Position(s) Applied
For: FFT2 - Basic
Firefighter FFT1 - Advance
Firefighter/Squad Boss ENGB - Engine Boss CRWB - Crew Boss
Note: Position
showing will be the one submitted with your
application. For multiple entry selections, hold
down Ctrl key and click on the . Highlighted fields will be
submitted.
Personal
Information
First
Name:
Middle
Name:
Last
Name:
Street
Address:
City: State: Zip Code:
Phone
Number: Pager/Message Number:
E-mail
Address: (Required)
Mailing
Address:
City: State: Zip Code:
Do
you have the legal right to work in the United States?
Yes
Yes
Height: 3 4 5 6 7 (feet)
1 2
3 4 5 6 7 8 9 10 11 (inches)
Weight: (For physical fitness
test)
In
Case of Emergency: Phone Number:
Have you ever
worked for this company before? Yes
Where?: Dates - From: To:
Rate of
Pay: Position:
Reason For
Leaving: Number of relatives in our employ?:
Are you currently employed? Yes
Who referred you?: Rate of pay expected?:
/Hr.
Is
there any reason you might be unable to perform the functions of
the Yes
If
yes, explain if you wish:
Employment Record Note: List Past Employment For At Least 3 Years and any Employment Relating To Position.
Last Employer Name: Contact:
Address:
Phone Number:
Position Held:
From: To:
Second Employer Name: Contact:
Address:
Phone Number:
Position Held:
From: To:
Reason For Leaving:
Third Employer Name: Contact:
Address:
Phone Number:
Position Held:
From: To:
Reason For Leaving:
Fourth Employer Name: Contact:
Address:
Phone Number:
Position Held:
From: To:
Reason For Leaving:
Military Status:
Have you ever
served in the U.S. Armed Forces? Yes
Branch: Date of Serve: From To:
Veteran of which war?:
Education:
Highest Grade Completed: 0 1 2 3 4 5 6 7 8
High School: 0 1 2 3 4 College: 0 1 2 3 4
Last School Attended :
School Name :
Address:
General:
Have you ever
been convicted of a felony? Yes
If
yes, give details . (Your response
will not necessarily disqualify you from consideration for
employment).
State of:
Date :
Explain :
Probation
Officer Name : Probation Officer Phone # :
Do you have
reliable transportation to and from work? Yes
Source of
Transportation:
Own
Transportation Public Transportation
Carpool Other
Experience & Qualifications: Training Qualifications : What is your current
Position/Qualification Status? Note: Training Certificates are required.
Check all that apply.
a.) FFT2 - Firefighter: Basic 32 Hours Training Course (first
year firefighter): Yes
b.) FFTI - Advanced Firefighter/Squad Boss Qualified:
Yes
c.) Single Resource Boss - Engine Boss (CRWB): Yes
d.) Single Resource Boss - Engine Boss (ENGB): Yes
e.) Chainsaw Qualified - Class B or C Faller: Yes Yes
Additional Qualifications or Other Training:
Medical History:
Have you had
a Physical Checkup in the last year? Yes Date:
How much time
loss from work in the last 3 years due to illness? :
You may explain
if you wish:
Note:
Exam may be requested before work can begin at employee's
expense.
To Be Read And Signed By Applicant: This certified 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 have read and understand the following
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 herby release employers, schools, health care
providers and other persons from all liability in responding to
inquires 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 at-will employer
Signature of
Applicant: Date: