APPLICATION FOR EMPLOYMENT
ANSWER ALL QUESTIONS AND FILL IN ALL BLANKS.
USE N/A FOR ITEMS NOT APPLICABLE - PLEASE PRINT
In compliance with Federal and State equal employment opportunity laws, qualified applicants
are considered for all positions without regard to race, color, religion, sex, national origin, age,
marital status, or non-job related disability.
POSITION (S) APPLIED FOR: _________________________________________________________
____________________________________________________________________________________
DATE
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NAME__________________________________________________________
FIRST MIDDLE LAST
MAILING ADDRESS_________________________________________________________________
P.O. BOX /STREET CITY STATE / ZIP CODE
PH#_(____)________________MESS#_(_____)______________PAGER#(____)_____________
IN CASE OF EMERGENCY NOTIFY: _________________________ PH#(______)__________
(ATTACH SHEET IF MORE SPACE IS NEEDED)
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DO YOU HAVE THE LEGAL RIGHT TO WORK IN THE UNITED STATES? YES / NO
ARE YOU 18 YEARS OR OLDER? YES / NO
HT__________ WT__________(For physical fitness test)
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HAVE YOU WORKED FOR THIS COMPANY BEFORE? YES / NO
IF YES WHERE_________________________DATES: From___________ To___________
RATE OR PAY_________________________POSITION_____________________________
REASON FOR LEAVING_______________________________________________________
WHO REFERRED YOU_______________________________________________________
NAMES OF RELATIVES IN OUR EMPLOYMENT_____________________________________
ARE YOU NOW EMPLOYED? YES / NO
IF NOT, HOW LONG SINCE LEAVING LAST EMPLOYMENT? ____________________
RATE OF PAY EXPECTED_________________
NOTE: List Past Employment for at Least 3 Years.
(Attach Sheet if More Space is needed)
LAST EMPLOYER: NAME______________________________________________
CONTACT_______________________________________(____)_________________
ADDRESS______________________________________________________________
POSITION HELD________________________________________________________
REASONS FOR LEAVING________________________________________________
FROM______________TO___________________
(EMPLOYMENT RELATING TO POSITION APPLYING)
SECOND EMPLOYER: NAME_____________________________________________
CONTACT________________________________________(_____)________________
ADDRESS_______________________________________________________________
POSITION HELD________________________________________________________
REASON FOR LEAVING__________________________________________________
FROM_____________ TO_____________
THIRD EMPLOYER: NAME______________________________________________
CONTACT_________________________________________(_____)______________
ADDRESS___________________________________________________________
POSITION HELD________________________________________________________
REASON FOR LEAVING__________________________________________________
FROM_____________ TO__________
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CIRCLE HIGHEST GRADE COMPLETED: 1 2 3 4 5 6 7 8
HIGH SCHOOL: 1 2 3 4
COLLEGE: 1 2 3 4
Course of studies________________________________________________________
GENERAL
HAVE YOU EVER BEEN CONVICTED OF A FELONY? IF YES, GIVE DETAILS.
(Your response will not necessarily disqualify you from consideration for employment)
STATE OF_____________________________DATE: _______/_______/_______
EXPLAIN:_______________________________________________________________________
PROBATION OFFICER:
NAME________________________________________PH#(______)_______________________
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DO YOU HAVE RELIABLE TRANSPORTATION TO AND FROM WORK? YES / NO
SOURCE_______________________
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EXPERIENCE AND QUALIFICATIONS
TRAINING QUALIFICATIONS:
WHAT IS YOUR CURRENT POSITION / QUALIFICATION STATUS?
***Training Certificates are required.
A.) FFT 2 FIREFIGHTER- BASIC 32 HOUR TRAINING COURSE. (First year firefighter)
YES / NO
B.)CURRENT REFRESHER
YES / NO
IF SO WHERE________________________________________WHEN______________________
HOW MANY HOURS___________________
C.) FFT 1 ADVANCED FIREFIGHTER / SQUAD BOSS QUALIFIED.
YES / NO
D.) SINGLE RESOURCE BOSS- CREW (CRWB) or (SRB-C)
YES / NO
E.) SINGLE RESOURCE BOSS- ENGINE (ENGB) or (SRB-E)
YES / NO
F.) CHAINSAW QUALIFIED- CLASS B or C FALLER
YES / NO
** ADDITIONAL QUALIFICATIONS OR TRAINING:
____________________________________________________________________________________
____________________________________________________________________________________
TO BE READ AND SIGNED BY APPLICANT
This certifies that this application was completed by me, and that all entries on it and information
in it are true and complete to the best of my knowledge.
I authorize you to make such investigations and inquiries of my personal, employment, financial
or medical history and other related matters as may be necessary in arriving at an employment
decision. I hereby release employers, schools, health care providers and other persons from all
liability in responding to inquiries and releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my
application or interview(s) may result in discharge. I understand, also, that I am required to abide
by all rules and regulations of the Company.
I understand that ORE-CAL FIRE SUPPRESSION, INC is an employee-at-will.
_________________________________________________________________________________
DATE APPLICANT’S SIGNATURE
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