APPLICATION FOR EMPLOYMENT

Size: px

Start display at page:

Download "APPLICATION FOR EMPLOYMENT"

Alexina Daniels
5 years ago
Views:

1 APPLICATION FOR EMPLOYMENT BUECHEL FIRE-EMS Name : Date: Please indicate which positions you would like to be considered for and whether you are seeking full-time and/or part-time. (Firefighters positions are only full-time) If you would like to be considered for both full-time or part-time mark both Do not list any 1. fulltime part-time 2. fulltime part-time 3. fulltime part-time

2 PERSONAL INFORMATION Name: Date: First Middle Last Address: Phone Number Drivers License#: Social Security: Are you either a U.S. citizen or an alien authorized to work in the U.S.? Have you ever worked or attended school under another name? If so, under what name? Understand that we may withdrawal any offers if you have a felony conviction. Initial if you understand POSITION DESIRED Position(s): Start date: Do you prefer: Full-time Part-time If part-time, hours per week Please check both boxes if you are interested in a part-time hrs. if not hired full-time Hours you are available to work Days of week you are available to work: Are you able to work: Weekends Holidays Nights Overtime 12-hour shifts? 24-hour shifts Current Employer: Dates of employment: to Reason(s) for leaving: Supervisor(s) at this company: How did you learn about this opening?

3 EDUCATION High School: Technical School: College/University: Post-Graduate Education: Other education, training or special skills: CERTIFICATIONS Emergency Medical Technicians: Yes No State License# Exp. Paramedic: Yes No State License# Exp. AHA ACLS: Yes No Exp. AHA PALS: Yes No Exp. Firefighter: Yes No IFSAC I and II: Yes No KY 400: Yes No Other License (s): including state of issue and number:

4 WORK EXPERIENCE Please list all previous employment, beginning with the most recent. If you need more room, you may attach another sheet of paper. Employer: Address: From To Position Held: Reason for Leaving: Supervisor's Name & Title: Description of Duties: May we contact? Starting Compensation: Employer: Final Compensation: Address: From To Position Held: Reason for Leaving: Supervisor's Name & Title: Description of Duties: May we contact? Starting Compensation: Final Compensation: References Identify three persons who know your work, beginning with the most recent. Name: Phone Number: Address: City, State, Zip: Position or Title: Years Known: Name: Phone Number: Address: City, State, Zip:

5 Position or Title: Years Known: Name: Phone Number: Address: City, State, Zip: Position or Title: Years Known: Please list any special skills, abilities, or knowledge you have which would add additional value to our organization if you are employed with: CONITNUED ON NEXT PAGE

6 Authorization and Acknowledgements I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge. I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure. Furthermore, I understand and authorize Buechel Fire Protection District to whatever background and personal reports needed to verify that the information I have provided is accurate in the efforts to verify my fitness for the position for which I am applying. A copy of this authorizations is as valid as the original. Print full name: Candidate's Signature: Date: Reviewer Notes:

APPLICATION OF EMPLOYMENT

APPLICATION OF EMPLOYMENT Applicant MUST have their own transportation It is the policy of this company provide equal employment opportunities all qualified persons without regard race, creed, color, religious