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Salem Fire Department
Application for part time employment
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Email
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Your email
First Name
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Your answer
Last Name
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Your answer
Address
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Your answer
Phone Number
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Your answer
Date of Birth
MM
/
DD
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YYYY
If you are currently affiliated with a fire department please list it here.
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Emergency Contact Name and Number
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Please list any related certifications you have. Please email copies of these certs to
salemfire1972@gmail.com
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How many years of experience do you have in fire service
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What is your current level of education?
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Personal reference #1 (Name and Phone Number)
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Personal reference #2 (Name and Phone Number)
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Your answer
Professional reference #1 (Name and Phone Number)
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Your answer
Professional reference #2 (Name and Phone Number)
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I understand that this is a PRN position and that shifts will be available at 10 hours/day, 7 days/week. I certify that all above information is accurate to the best of my knowledge.
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