OEMC Application - Franklin County

Thank you for your interest in joining the Franklin County Office of Emergency Management & Communications.

Please complete the application form in its entirety. Incomplete applications may result in disqualification from consideration.

If you have a disability or functional need that prevents you from completing this application online, please contact our office at (618) 439-4362. Assistance will be provided to ensure you can apply through an alternative (paper-based) process.

If you have any questions or concerns about your application after submission, please email us at [email protected].

At the end of this form, you will be required to upload a PDF copy of your professional résumé. You may also upload any additional documentation supporting your training, certifications, or relevant experience.

Equal Opportunity Employer

Franklin County OEMC is committed to the principles of equal opportunity in all employment practices. We do not discriminate based on race, color, religion, sex, age, national origin, marital status, or disability.

We also recognize that sexual harassment constitutes a form of discrimination based on sex and is strictly prohibited. The agency maintains a zero-tolerance policy for such conduct.

If you experience or witness any form of discrimination or harassment, please contact:

Director Ryan M. Buckingham
Phone: (618) 439-4362
Mail: 403 E. Main Street, Benton, IL 62812
Email: [email protected]

PERSONAL INFORMATION

Name *

First

Last

Please list any other names you have used: *

Use N/A if none.

Present Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you 18 years of age or older? *

Telephone Phone Number: *

Alternate Telephone Phone Number: *

Driver's License Number: *

A Valid Driver’s license is required for this position.

Driver's License State: *

Email Address: *

DESIRED EMPLOYMENT

Please complete this section concerning your desired employment and/or former employment with Franklin County Government. You can access job postings and position description by visiting the employment opportunities section of our website.

Desired Position *

Position Requested *

Date you can start if selected: *

Desired Salary: *

Are you currently employed? *

If so, may we inquire with your current employer? *

Have you applied to the County Government Before? *

If so, when, and what office/department/agency did you apply for?

Use N/A if you answered NO to the prior question.

Have you ever worked for Franklin County Government or Agency Before? *

If so, when, and what office/department/agency did you work for?

Use N/A if you answered NO to the prior question.

If so, reason for leaving?

Use N/A if you answered NO to the prior question.

If so, who was your former Supervisor?

Use N/A if you answered NO to the prior question.

EMPLOYMENT HISTORY

Please complete this section concerning your last two prior locations of employment. If you have no former employment please list N/A.

Please include additional information on your employment history and experience in your professional resume that will be uploaded at the end of this form.

Employer: *

Position at Employer: *

Employer Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Starting Date: *

Leaving Date: *

If you are currently employed use N/A.

Reason for Leaving: *

If you are currently employed use N/A.

May we contact your Supervisor? *

Description of Work: *

Employer: *

Position at Employer: *

Employer Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Starting Date: *

Leaving Date: *

If you are currently employed use N/A.

Reason for Leaving: *

If you are currently employed use N/A.

May we contact your Supervisor? *

Description of Work: *

EDUCATION

Please complete this section concerning your educational background. Additional details not listed here concerning your education can be listed in your professional resume that will be uploaded at the end of this form.

School Level / Name of Elementary School / Number of Years Attended / Subjects Studied *

Use the format above to provide the information requested.

Did you graduate? *

High School / Name of School / Number of Years Attended *

Use the format above to provide the information requested. Use N/A if you do not need to use this section to list additional information.

Did you graduate? *

Use N/A if you do not need to use this section to list additional information.

College or University Level School / Number of Years Attended / Subjects Studied

Use the format above to provide the information requested. Use N/A if you do not need to use this section to list additional information.

Did you graduate?

Use N/A if you do not need to use this section to list additional information.

College or University Level School / Number of Years Attended / Subjects Studied

Use the format above to provide the information requested. Use N/A if you do not need to use this section to list additional information.

Did you graduate?

Use N/A if you do not need to use this section to list additional information.

Do you have any special work or research experience? *

If so, in what areas/topics? *

Use N/A if not applicable.

Do you have any special skills or training we should consider? *

If so, in what areas/topics? *

Use N/A if not applicable.

