Felton Fire Protection District

131 Kirby Street

Felton CA 95018

831-335-4422 Office        831-335-2635 FAX

 

Fire Fighter Application

 

 

______________________________________________________________________

Last Name                               First Name                               Middle Initial   

           

 

Address, include mailing address if different

 

 

Town, State, Zip Code

 

 

Date of Birth                                                     Social Security Number

 

 

Home Phone #                         Work Phone #                          Cell and/or pager #

 

 

Driver’s License #        Issuing State     Expiration Date Class(s) A,B,C,endorsements

 

________________________________________________________________________

Citizen of the United States of America Yes/No                        Work Visa Yes/No

 

 

Married or single.  If married, spouses name.  Do you have children?  Names and ages

 

 

Criminal Record:  Any felony or misdemeanor arrests, parole or probation?  If yes, list on a separate sheet of paper and include with this application.

 

 

High School Education              High school diploma, G.E.D. certificate

 

 

What is the highest grade you have completed? High school, college, post graduate.

 

  • List on a separate sheet of paper the name(s) and dates of the college/university or trade/vocational schools you have attended and the degree or certification received.  Include the page(s) with this application

 

  • Include with this application any certifications or documents regarding fire fighting, emergency medical, rescue, and fire prevention training you have.

 

 

Employment History

    1. Please list, on a separate sheet of paper, the jobs you have had in the last ten years, beginning with the current or most recent.  Include name, address and phone number of company, dates employed, job title and brief description of duties, and reason for leaving.
    2. If you have additional information regarding your employment history you feel is helpful please include it with your application
    3. If you have a resume you may include it your application.

 

 

Agreement:

I ___________________________________, understand that any misrepresentation or deliberate omission in my application may be justification for termination or refusal of this application.  I agree to undergo a physical examination if an offer to join is made and understand that acceptance is contingent upon meeting the agency’s physical requirements.  I agree to an interview with representatives of the fire district and understand that acceptance is contingent on confirmation by the interview panel.  I authorize employers, schools, or persons named in this application to give any information regarding my qualifications and character.  I hereby release said employers, schools, persons and the Felton Fire Protection District from any liability for damages for receiving or releasing information.  I further agree to provide proof of citizenship or right to work.

 

____________________________________                        ________________________

Signature                                                                                  Date signed