Application

Personal Information

Last Name
First Name
Middle
Date
Street Address
City, State, ZIP
Home Telephone
Business Telephone
Cell/Other Phone
Email
Social Security Number
Salary Expected
Please attach a copy of your Valid Drivers License:(PDF Only)

Types of Work Accepted
Full TimePart Time

Will you work overtime if asked?
YesNo

Legally eligible to work in the U.S.?
YesNo

Available to begin work

Ever been convicted of any crimes (excluding misdemeanors/expunged)?
YesNo

If yes, please describe:

Education, Training, and Skills

High School DiplomaYesNo

G.E.D.YesNo

Diploma or G.E.D. received from:

City/State:

Please attach a Diploma or G.E.D.:(PDF Only)

College, Technical, or Vocational School

Other specialized training/apprenticeships:

Please attach any certificates from training/apprenticeships:(PDF Only)

(PDF Only)

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Software Proficiency

Microsoft Word version:

Other word processor:

Excel version:

Firehouse Reporting Software:

Microsoft Office version:

Equipment

Business copierCalculator / 10 KeyOther (specify below)

Other job-related skills:

Employment History (last 10 years)

Beginning with the most recent, list all employment for the past ten (10) years. ALL APPLICABLE BLANKS MUST BE COMPLETED. RESUMES MAY NOT BE SUBMITTED IN PLACE OF EMPLOYMENT HISTORY, but may be attached as a supplement to your application. If any employment was under a different name, indicate name:

Employer #1
Phone
Position Held
Employment Dates
Address
Supervisor Name
Salary
Type of Business
May we contact this employer? YesNo
Description of duties
Reason for leaving

Employer #2
Phone
Position Held
Employment Dates
Address
Supervisor Name
Salary
Type of Business
May we contact this employer? YesNo
Description of duties
Reason for leaving

Employer #3
Phone
Position Held
Employment Dates
Address
Supervisor Name
Salary
Type of Business
May we contact this employer? YesNo
Description of duties
Reason for leaving

Military Service

YesNo
If yes, Branch
Describe relevant training

Personal References (3 required)

Additional Information

Please attach any relevant additional information:(PDF Only)

How did you learn about this opening?

Authorization

PLEASE READ CAREFULLY BEFORE SIGNING!
I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by SHELDON COMMUNITY FIRE & RESCUE.

I understand that any employment is conditioned on a background check. I authorize SHELDON COMMUNITY FIRE & RESCUE, by signing the accompanying release form(s), to thoroughly investigate all statements contained in my application or resume, and I authorize my former employer(s) and references to disclose information regarding my former employment, character and general reputation to SHELDON COMMUNITY FIRE & RESCUE, without giving me prior notice of such disclosure. In addition, I release the SHELDON COMMUNITY FIRE & RESCUE, any former employer(s) and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation of disclosure.

I understand and agree that nothing contained in this application, or conveyed during my interview if one is held, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without cause and without prior notice and/or at the option of either myself or SHELDON COMMUNITY FIRE & RESCUE. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon SHELDON COMMUNITY FIRE & RESCUE unless made in writing and signed by all parties concerned.

IF YOU ARE HIRED BY SHELDON COMMUNITY FIRE & RESCUE, YOU WILL BE REQUIRED TO ATTEST TO YOUR IDENTITY AND EMPLOYMENT ELIGIBILITY, AND TO PRESENT DOCUMENTS CONFIRMING YOUR IDENTITY AND EMPLOYMENT ELIGIBILITY. YOU CANNOT BE HIRED IF YOU CANNOT COMPLY WITH THESE REQUIREMENTS.

If employed, I also agree to submit to a medical examination and drug test if required before starting work. If employed, I also agree to submit to a medical examination or drug test AT ANY TIME DEEMED APPROPRIATE by SHELDON COMMUNITY FIRE & RESCUE, and permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to SHELDON COMMUNITY FIRE & RESCUE the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug testing, and if I am hired, a condition of my employment will be that I abide by SHELDON COMMUNITY FIRE & RESCUE’S
Drug and Alcohol Policy.

I understand that filling out this form does not obligate SHELDON FIRE & RESCUE to hire. If hired, I agree to abide by all SHELDON COMMUNITY FIRE & RESCUE work rules, policies and procedures. SHELDON COMMUNITY FIRE & RESCUE retains the right to revise its policies and/or procedures, in whole or in part, at any time.

Date

Digital Signature (type full name)

SHELDON COMMUNITY FIRE & RESCUE IS AN AT-WILL-EMPLOYER. APPLICATIONS WILL BE REVIEWED BY ADMINISTRATION. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. THE ADMINISTRATOR WILL CONTACT THE SELECTED APPLICANTS FOR INTERVIEWS. YOUR APPLICATION DOES NOT GUARANTEE ANY TYPE OF CALL BACK INTERVIEW OR ANY TYPE OF JOB OFFERING. ONLY APPLICANTS SELECTED FOR INTERVIEWS WILL BE CONTACTED. THANK YOU FOR YOUR INTEREST IN EMPLOYMENT WITH SHELDON COMMUNITY FIRE & RESCUE.