Part-Time Firefighter/EMT Application Helpful tip: Please review this form and ensure you have all the information needed to complete it before starting as you cannot save your progress. A resume and cover letter are required with this application. Applicant Information Last Name (required) First Name (required) Middle Name Address (required) City (required) Zip Code (required) Email (required) Phone Number (required) Have you applied here before? (required) Yes No Work Authorization Are you legally authorized to work in the U.S? (required) Yes No Will you now or in the future require employer sponsorship for a work visa or permit? (required) Yes No Criminal History Have you ever been convicted of a felony? (required) Yes No If yes, please explain. Driver License Information Do you have a valid driver's license? (required) Yes No Are you 18 years of age or older? (required) Yes No Qualifications Date of Firefighter I certification? (required) Date of current EMT certification? (required) Please list any skills which you feel relate to this position. How many years of Firefighting experience do you have? (required) Availability Do you have any commitments or responsibilities that might prevent you from meeting organization requirements? (required) Yes No If yes, please explain: What hours are you available to respond to emergency calls? Can you be available Monday evenings, 6:00 p.m. - 9:00 p.m. for training drills? Yes No Can you be available on the occasional Saturdays, 8:00 am - 12:00 p.m.? Yes No Education and Training High School (required) Did you graduate? (required) Yes No College/Trade School Subject/Major Work History Employer 1 Present Employer (required) Supervisor's Name (required) Address (required) Phone Number (required) Job Title (required) Date Employed (required) Working Hours (required) May we contact Employer? (required) Yes No Specific Duties (required) Employer 2 Previous Employer (required) Supervisor's Name (required) Address (required) Phone Number (required) Job Title (required) Dates Employed (required) Working Hours (required) May we contact Employer? (required) Yes No Specific Duties (required) Employer 3 Previous Employer (required) Supervisor's Name (required) Address (required) Phone Number (required) Job Title (required) Dates Employed (required) Working Hours (required) May we contact Employer? (required) Yes No Specific Duties (required) Military Service (if applicable) Branch of Service Duty Status Active Veteran Reserve References (Please list 3, not related to you) Reference 1 Name (required) Employer (required) Email Phone Number (required) How do you know this person? Reference 2 Name (required) Employer (required) Email Phone Number (required) How do you know this person? Reference 3 Name (required) Employer (required) Email Phone Number (required) How do you know this person? Additional Documents Upload (16MB max per file) A resume, cover letter, and certifications supporting your qualifications are all required. If you cannot attach them to this application, please send them to hradmin@nwfr.org. If you receive an error upon submitting your application, it is very likely your attachments are too big to send. Be aware, we have recieved your application without the attachments. Please send them to the email address above. Cover Letter (required) Resume (required) Certificates (required) I certify that my answers are true and complete to the best of my knowledge. I understand that if this application leads to employment that any false or misleading information in my application or interview may result in my immediate termination. Your Signature (required) Confirm e-Signature Review Electronic Records and Signatures Policy (required)Read our Electronic Record and Signature Disclosure I agree to use electronic records and signatures There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
