Employment CURRENT JOB OPENINGS EMT I, EMT II, and EMT III (Firefighter I Experience Preferred) Fire/EMS Coordinator Online Job Application 1 Personal Information2 Position Applying For3 Work Experience4 Prior Employment5 Education6 References7 Disclaimer Name * Required First MI Last Social Security Number - Last 4 Digits * RequiredEmail * Required Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone * RequiredMobile Phone * RequiredAre you Entitled to Work in the United States? * RequiredYesNoAre you 18 or older? * RequiredYesNoHave you ever been convicted of a felony or been incarcerated in connection with a felony in the past 7 years? * RequiredYesNoIf yes please explain: * RequiredMilitary Service? * RequiredYesNoAre you a veteran? * RequiredYesNo What position are you applying for? * Required How did you hear about this position? * RequiredExpected Hourly RateExpected Weekly EarningsDate Available - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY CURRENT or PRIOR WORK EXPERIENCECURRENT or MOST RECENT EMPLOYER * RequiredAddress * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone * RequiredName of Immediate Supervisor * Required First Last Dates of Employment FROM - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Dates of Employment TO - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Position/Job Title * RequiredPay * RequiredReason for Leaving? * RequiredMay We Contact? * RequiredYesNo PRIOR EMPLOYMENTPRIOR EMPLOYER * RequiredPrior Employer Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Prior Employer Telephone * RequiredPrior Employer Supervisor * Required First Last Prior Employer Dates of Employment FROM - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Prior Employer Dates of Employment TO - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Prior Employment Position/Job Title * RequiredPrior Employment PayReason for Leaving Prior Employer ? * RequiredMay We Contact Prior Employer? * RequiredYesNo EDUCATIONHigh School Name * RequiredLast Year Completed * Required9th Grade10th Grade11th Grade12th GradeCheck the box of the year you last completed.Name of College or UniversityLast Year Completed1st Year2nd Year3rd Year4th YearGraduateCheck the box of the year you last completed.Other Education/Certifications/EndorsementsList any applicable special skills, training, or proficiencies REFERENCESReference #1 * Required First Last Phone * RequiredReference #2 * Required First Last Phone * Required Signature * RequiredDisclaimer - By Typing my name (signing), I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired. I also provide consent for former employers to be contacted regarding work records.
