Dispatcher – El Dorado Police Department

First Name *

Last Name *

Phone Number *

Mailing Address *

Date of Birth *

Are you a U.S Citizen *

Most recent employer

Direct Supervisor

Supervisor's Phone Number

Date Hire

End of Employment Date

Reason for Leaving

If within 5 years next most recent employer

Direct Supervisor

Supervisor's Phone Number

Date Hire

End of Employment Date

Reason For Leaving

If within 5 years next most recent employer (copy)

Direct Supervisor

Supervisor's Phone Number

Date Hired

End of Employment Date

Reason For Leaving

Do you have a High School diploma or equivalent?

Name of High School

Address of high School

Highest Grade Completed

Date of Graduation

List all College, University, Trade, Business, or Correspondence Schools

Dates of Attendance ( Started - Exited)

Hours Completed

Did You Earn a Degree?

College, University, Trade, Business, or Correspondence Schools

Dates of Attendance ( Started - Exited)

Hours Completed

Did You Earn a Degree?

College, University, Trade, Business, or Correspondence Schools

Dates of Attendance ( Started - Exited)

Hours Completed

Did You Earn a Degree?

Can you preform the duties of the job you applying for?

List any Licenses you currently hold (Driver's, CDL, Electricians, etc.) please list type, number, expiration, and state issued in

Specify equipment of office machines you operate

Reference #1: Name *

List people you are NOT related to, but have good knowledge of your character, experience or ability

Address *

Phone Number *

Occupation *

Reference #2: Name *

List people you are NOT related to, but have good knowledge of your character, experience or ability

Address *

Phone Number *

Occupation *

Reference #3: Name *

List people you are NOT related to, but have good knowledge of your character, experience or ability

Address *

Phone Number *

Occupation *

List any additional experience and training you have that would qualify you for this position

I understand that this application is not is not intended to create any contractual or other legal rights. It does not alter the at-will employment status nor does it create an employment contract for any specific period of time *

I understand and agree

I certify that I have no willful misrepresentation in this application nor have I withheld information in my statement and answers to questions. I am aware that the information given by me in my application will be investigated, with my full permission, and that any misrepresentation may cause my application to be rejected or my employment terminated. *

I understand and agree

I authorize any former employer to release to the city or its authorized representative any and all employment records and other information it may have about my employment. I understand that the information will be used for the purpose of evaluating my application for employment with the city. I also authorize for the department representative to conduct a background check to include a check of my criminal and driving history. A photocopy of this virtual authorization shall be as valid as the original. *

I understand and agree

I understand that this appointment will be at the discretion of the department head concerned; subject to the approval of the (chief administrative officer) and that this application is the property of the city and will become a part of my file if I am accepted for employment. *

I understand and agree

Your name and last four (4) digits of your S.S.N. below with serve as your virtual signature and certify and agree to all information above.

Name: First, Middle, Last

Las t four (4) digits of S.S.N