Alvaton Fire Recruitment Application
Online Application
Candidate Information
Full Name (First, Middle, Last) *
Email Address *
Current Address (Street, Apt. #, PO Box) *
City, State, Zip Code *
Country *
Telephone Number (Best # for Contact) *
Previous Address (If above is less than 5 years)
Previous City, State, Zip Code (If above is less than 5 years)
Previous Country (If above is less than 5 years)
In Case of Emergency, Notify:
Emergency Contact (First, Last - Relationship) *
Emergency Contact Address (Street, Apt. PO Box) *
Emergency Contact (City, State, Zip Code) *
Emergency Contact Phone Number *
Employment Information
Present Employer - Position
Employer Address
Employer Location (City, State, Zip Code)
Employer Contact Information (Name and Telephone #)
Previous Fire/Emergency Experience
Previous Fire/Emergency Experience (Department & Position)
Type of Department
Clear selection
Service Dates (When to When)
Previous Emergency/Fire Department Address
Previous Emergency/Fire Department Location (City, State, Zip Code)
Previous Fire Department Contact Info (Chief's Name & Telephone #)
Additional Emergency/Fire Service Experience
Department Name, Address, Service Dates, Contact Information
Current Certifications
Current Certifications
(Fire Service Instructor, IFSAC, EMT, CPR, Etc.)
Education
Education *
Schools Attended (High School and College)
If Graduated, What Year (High School and College)
Highest Grade Completed *
Vehicle Information
Vehicle License Plate Number & State *
Driver's License Number *
(Photo copy of Driver's License MUST be sent to alvatonfire@gmail.com)
Drivers License Expiration Date *
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Has your driver's license ever been suspended or revoked? *
If yes to previous question, Please explain
Do you have insurance for your private vehicle? *
(A photocopy of insurance card MUST be sent to alvatonfire@gmail.com)
Convictions, Citations, Accidents
Have you ever been convicted of a felony? *
List all criminal convictions for the past THREE years
(Include date and description of each conviction)
List all traffic citations or convictions in the past THREE years
(Include date and description of each citation, not parking citations)
List all automobile accidents in the past THREE years
(Include date and description of each citation)
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.
References
Name, Telephone Number, Address
(List THREE references that are not related to you)
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)
Today's Date *
MM
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BY FILLING IN YOUR INFORMATION ABOVE, AND CLICKING SUBMIT YOU AGREE TO THESE TERMS.
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