Are you currently licensed by the Illinois Department of Public Health as an Emergency Medical Service or EMD Provider? *

IDPH license Number: *

Use N/A if not applicable.

MILITARY SERVICE

Please list any prior military service. Please list your primary branch of service. If you have served in multiple branches at different times, please include that information on your profession resume that will be uploaded at the end of this form.

Branch of Service: *

Use N/A if not applicable.

Discharge Date: *

Use N/A if not applicable.

Discharge Rank: *

Use N/A if not applicable.

References

Please provide (3) personal references who you are not related to that have known you for at least three years.

Reference #1 *

First

Last

Use N/A if you do not need to use this section to list additional information.

Reference #1 Telephone Phone Number: *

Reference #2 *

First

Last

Use N/A if you do not need to use this section to list additional information.

Reference #2 Telephone Phone Number: *

Reference #3 *

First

Last

Use N/A if you do not need to use this section to list additional information.

Reference #3 Telephone Phone Number: *

BACKGROUND INFORMATION

Franklin County reserves the right to contact the references you have provided, as well as other individuals who may have knowledge of your overall qualifications for the position.

Please note that the County will not inquire into your financial status, religious affiliation, marital status, or any other matters unrelated to your qualifications for the position for which you have applied.

Information obtained through these inquiries will be used solely to assess your suitability for employment with the County and will not be disclosed to anyone outside the selection process.

By submitting your application, you acknowledge and authorize the County to make such inquiries. If you do not consent to this, your application cannot be considered.

Neighborhood, Community, or Civic Organization Service: *

Please list and current or prior involvement with any neighborhood, community or civic organizations.

History of Public Safety Service: *

Please list and current or prior involvement with any public safety services.

NOTICE TO APPLICANTS

Applicants must be 18 years of age.
Applicants must legally eligible to work in the United States.
Applicants are subject to a criminal and personal background investigation during the hiring process.
Applicants are subject to an illegal substance and medical screening once a conditional offer of employment has been made.
Incomplete applications will not be processed / considered.
A professional resume is required to be submitted for this application via the upload link provided.
Providing false information on this form will disqualify the applicant.

CONFIRMATION *

I have read the Notice to Applicants and confirm that I understand the conditions for application, selection and employment.

PROFESSIONAL RESUME UPLOAD

Please upload a copy of your professional resume: *

Drag & Drop Files, Choose Files to Upload

SUPPORTING DOCUMENTS UPLOAD

Please upload a copy of additional supporting documents that you would like for us to take into consideration.

Drag & Drop Files, Choose Files to Upload

AUTHORIZATION

Authorization and Consent to Contact References and Background Verification

Franklin County OEMC reserves the right to contact the references you have provided, as well as any other individuals it deems appropriate, to assess your overall qualifications for the position. The OEMC will not inquire into your financial status, religious affiliation, marital status, or any other matters unrelated to your eligibility for employment.

Any information obtained through these inquiries will be used solely for the purpose of evaluating your suitability for employment with Franklin County and will be shared only with those County representatives directly involved in the hiring process. If you do not authorize the County to make such inquiries, your application will not be considered.

By signing below, I hereby consent to Franklin County contacting any individuals it deems appropriate to verify or investigate any information I have provided, and to discuss my background, past performance, and suitability for employment. I further consent to being the subject of such discussions and expressly waive any right to bring claims for defamation, invasion of privacy, or any similar cause of action against any individual contacted in connection with this process.

Confirmation of Release Form *

I have read the release form and AGREE to the terms stated.
I have read the release form and DO NOT AGREE to the terms stated.

Signature

Applicant Certification and Authorization

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts may result in disqualification from employment or, if employed, dismissal from service with Franklin County.

I authorize the investigation of all statements contained in this application. I further authorize the references and former employers listed above to provide any and all information concerning my previous employment, as well as any other relevant personal or professional information they may have. I release Franklin County from any and all liability that may result from the use or disclosure of such information during the employment evaluation process.

I understand and agree that no representative of the County has the authority to make any assurances or enter into any agreement for employment for any specified period of time, unless such agreement is in writing and signed by an authorized representative of Franklin County.

Date / Time

Date

Time

Signature

Clear Signature