Job Application
 

To apply for an open position with Wicktonville Fire Department, Inc., you may use this job application and either (a) print out the blank form and print or type in your information, or (b) fill out the form in your internet browser. In either event, you will need to mail or FAX in your form to us.

For privacy purposes (because our site does not use secure encryption), we do not want to transmit or store personal information through the site.
 
YOUR INFORMATION
Name (First, Middle Initial/Name, Last)
Current Street Address
City, State, ZIP ,
Phone Numbers Home:   Mobile:
Email Address
Preferred Contact Method Regular Mail    Email    Home Phone   Mobile Phone
Do you have any foreign language skills? No   Yes, language, abilities (read/write/understand):
Have you applied to us before? No   Yes, when:
Are you over the age of 18? Yes   No (Hire is subject to verification of minimum legal age)
Able to provide citizenship proof? Yes   No (Evidence of legal right to work in the U.S. required)
THE APPLIED FOR JOB POSITION
Position Applied For
Are You Applying For Full-Time    Part-Time   
Seasonal (date available: )
What is Your Work Schedule Availability?
Do you have any schedule restrictions?
Desired Pay Rate: $ per    Hour    Week    Month    Open
Are you able to submit and pass controlled substance test? Yes   No (Certain job classes are subject to pre-employment, random and post-accident controlled substance and alcohol testing )
Vehicle Driver Applicants Only:

Drivers License # State
Expiration Date     Class

Are you able to perform the job duties and functions listed on the job description (either with or without reasonable accommodation)? Yes   No
If no, describe the functions that cannot be performed:
Wicktonville Fire Department, Inc. complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants or employees to perform essential job functions. It is possible that a candidate may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.
EDUCATION, TRAINING AND EXPERIENCE
High School Name, City, State:
Years Completed, or Graduated: Graduate   GED   Years Completed:
College Name, City, State:
Years Completed, or Graduated:

Graduate   Years Completed:
Degree/Certificate:

Trade School Name, City, State:
Years Completed, or Graduated:

Graduate   Years Completed:
Degree/Certificate:

Military Branch, Rank:
Years, Discharge:

Years Completed: Discharge Type:

Do you have any specific training, skills, or expertise you wish to have considered for this position?
EMPLOYMENT HISTORY
You may substitute the employment history with an attached resume, IF AND ONLY IF, you also provide a listing of the employer's address, supervisor name and contact information. You may also list any relevant volunteer work you would like to have considered as part of your application.
Name of Employer
Name of Supervisor, Phone Number Ph#
Business Address
Business City, State, ZIP ,
Dates of Employment to
Reason for Leaving
May we contact this employers? Yes   No
»»» Next Previous Employer »»»  
Name of Employer
Name of Supervisor, Phone Number Ph#
Business Address
Business City, State, ZIP ,
Dates of Employment to
Reason for Leaving
May we contact this employers? Yes   No
»»» Next Previous Employer »»»  
Name of Employer
Name of Supervisor, Phone Number Ph#
Business Address
Business City, State, ZIP ,
Dates of Employment to
Reason for Leaving
May we contact this employers? Yes   No
»»» Next Previous Employer »»»  
Name of Employer
Name of Supervisor, Phone Number Ph#
Business Address
Business City, State, ZIP ,
Dates of Employment to
Reason for Leaving
May we contact this employers? Yes   No
Attach additional pages as needed to date back five years.
PROFESSIONAL REFERENCES
List three persons who have knowledge of your work performance within the last five years. Please use professional references only (volunteer work is also acceptable).
Name of Reference #1
Phone Number
Address
City, State, ZIP ,
Number of Years Acquainted
Occupation
Name of Reference #2
Phone Number
Address
City, State, ZIP ,
Number of Years Acquainted
Occupation
Name of Reference #3
Phone Number
Address
City, State, ZIP ,
Number of Years Acquainted
Occupation
ACKNOWLEDGEMENT AND SIGNATURE

_____ I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by Wicktonville Fire Department, Inc., terms for my immediate expulsion from Wicktonville Fire Department, Inc.

_____ I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or Wicktonville Fire Department, Inc.

_____ I permit Wicktonville Fire Department, Inc. to examine my references, record of employment, education record, and any other information I have provided. 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 Wicktonville Fire Department, Inc., my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such examination or revelation.
   
Applicant's Signature and Date: _________________________________________, Dated _____________________
 
HR USE ONLY: HIRE___ EE#_____ DEPT#_____ HIREDATE___/___/20___
app ver 1.2 07/09
 
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