policy, all applicants being recommended or offered initial employment are subject to a post-employment blood and/or urinalysis screening. Any applicant who tampers with or refuses the drug/alcohol test will be considered to have withdrawn his/her application for the position for which he/she applied. An applicant who receives a positive confirmed test result will not be eligible for hire by the City of Quincy for a period of six months from the date the positive drug test was administered. I further understand and agree that my employment will be contingent upon the results. I understand that unless otherwise defined by applicable law, any employment relationship with this office is “at will”, which means the City may discharge me at any time with or without cause and that this “at will” relationship may be changed unless authorized in writing by the City of Quincy. The City of Quincy does not discriminate on the basis of race, color, national origin, sex, religion, age, marital status or disability in employment or provision of services.

Untitled(Required)

I understand I need to download, scan, and submit with this application the Background Investigation Waiver

Phone

This field is for validation purposes and should be left unchanged.

Quincy Police

Department

Quincy Police

Department

Please download, scan, and submit with this application the Background Investigation Waiver

City of Quincy Employee Application

Personal Data

Education

Employment History

Office Skills (please indicate areas of competency)

Trade Skills (please indicate areas of competency)

Job Task Analysis Information

Citizenship

Other Information

VETERAN’S PREFERENCE: A DD214 or comparable document which serves as a certificate of release or discharge must be furnished at the time of application.

Certification

Honest, Transparency, and Commitment

VISION

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