Part-Time Firefighter/EMT ApplicationApplicant InformationLast Name (required)First Name (required)Middle NameAddress (required)City (required)Zip Code (required)Email (required)Phone Number (required)Are you legally authorized to work in the U.S? (required)YesNoAre you 18 years of age? (required)YesNoDate of Firefighter I certification? (required)Date of current EMT certification? (required)Do you have any commitments of responsibilities that might prevent you from meeting organization requirements? (required)YesNoIf yes, please explain.Please list any skills which you feel relate to this position.Have you applied here before?YesNoHow many years of Firefighting experience do you have? (required)Are you interested in Part-Time or Part-Time Per diem? (required)Part-TimePart-Time Per diemAvailabilityWhat 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?YesNoCan you be available on the occasional Saturdays, 8:00 am - 12:00 p.m.?YesNoDriving Record CheckDo you have a valid driver's license? (required)YesNoEducation and TrainingHigh School (required)Did you graduate? (required)YesNoCollege/Trade SchoolSubject/MajorWork HistoryPresent 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)YesNoSpecific Duties (required)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)YesNoSpecific Duties (required)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)YesNoSpecific Duties (required)Military Service (if applicable)Branch of ServiceDuty StatusActiveVeteranReserveReferences (Please list 3, not related to you)Name (required)Employer (required)EmailPhone Number (required)Name (required)Employer (required)EmailPhone Number (required)Name (required)Employer (required)EmailPhone Number (required)Additional Documents Upload (16MB max per file)Cover Letter (required)Resume (required)Certificates (required)There was a problem saving your submission. Please try again later.Please wait while your submission is being saved...Submitting...SubmitThank you, your submission has been received.
