Employment Form | Kalamazoo Employment

Last Name

First Name

Middle Name

Address

City

State

Zip Code

Mobile/Cell Phone

Alternate Phone

Email Address

Position(s) you are applying for

What source referred you to KCCDA?

Are you 18 years or older?

Yes No

Do you need full-time employment?

Yes No

Will you consider part-time?

Yes No

Temporary?

Yes No

Date You Are Available:

Rate of Pay Desired/Expected:

Are you authorized to work in the United States?

Have you ever applied for a position with KCCDA before?

Yes No

If Yes, what position and when (month & year):

List any relatives currently working for or contracted by KCCDA:

Have you ever been suspended or discharged from a former employer?

Yes No

If Yes, please explain:

Do you have any employment records under a name other than the one listed above?

Yes No

If yes, please list additional names:

Michigan law requires employers to make accommodations to applicants who are persons with disabilities and such employees where the accommodation does not impose an undue hardship on the employer. Persons with disabilities who are employees and applicants may request an accommodation of their disability by notifying the Employer in writing of the need for accommodation within 182 days of the date the person knows or should know that an accommodation is needed. Failure to properly notify the Employer will preclude any claim that the Employer failed to accommodate the person with disabilities.

I understand and agree

Can you perform the essential job functions for the position(s) you are applying either with or without a reasonable accommodation?

Do you have a valid Driver’s License?

Yes No

Driver's License #

State of Issue

Expiration Date:

Endorsements

**SPECIAL NOTE – All KCCDA positions require criminal background checks on prospective employees**

I understand and agree

Have you ever been convicted of a crime (convictions only)?

Yes No

If yes, please describe (include location and date):

Please list all civil infractions – parking tickets, speeding tickets, etc. – in the last five years (include location and date):

Please list any special skills, abilities, and interests you feel could be an asset:

Resume Upload

Name of High School Attended

Dates Attended

Areas of Specialization

Graduated/Degree

Yes No

College

Dates Attended

Areas of Specialization

Degree

Graduate

Dates Attended

Areas of Specialization

Degree

List other formal education or licenses you feel are relevant to the position for which you are applying:

I hereby certify that I have read and understand the disclaimer.

I certify that my answers are true and complete. I authorize investigation of all statements, including references, contained in this application for employment as may be necessary in arriving at an employment decision. I also specifically waive any written notice requirements of Section 6&7 of 1978 PA 397 pertaining to disciplinary reports, letters of reprimand or other disciplinary actions. I also waive any claim against the KALAMAZOO COUNTY CONSOLIDATED DISPATCH AUTHORITY and all current or former employers arising from such investigation or disclosure, including, but not limited to, slander and libel, that may result from furnishing any information to the KALAMAZOO COUNTY CONSOLIDATED DISPATCH AUTHORITY.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, in the absence of an express written contract or agreement to the contrary; any employment relationship with the KALAMAZOO COUNTY CONSOLIDATED DISPATCH AUTHORITY is of an “at-will” nature, which means that the employee may resign at any time and the Employer may discharge employee at any time with or without cause.
The undersigned applicant agrees, authorizes and consents to the procurement of a Consumer Report and/or an Investigate Consumer Report and understands that it may contain information about the applicant’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. I certify that the KALAMAZOO COUNTY CONSOLIDATED DISPATCH AUTHORITY has provided a separate notice of my rights under the Fair Credit Reporting Act.
In the event of employment, I understand that false or misleading information given in my application or interview(s) would be grounds for discharge. I understand, also, that I am required to abide by all rules and regulations of the KALAMAZOO COUNTY CONSOLIDATED DISPATCH AUTHORITY.
I further understand and agree to a physical which may include hearing and drug testing (at the KALAMAZOO COUNTY CONSOLIDATED DISPATCH AUTHORITY’s expense), proof of educational and licensing attainment must be submitted, and if any driving will be done for the KALAMAZOO COUNTY CONSOLIDATED DISPATCH AUTHORITY purposes, I must be both eligible to drive and be qualified for insurance coverage. I understand an offer of employment from the KALAMAZOO COUNTY CONSOLIDATED DISPATCH AUTHORITY shall be conditioned upon receiving satisfactory results of the above items and in the sole discretion of the KALAMAZOO COUNTY CONSOLIDATED DISPATCH AUTHORITY.
I agree that any action or suit against the KALAMAZOO COUNTY CONSOLIDATED DISPATCH AUTHORITY or its board elected or appointed officials, officers and/or employees arising out of my application for employment, employment, or termination of employment, including but not limited to claims arising under State or Federal civil rights statutes, must be brought within 180 days of the event giving rise to the claims or be forever barred. I waive any limitation periods to the contrary.

Print First and Last Name

Date Signed

Position(s)

Applicant's Full Name

Address

Social Security Number

I hereby certify that I have read and understand the disclosure..

