CITY OF WALTHAM
OPEN COMPETITIVE EXAMINATION
WALTHAM SENIOR HIGH SCHOOL
617 LEXINGTON STREET, WALTHAM, MA 02452
SATURDAY, SEPTEMBER 23, 2017
DEADLINE TO REGISTER: FRIDAY, SEPTEMBER 15, 2017
Emergency Telecommunicators Dispatchers Exam
9:00 AM
PLEASE PRINT
FIRST NAME:______LAST: ______
ADDRESS:______
CITY:______STATE:______ZIP:______EMAIL:______
TELEPHONE: HOME______CELL: ______
(AREA CODE) (AREA CODE)
I seek a fee waiver c Yes c No (Attach fee wavier form and documentation if necessary)
I am a Veteran as defined M.G.L. Chapter 4, Section 7, Clause 43 amended by the Acts of 2004
c Yes c No (Attach copy of DD Form 214 Member-4 Form (Release From Active Duty-Long Form)
Exam starts at 9:00 am, there will be no admittance once the exam has begun.
I hereby declare all statements and answers made as part of this application are true and are made under the penalties of perjury.
Signature______Date______
TO APPLY: Applicants must pay the $55.00 application fee at the Treasurers' Office, City Hall, 610 Main St., Waltham, between the hours of 8:30 am - 4:30 pm Monday - Friday, at which time the application will be stamped and receipt will be given. Cash, check, money orders and credit cards (Mastercard, Discover and Visa) accepted.
FEE: Payment of the fee will not be accepted on the day of the examination. The examination fee may be waived for candidates receiving certain state or federal public assistance, unemployment insurance, or workers' compensation. Waiver forms must be accompanied by proof of eligibility, for the subject time period, in the form of signed and dated receipts, check stubs and/or other documentation from the agency providing assistance. Waiver form may be picked up in the Human Resources Department, 119 School Street, Waltham. Waivers must be submitted to and approved by Human Resources Department.
You must bring with you two number 2 pencils with erasers on the day of the exam. Applicants must present a current and valid photo identification with their signature, such as a current motor vehicle operator’s license, passport, military ID. No refunds of examination fees. The examination will take approximately 3 hours.
PROOF OF PAYMENT OR APPROVED WAIVER MUST BE BROUGHT TO THE EXAM ON THE TEST DATE.
Treasurers' Stamp
Acct: 001-152-4370-4371