Telecommunication Specialist Preliminary ApplicationName (Last, First, MI) (required)Have you ever used another name? (required)YesNoIf Yes, list any assumed name, nickname, maiden, or another married nameCurrent Address (include city, state & zip) (required)Telephone Number (required)Email Address (required)Have you ever applied or worked for the District before? (required)YesNoIf Yes, whenHave you ever been convicted of a crime? (required)YesNoIf Yes, Please provide detailEDUCATION & TRAININGHighschool Name (required)City and State (required)Year of Graduation (required)Certification Received (required)DiplomaGEDCollege NameCity and StateDegree or Number or CreditsTrade or Tech School NameCity and StateCertification, DiplomaMajor Area of StudyEMPLOYMENT HISTORYCurrent or Most Recent Employer (required)Address (required)Supervisor Name (required)Contact Phone # (required)Email Address (required)Start Date (required)End Date (required)Position Held (required)May we contact this employer? (required)YesNoDuties (required)Reason for Leaving (if still employed, why are you seeking other employment)? (required)2nd Most Recent Employer Name:AddressSupervisor NameContact Phone #Email AddressStart DateEnd DatePosition HeldMay we contact this employer?YesNoDutiesReason for LeavingTHIS DISTRICT IS AN EQUAL OPPORTUNITY PROVIDERKlamath 9-1-1 Communications District does not discriminate on the basis of race, color, national origin, sex, religion, age, or disability in employment. In compliance with the Americans with Disabilities Act, the District will provide reasonable accommodations to qualified individuals with disabilities. (required)ACKNOWLEDGMENTVETERANS' PREFERANCE (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 and would like to be granted preference in the selection and hiring process for a specific posted job, please fill out this Veterans' Preference Form and provide proof of eligibility by submitting a copy of form DD-214 or 215 (copy 4). This completed form and required supporting documentation must (required)ACKNOWLEDGEMENTCERTIFICATION & AGREEMENTI certify all information given on this application and any supporting information is true and complete. I agree that if accepted for employment, I may be discharged if the District, at any time learns of any falsification or material omission in the information I have provided and if discovered prior to acceptance, I would be ineligible for consideration. I agree that, if accepted for employment, I will follow all District policies, rules, procedures, and all other directions. I understand that the District is committed to promoting safety and high professional standards of performance, productivity and reliability. In order to achieve this, all considered candidates must pass mandatory skills based tests and finalists may be subjected to a psychological testing, drug testing and physical testing prior to being hired to assure the applicant meets the mental stability and physical requirements and does not currently have narcotics, sedatives, stimulants, and other controlled substances in their body. I further understand that if I am selected as a finalist with the District, a thorough background investigation will be conducted. (required)I CERTIFYAPPLICANT SIGNATURE: (required)DATE: (required)There was a problem saving your submission. Please try again later.Please wait while your submission is being saved...Submitting...SubmitThank you, your submission has been received.