As an applicant for employment or a current employee of the Kalamazoo County Consolidated Dispatch Authority ("Employer"), you are a consumer with rights under the Fair Credit Reporting Act. As part of the employment process, including for determinations related to initial employment reassignment, promotion, or other employment-related actions, the Employer may obtain, or has decided to obtain, from a consumer reporting agency, a consumer report and/or investigative consumer report on you as defined by the Fair Credit Reporting Act.
A “consumer reporting agency" is a person or business which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing consumer reports to others, including employers. A “consumer report” means any written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, and credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing your eligibility for employment. An “investigative consumer report” means a consumer report or portion thereof in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews by an entity or person that is a consumer reporting agency with your neighbors, friends, or associates or with others with whom you are acquainted or who may have knowledge concerning any such items of information. In connection with an investigative consumer report, you may request, in writing and within a reasonable time, additional disclosures regarding the nature and scope of the investigation as well as a written summary of your rights under the Fair Credit Reporting Act.
The information sought may include but not be limited to a number of sources, such as: criminal conviction records; public court records; and when applicable, Department of Motor Vehicle records; credit reports; and verification of highest degree; and, if applicable, current professional license or certification earned, including information regarding your credit, standing, capacity and history or similar characteristics; character; general reputation; personal characteristics; or mode of living. The information requested may also include employment verification and social security verification. A consumer report and/or investigative consumer report as defined by the Fair Credit Reporting Act will not be used to discriminate against an applicant or employee in violation of any law.
AUTHORIZATION AND RELEASE: I have read and understand the above Disclosure. During the application process as an applicant for employment and at any time during the tenure of my employment/service with the Employer, I hereby authorize the Employer to procure one or more consumer reports and/or investigative consumer reports on me for employment purposes, as described in the above Disclosure. I understand the consumer report(s) and/or consumer investigative report(s) may include information regarding my credit worthiness, standing and capacity if applicable, criminal conviction records, public court records, Department of Motor Vehicle records, verification of highest degree, professional license or certification, character, general reputation, personal characteristics, or mode of living. This report(s) may be compiled with information from credit bureaus, court records repositories, departments of motor vehicles, past or present employers and educational institutions, governmental occupational licensing or registration entities, business or personal references, and any other source required to verify information that I have voluntarily supplied. I understand that I have rights under the Fair Credit Reporting Act, including that I may request a complete and accurate disclosure of the nature and scope of the background verification, to the extent such investigation includes information bearing on my character, general reputation, personal characteristics or made of living obtained through personal interviews by an entity or person that is a consumer reporting agency, as well as a written summary of my rights under the Fair Credit Reporting Act. I understand that the Employer requires my social security number, date of birth, race and sex information, as required by the Immigration and Control Act of 1986-8 USC 1324, for use in the proper identification and background screening of employees. I understand that this information will not be used to discriminate against me in violation of any law.
I acknowledge that I have read this Disclosure and Authorization To Release Information, fully understand it, and freely and voluntarily agree to its provisions. All fields below are required to be completed by the candidate.

Print First and Last Name

Date Signed

To help us comply with Federal/State equal employment opportunity recordkeeping, reporting, other legal requirements, as well as to assist in assessment of Kalamazoo County Consolidated Dispatch Authority’s (KCCDA) effectiveness in recruiting and outreach efforts, please answer the questions below. The information requested on this form is not used to evaluate your application. This form will be kept in a Confidential File separated from the attached Application for Employment. This form is completely voluntary and failure to complete it will NOT adversely affect your consideration for employ.

I understand and agree

Today's Date

Position applied for at KCCDA

Name

Race/Ethnicity

Sex

Marital Status

Number of Children

Are You a Veteran?

Yes No

If marked YES above: Were you honorably discharged?

Yes No

How long have you resided in Michigan?

How did you hear about this job?

Job Service Advertisement Social Media Other

If checked "other", please specify:

Employment Application

An Equal Opportunity Employer

EMERGENCY

9-1-1

Non-emergency phone number

269-488-8911

7040 STADIUM DRIVE KALAMAZOO, MI 49009

Admin Hours

Monday thru Thursday 8:00 a.m. - 4:00 p.m.
Friday 8:00 a.m. - 3:00 p.m.

Employment Application

An Equal Opportunity Employer

EMERGENCY

9-1-1

Non-emergency phone number

269-488-8911

7040 STADIUM DRIVE KALAMAZOO, MI 49009

Admin Hours

Monday thru Thursday 8:00 a.m. - 4:00 p.m. Friday 8:00 a.m. - 3:00 p.m.

Monday thru Thursday 8:00 a.m. - 4:00 p.m.
Friday 8:00 a.m. - 3:00 p.m.