Dispatcher Position Supplemental Questions
Stephen Weston
Name (First and Last): ___________________________________________________________
1. Are you at least 19 years of age or older? ✔
Yes ______ No ______
2. Are you a U.S. citizen or eligible to work in the U.S? Yes ______
✔ No ______
3. Did you graduate from high school or obtain an equivalent GED? Yes ______
✔ No ______
4. Do you have experience operating communication and emergency service equipment as it relates to
dispatching public safety and medical emergency personnel?
______
✔ No experience
______ Yes, less than 6 months experience ______ Yes, 2 to 4 years experience
______ Yes, 6 months to 2 years experience ______ Yes, more than 4 years experience
5. If yes, please list the employers from your application where you acquired this experience AND
describe your work experience.
6. Do you have any Felony and/or Class I Misdemeanor convictions? Yes ______ No ______
✔
(Including sealed and set asides).
7. Have you been convicted of any of the following Class I Misdemeanor? Check all that apply. (Note
if yes, it may result in disqualification)
______ Third Degree Assault ______ Stalking ______ False Reporting
______ Violating a sexual assault ______ Criminal Trespass, ______ Assault of a public
protection order first degree safety officer
______ Violation of a protection order ______ Second-degree ______ Public Indecency
false imprisonment
______ Domestic assault (first-time ______ Negligent child abuse ______ Criminal mischief
offense involving bodily injury that does not result in causing loss of $1500
or threat of bodily injury) serious bodily injury or more
or death
✔ None
______
8. Do you currently have any debts serviced by a collection agency? Yes ______ ✔
No ______
(Note if yes, it may result in disqualification).
9. If you answered yes to the above question please explain:
10. Check below if you have been convicted of any of the following violent crimes?
(check all that apply)
______ Assault ______ Resisting Arrest
______ Child Abuse ______ Domestic Violence
______ Sexual Assault ______
✔ None
11. If yes, list specific crime(s), circumstances, date of crime and conviction, state and city of
offense.
12. Have you used any illegal drugs, other than marijuana, in the last 5 years?
Yes ______ ✔
No ______
13. If yes, list drugs, date and year of usage.
14. Have you used any prescription medication(s), that were not prescribed to you in the last 5
years?
Yes ______ ✔
No ______
15. If yes, please list the medication(s) and date and year of usage.
16. Have you used marijuana or any other cannabis products and all its derivatives for any purpose
on the last two (2) years? Check all that apply
______ Marijuana ______ Vape
______ Delta 8 ______ Edibles
______ THC ______ Other (specify below)
______
✔ None
17. If you answered yes, please explain circumstances and date of last usage.
18. Have you sold, produced, cultivated, transported or distributed marijuana or any illegal
narcotics or drugs.
Yes ______ ✔
No ______
19. If yes, please list the circumstances and date.
20. Do you have any convictions, diversions, dismissal or refusal to be tested for Driving Under
the Influence during the last 5 years?
Yes ______ ✔
No ______
21. Are you subject to an order of protection or restraining order?
Yes ______ ✔
No ______
22. If yes, please list the circumstance and date.
23. Have you been adjudged or convicted of traffic violations with such frequency so as to indicate
a disrespect for traffic laws and disregard for the safety of others within the past three years? (i.e.
speeding, reckless driving, negligent driving)
Yes ______ ✔
No ______
24. If yes, list violations, dates, city and state of occurrence.
25. Have you been convicted or been pardoned of a crime punishable by imprisonment in a
penitentiary for a term of one year or more?
Yes ______ ✔
No ______
26. If yes, list specific crime(s), circumstances, date of crime and conviction, state and city of
offense.
27. Are you fluent in a language other than English? (Check all that apply)
______ Spanish ______ German ______ Korean
______ Russian ______ French ______ Other (specify below)
______ Arabic ______
✔ None
28. If other, please specify
I certify that, to the best of my knowledge, the information provided on this form is true and correct.
Signature of Applicant: ________________________________ 10/27/2025
Date: __________________