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Job Application for:

City of Derby

Utility Coordinator

611 N Mulberry Rd 
Derby, KS   67037

Salary: 50,960 - 68,786 USD / YEAR

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    Contact Info
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    Questions
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    Voluntary Surveys
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    Agreements
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Next: Contact Info (2/6)
Do you have a High School diploma or equivalent?
Yes No

Do you have an associate or bachelor's degree?
Yes No

Please list the title of all degrees received from an accredited university.


Which best describes your utility billing experience?
No experience
Less than 1 year of experience
1-2 years of experience
2-3 years of experience
More than 3 years of experience


Which best describes your office support experience?
No office support experience.
Less than one year of office support experience.
1-3 years of office support experience.
3-5 years of office support experience.
5 or more years of office support experience.


Please list which of the following software programs you are proficient in operating: Word, Excel, Access, Publisher, PowerPoint. Put N/A if none.


Have you ever been convicted of a felony? If so, please explain. If not, put N/A.


Have you ever been convicted of a crime, other than a minor traffic violation? If so, please explain. If not, put n/a.


Have you ever been dismissed, asked to resign, or had any disciplinary action taken against you from any employment or position you have held? If so please explain. If not, put n/a.


Do you have a family relationship with any current employee of the City of Derby? If yes, please include the employees name. If no, please put N/A.


How did you hear about this opening?


If a City employee told you about this job, please list their name here. If not, please put "N/A".


Are you currently drawing money from a KPERS retirement benefit?
Yes No

Are you claiming Veterans Preference under Kansas law? (You will need to provide supporting documentation to verify eligibility (e.g., DD-214, proof of disability, marriage certificate, etc. Document can be uploaded with resume.)
Yes No

If you are claiming veterans preference, please select one of the following. If you are not claiming veterans preference, please choose n/a.
I am a veteran who served on active duty in the Armed Forces and was honorably discharged.
I have a service-connected disability.
I am the spouse of a veteran who was honorably discharged and has a service-connected permanent and total disability.
I am the unremarried surviving spouse of a veteran who died in service or from service-connected causes.
I am the spouse of a prisoner of war (POW).
I am the spouse of a veteran missing in action (MIA).
N/A


Next: Voluntary Survey (4/6) Go back Continue Save my work...

Voluntary EEO Questionnaire:

This company may be required by state and federal laws to furnish statistical data and to maintain records of certain population characteristics of those applying for jobs with them. The information you supply will be aggregated and used for statistical purposes only. If you are offered employment with this company, it will not be used as employment criteria. This company is an equal employment opportunity employer. Thank you for your cooperation in completing this form.

White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa. Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa. Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. Native Hawaiian or Pacific Islander (Not Hispanic or Latino):A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands. Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races. I don’t wish to answer
Male
Female
I don’t wish to answer


Voluntary Veteran Self-Identification Form:


This employer may be a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take steps to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

A "disabled veteran" is one of the following:
  • a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
  • a person who was discharged or released from active duty because of a service connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended. The information you submit will be kept confidential.

I belong to one or more of the classifications of protected veteran listed above
I am not a protected veteran (I served in the military but do not fall into any veteran categories listed above)
I am not a veteran (I did not serve in the military)
I don’t wish to answer


Voluntary Self-Identification of Disability:

Form CC-305
OMB Control Number 1250-0005
Expires 04/30/2026

Why are you being asked to complete this form?
We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability.

Disabilities include, but are not limited to:

Alcohol or other substance use disorder (not currently using drugs illegally) Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS Blind or low vision Cancer (past or present)
Cardiovascular or heart disease Celiac disease Cerebral palsy Deaf or serious difficulty hearing
Diabetes Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders Epilepsy or other seizure disorder Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
Intellectual or developmental disability Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD Missing limbs or partially missing limbs Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS) Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities Partial or complete paralysis (any cause) Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism) Traumatic brain injury

Yes, I have a disability, or have had one in the past
No, I do not have a disability and have not had one in the past
I do not want to answer

PUBLIC BURDEN STATEMENT:

According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.


Next: Agreements (5/6) Go back Continue Save my work...
"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, and I agree to hold my employer harmless in the event of my dismissal based thereon. I authorize investigation of all statements contained herein and to do background checks to give you and all information concerning my previous employment and any pertinent information they may have, confidential or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I realize that under certain legal provisions, pre-employment drug testing could be a condition of my employment. I also acknowledge that the employer may require drug testing at a subsequent time providing that proper advance notice of testing is provided. I also recognize that I could be offered employment subject to appropriate medical examination and that such a report could nullify my ultimate employment by this employer. I agree to submit to physical examination if required. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the method of payment of my wages and salary, be terminated at any time without prior notice. If employment is obtained under this application, I will comply with all the rules and policies of my employer." AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER This employer does not discriminate in hiring or employment on the basis of age, race, color, sex, religion, national origin, disability, military or veteran status I understand and accept the

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Application Error Application Message Please review the resume information that was extracted for accuracy The current/prior pages have not been completed yet. A section is open for editing. Please save your work before moving forward. Save Cancel Are you sure you want to remove this section? Submit Application processing... please wait. {0} is required {0} must contain at least {1} characters {0} must contain no more than {1} characters {0} must not be less than {1} {0} must not be greater than {1} {0} is an invalid phone number {0} is an invalid number {0} is an invalid decimal {0} is an invalid currency amount {0} is an invalid email address {0} is an invalid url {0} is an invalid zip code {0} is an invalid field format select a location select a value * Add Signature Application Information Go back Continue Employer Questions (3/6) Next: Preview (6/6) Click OK to confirm that you have read the voluntary survey form. You must click the check box to continue with the application process You must enter your name in the text box to continue with the application process Please indicate your ethnicity choice or select 'I don't wish to answer' Please indicate your gender choice or select 'I don't wish to answer' Please indicate your veteran status choice or select 'I don't wish to answer' Please indicate your disability choice or select 'I do not want to answer' The question "{0}" has not been answered The {0} section must contain at least {1} items Screening Questions / Responses "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, and I agree to hold my employer harmless in the event of my dismissal based thereon. I authorize investigation of all statements contained herein and to do background checks to give you and all information concerning my previous employment and any pertinent information they may have, confidential or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I realize that under certain legal provisions, pre-employment drug testing could be a condition of my employment. I also acknowledge that the employer may require drug testing at a subsequent time providing that proper advance notice of testing is provided. I also recognize that I could be offered employment subject to appropriate medical examination and that such a report could nullify my ultimate employment by this employer. I agree to submit to physical examination if required. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the method of payment of my wages and salary, be terminated at any time without prior notice. If employment is obtained under this application, I will comply with all the rules and policies of my employer." AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER This employer does not discriminate in hiring or employment on the basis of age, race, color, sex, religion, national origin, disability, military or veteran status
Accessibility: If you need an accommodation as part of the employment process please contact Human Resources at
Phone:
Email:

Equal Opportunity Employer, including disabled and veterans.

If you want to view the Know Your Rights: Workplace Discrimination is Illegal poster, please choose your language: HERE

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