Planning Specialist Application

Thank you for your interest in the position of Planning Specialist with Franklin County Emergency Management Agency. Please complete the application below in full. Failure to do so can exempt you from consideration. If you have a functional need or disability that limits you from completing this application online, please contact our office at 618-439-4362, ext. 301 and you will be given assistance with a paper application process in order to ensure you can apply for this position. If you have any questions, comments or concerns about your application after submission, please email us at [email protected]. You will be required to upload a PDF copy of your professional resume at the end of this form. You may also upload any additional documents related to your training and experience that you would like to submit.

JOB POSTING

Planning Specialist

EQUAL OPPORTUNITY EMPLOYER

Franklin County Emergency Management Agency is dedicated to the concept of equal opportunity. The agency will not discriminate on the basis of race, color, religion, sex, age, national origin, or marital status, or against any qualified individual with disabilities, in its employment practices, and the treatment of employees. Recognizing that sexual harassment constitutes discrimination on the basis of sex and violates this rule, the agency will not tolerate such conduct. Should you experience such behavior, please contact Director Ryan M. Buckingham, at (618) 439-4EMA; or by mail at 401 E. Park Street, Benton, IL 62812-1300; or by e-mail at [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 are applying for the position of Planning Specialist with Franklin County Emergency Management Agency. You can access the job posting and position description by visiting the employment opportunities section of our website.

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 or Agency 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 apply 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 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

THE COUNTY RESERVES THE RIGHT TO CONFER WITH PERSONS LISTED BY YOU AS A REFERENCE, OR WITH ANY OTHER INDIVIDUALS, WITH KNOWLEDGE CONCERNING YOUR TOTAL QUALIFICATIONS FOR THE POSITION. THE COUNTY WILL NOT INQUIRE INTO YOUR FINANCIAL STATUS, RELIGIOUS AFFILIATION, MARITAL STATUS, OR ON OTHER MATTERS UNRELATED TO YOUR QUALIFICATIONS TO FILL THE POSITION FOR WHICH YOU APPLIED. INFORMATION RECEIVED FROM SUCH INQUIRIES WILL BE USED SOLELY FOR DETERMINING YOUR EMPLOYABILITY WITH THE COUNTY AND FOR NO OTHER PURPOSE. THIS INFORMATION WILL NOT BE SHARED WITH ANYONE OTHER THAN THOSE COUNTY REPRESENTATIVES INVOLVED IN THE SELECTION PROCESS. UNLESS YOU ARE WILLING TO AUTHORIZE THE COUNTY TO MAKE SUCH INQUIRIES, YOUR APPLICATION WILL NOT 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 once selected for an interview.
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.

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: *

Click or drag a file to this area to upload.

SUPPORTING DOCUMENTS UPLOAD

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

Click or drag a file to this area to upload.

AUTHORIZATION

THE COUNTY RESERVES THE RIGHT TO CONFER WITH PERSONS LISTED BY YOU AS A REFERENCE, OR WITH ANY OTHER INDIVIDUALS, WITH KNOWLEDGE CONCERNING YOUR TOTAL QUALIFICATIONS FOR THE POSITION. THE COUNTY WILL NOT INQUIRE INTO YOUR FINANCIAL STATUS, RELIGIOUS AFFILIATION, MARITAL STATUS, OR ON OTHER MATTERS UNRELATED TO YOUR QUALIFICATIONS TO FILL THE POSITION FOR WHICH YOU APPLIED. INFORMATION RECEIVED FROM SUCH INQUIRIES WILL BE USED SOLELY FOR DETERMINING YOUR EMPLOYABILITY WITH THE COUNTY AND FOR NO OTHER PURPOSE. THIS INFORMATION WILL NOT BE SHARED WITH ANYONE OTHER THAN THOSE COUNTY REPRESENTATIVES INVOLVED IN THE SELECTION PROCESS. UNLESS YOU ARE WILLING TO AUTHORIZE THE COUNTY TO MAKE SUCH INQUIRIES, YOUR APPLICATION WILL NOT BE CONSIDERED.

I HEREBY CONSENT TO HAVING FRANKLIN COUNTY CONTACT ANYONE THAT IT DEEMS APPROPRIATE TO INVESTIGATE OR VERIFY ANY INFORMATION I HAVE GIVEN, OR TO DISCUSS MY BACKGROUND, PAST PERFORMANCE, OR SUITABILITY
FOR EMPLOYMENT. I FURTHER CONSENT TO BEING DISCUSSED BY ANY PERSON SO CONTACTED AND I WAIVE ALL RIGHTS TO BRING ANY ACTION FOR DEFAMATION, INVASION OF PRIVACY, OR ANY SIMILAR CAUSE AGAINST ANYONE CONTACTED AS A RESULT OF WHAT HE OR SHE MAY SAY ABOUT ME.

THE COUNTY RESERVES THE RIGHT TO CONFER WITH PERSONS LISTED BY YOU AS A REFERENCE, OR WITH ANY OTHER INDIVIDUALS, WITH KNOWLEDGE CONCERNING YOUR TOTAL QUALIFICATIONS FOR THE POSITION. THE COUNTY WILL NOT INQUIRE INTO YOUR FINANCIAL STATUS, RELIGIOUS AFFILIATION, MARITAL STATUS, OR ON OTHER MATTERS UNRELATED TO YOUR QUALIFICATIONS TO FILL THE POSITION FOR WHICH YOU APPLIED. INFORMATION RECEIVED FROM SUCH INQUIRIES WILL BE USED SOLELY FOR DETERMINING YOUR EMPLOYABILITY WITH THE COUNTY AND FOR NO OTHER PURPOSE. THIS INFORMATION WILL NOT BE SHARED WITH ANYONE OTHER THAN THOSE COUNTY REPRESENTATIVES INVOLVED IN THE SELECTION PROCESS. UNLESS YOU ARE WILLING TO AUTHORIZE THE COUNTY TO MAKE SUCH INQUIRIES, YOUR APPLICATION WILL NOT BE CONSIDERED.

I HEREBY CONSENT TO HAVING FRANKLIN COUNTY CONTACT ANYONE THAT IT DEEMS APPROPRIATE TO INVESTIGATE OR VERIFY ANY INFORMATION I HAVE GIVEN, OR TO DISCUSS MY BACKGROUND, PAST PERFORMANCE, OR SUITABILITY
FOR EMPLOYMENT. I FURTHER CONSENT TO BEING DISCUSSED BY ANY PERSON SO CONTACTED AND I WAIVE ALL RIGHTS TO BRING ANY ACTION FOR DEFAMATION, INVASION OF PRIVACY, OR ANY SIMILAR CAUSE AGAINST ANYONE CONTACTED AS A RESULT OF WHAT HE OR SHE MAY SAY ABOUT ME.

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

“I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE
GROUNDS FOR DISMISSAL.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES AND EMPLOYERS
LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY
PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE AND RELEASE THE COUNTY FROM ALL
LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION.

I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COUNTY HAS ANY AUTHORITY TO ENTER
INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED COUNTY REPRESENTATIVE”.

Date / Time

Date

Time

Signature