APPLICATION

PERSONAL INFORMATION REQUESTED ON THIS APPLICATION ASSISTS THE DISTRICT IN PROCESSING AND SECURING THE NECESSARY INFORMATION TO DETERMINE ELIGIBILITY. APPLICATIONS ARE HELD IN CONFIDENCE AND CONSIDERED CLOSED RECORDS BY ORDINANCE.
Position:

Date Of Application:

Name
Last:

First:

Middle:

Address:

Email:

Phone #:

Social Security Number:

Best time to contact you at home is:

Have you filed an application here before? If yes, give date:

Have you ever been employed or volunteered here before? When?

Are you legally eligible for employment in this Country?(Proof required on employment).

Have you ever been convicted of a felony? If yes explain

Drivers license number

State

List any special training you already have associated with the fire service.

EMPLOYMENT HISTORY
List your last employer, assignments or volunteer activities
Employer Name

Phone

Dates Employed

Nature of work

Address

Job Title

Supervisor

Reason for leaving

May we contact?

Comments:

Summarize special skills acquired that may qualify you to work for us.


Certifications (check all that apply):
Firefighter I & II (Class Only)
Firefighter I & II (Certification)
EMR or Fire Dept. Medical First Responder
CPR
EMT
HAZMAT AWARENESS
HAZMAT OPS
OTHERS
If other is checked list here:



This application is the property of the DeSoto Rural Fire Protection District and is covered under Resolution Number 1197-2 as a confidential, closed document. This document may only be viewed by authorized personnel pursuant to the Resolution.
The DeSoto Rural Fire Protection District is an Equal Opportunity Employer