Alvaton Fire Recruitment Application
Online Application
* Required
Candidate Information
Full Name (First, Middle, Last)
*
Your answer
Email Address
*
Your answer
Current Address (Street, Apt. #, PO Box)
*
Your answer
City, State, Zip Code
*
Your answer
Country
*
Your answer
Telephone Number (Best # for Contact)
*
Your answer
Previous Address (If above is less than 5 years)
Your answer
Previous City, State, Zip Code (If above is less than 5 years)
Your answer
Previous Country (If above is less than 5 years)
Your answer
In Case of Emergency, Notify:
Emergency Contact (First, Last - Relationship)
*
Your answer
Emergency Contact Address (Street, Apt. PO Box)
*
Your answer
Emergency Contact (City, State, Zip Code)
*
Your answer
Emergency Contact Phone Number
*
Your answer
Employment Information
Present Employer - Position
Your answer
Employer Address
Your answer
Employer Location (City, State, Zip Code)
Your answer
Employer Contact Information (Name and Telephone #)
Your answer
Previous Fire/Emergency Experience
Previous Fire/Emergency Experience (Department & Position)
Your answer
Type of Department
Volunteer
Combination
Paid
Other
Clear selection
Service Dates (When to When)
Your answer
Previous Emergency/Fire Department Address
Your answer
Previous Emergency/Fire Department Location (City, State, Zip Code)
Your answer
Previous Fire Department Contact Info (Chief's Name & Telephone #)
Your answer
Additional Emergency/Fire Service Experience
Department Name, Address, Service Dates, Contact Information
Your answer
Current Certifications
Current Certifications
(Fire Service Instructor, IFSAC, EMT, CPR, Etc.)
Your answer
Education
Education
*
Did Not Graduate High School
High School Student
High School Graduate
College Student
College Graduate
Schools Attended (High School and College)
Your answer
If Graduated, What Year (High School and College)
Your answer
Highest Grade Completed
*
Your answer
Vehicle Information
Vehicle License Plate Number & State
*
Your answer
Driver's License Number
*
(Photo copy of Driver's License MUST be sent to
alvatonfire@gmail.com
)
Your answer
Drivers License Expiration Date
*
MM
/
DD
/
YYYY
Has your driver's license ever been suspended or revoked?
*
Choose
Yes
No
If yes to previous question, Please explain
Your answer
Do you have insurance for your private vehicle?
*
(A photocopy of insurance card MUST be sent to
alvatonfire@gmail.com
)
Choose
Yes
No
Convictions, Citations, Accidents
Have you ever been convicted of a felony?
*
Choose
Yes
No
List all criminal convictions for the past THREE years
(Include date and description of each conviction)
Your answer
List all traffic citations or convictions in the past THREE years
(Include date and description of each citation, not parking citations)
Your answer
List all automobile accidents in the past THREE years
(Include date and description of each citation)
Your answer
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.
Your answer
References
Name, Telephone Number, Address
(List THREE references that are not related to you)
Your answer
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)
Your answer
Today's Date
*
MM
/
DD
/
YYYY
BY FILLING IN YOUR INFORMATION ABOVE, AND CLICKING SUBMIT YOU AGREE TO THESE TERMS.
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