Alvaton Fire Recruitment Application

Online Application

Candidate Information

Full Name (First, Middle, Last)

This is a required question

Email Address

This is a required question

Current Address (Street, Apt. #, PO Box)

This is a required question

City, State, Zip Code

This is a required question

Country

This is a required question

Telephone Number (Best # for Contact)

This is a required question

Previous Address (If above is less than 5 years)

This is a required question

Previous City, State, Zip Code (If above is less than 5 years)

This is a required question

Previous Country (If above is less than 5 years)

This is a required question

In Case of Emergency, Notify:

Emergency Contact (First, Last - Relationship)

This is a required question

Emergency Contact Address (Street, Apt. PO Box)

This is a required question

Emergency Contact (City, State, Zip Code)

This is a required question

Emergency Contact Phone Number

This is a required question

Employment Information

Present Employer - Position

This is a required question

Employer Address

This is a required question

Employer Location (City, State, Zip Code)

This is a required question

Employer Contact Information (Name and Telephone #)

This is a required question

Previous Fire/Emergency Experience

Previous Fire/Emergency Experience (Department & Position)

This is a required question

Type of Department

Volunteer
Combination
Paid
Other

This is a required question

Service Dates (When to When)

This is a required question

Previous Emergency/Fire Department Address

This is a required question

Previous Emergency/Fire Department Location (City, State, Zip Code)

This is a required question

Previous Fire Department Contact Info (Chief's Name & Telephone #)

This is a required question

Additional Emergency/Fire Service Experience

Department Name, Address, Service Dates, Contact Information

This is a required question

Current Certifications

(Fire Service Instructor, IFSAC, EMT, CPR, Etc.)

This is a required question

Education

This is a required question

Schools Attended (High School and College)

This is a required question

If Graduated, What Year (High School and College)

This is a required question

Highest Grade Completed

This is a required question

Vehicle Information

Vehicle License Plate Number & State

This is a required question

Driver's License Number

(Photo copy of Driver's License MUST be sent to alvatonfire@gmail.com)

This is a required question

Drivers License Expiration Date

Has your driver's license ever been suspended or revoked?

This is a required question

If yes to previous question, Please explain

This is a required question

Do you have insurance for your private vehicle?

(A photocopy of insurance card MUST be sent to alvatonfire@gmail.com)

This is a required question

Convictions, Citations, Accidents

Have you ever been convicted of a felony?

This is a required question

List all criminal convictions for the past THREE years

(Include date and description of each conviction)

This is a required question

List all traffic citations or convictions in the past THREE years

(Include date and description of each citation, not parking citations)

This is a required question

List all automobile accidents in the past THREE years

(Include date and description of each citation)

This is a required question

Medical Information

List any medical condition(s) you have

(List any condition(s) which affect your ability to perform heavy manual work (resiratory, back, muscular conditions, etc.), which would affect your abilities to perform as a firefighter.

This is a required question

References

Name, Telephone Number, Address

(List THREE references that are not related to you)

This is a required question

Legal

I UNDERSTAND BY FILLING OUT THIS INITIAL APPLICATION THAT I WILL BE SUBJECT TO A CRIMINAL BACKGROUND CHECK AND FURTHER APPLICATION PROCESS DEPENDING ON THE FIRE DEPARTMENT DISTRICT THAT I AM APPLYING FOR. I FURTHER UNDERSTAND THAT I MAY BE REQUIRED TO PASS A MEDICAL EVALUATION AS A CONDITION OF CONTINUING MEMBERSHIP. IN ORDER THAT THE CHIEF OR THE DESIGNEE MAY BE FULLY INFORMED AS TO MY PERSONAL CHARACTER AND QUALIFICATIONS FOR MEMBERSHIP, I REFER TO MY EMPLOYER, REFERENCES GIVEN, AND ANY OTHER PERSON WHO MAY HAVE INFORMATION CONCERNING ME. AS THIS INFORMATION IS FURNISHED AT MY EXPRESS REQUEST AND FOR MY BENEFIT, I DO HEREBY RELEASE THEM FROM ANY AND ALL LIABILITY FOR DAMAGE OR WHATEVER NATURE ON ACCOUNT OF FURNISHING SUCH INFORMATION. I DO AGREE TO THESE CONDITIONS AND I HEREBY CERTIFY THAT ALL STATEMENTS MADE BY ME ON THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT WILLFULLY WITHHOLDING INFORMATION OR MAKING FALSE STATEMENTS ON THIS APPLICATION WILL BE GROUNDS FOR DENIAL OF THIS APPLICATION OR DISMISSAL.

Applicant's Name

(First, Middle, Last)

This is a required question

Today's Date

BY FILLING IN YOUR INFORMATION ABOVE, AND CLICKING SUBMIT YOU AGREE TO THESE TERMS.