Brookhaven Fire Company
Employee Application
Email address *
First & Last Name *
Email *
Phone number *
Address/City/St/Zip *
Social Security *
Date of Birth *
MM
/
DD
/
YYYY
Education Level *
Past and Present Fire & EMS Organization(s) (N/a if none) *
What times are you available to work? *
Prefer 12 hour shift availability. Please select all that apply
12AM-6AM
6AM-12PM
12PM-6PM
6PM-12AM
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Employee Position *
Please Tell us why you want to come to BFC? *
Current Occupation *
Current Employer *
Current Employer Address/City/St/ZIP *
Current Employer Phone Number *
Current Employer Supervisor *
Dates Employed with Current Employer *
Current Employer Job Duties *
Please list at least 2 Past Employers Info (can be Copy and Paste from resume) N/A if no info available *
Answer the following questions that apply:
Have you been arrested? If yes, please explain. *
Do you have any physical limitations? *
Do you have any Medical limitations? *
Please Explain if you answer YES to above 2 questions.
Please list any Certifications with date received. Put N/A if none *
Please list At Least 3 References with Name, Address, Phone Number and/or Email (do not use relatives) *
Any other comments and/or questions?
Submit
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