Employment ApplicationApplication for Employment I am applying for * Career Firefighter/EMT Part-time Firefighter/EMT Career Civilian EMS Part-time EMS First Name * Middle Initial * Last Name * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Home Phone * Cell Phone Date of Birth * Email * Which High School Certification have you received * Diploma GEDCurrent Certification ( Check all that Applies ) * FF-I FF-II Paramedic EMT Advanced EMT Other CertificationOther Certification PSID Number * Drivers License * Expiration Date * It is the policy of the Bargersville Community Fire Protection District to recruit the best qualified applicants from all segments of the surrounding communities. In pursuing this goal, a background investigation of each applicant is conducted with respect to factors that may have a bearing upon the applicant’s future job performance. Members of the Bargersville Community Fire Protection District are public servants and must present a good image of the Bargersville Community Fire Protection District to the public. All employees must be of high integrity and character. They also must exhibit personal habits which make them compatible with other members of the Bargersville Community Fire Protection District. A members job often involves critical and dangerous situations which he/she should not be subject to external pressures that would affect his/her ability to perform the task. Accordingly, the following items are reviewed during the background investigation:Contents and completeness of the employment applicationDriver’s responsibity (copy of driving summary)Former EmploymentCriminal RecordReferencesPersonal history and character of applicant. A negative finding on any of these factors shall not be automatic reason for rejection of an applicant. Instead, the circumstances underlying such matters will be considered as they relate to the applicant’s ability to perform the task of a member of Bargersville Community Fire Protection District.The background investigation phase of the hiring process shall be based upon objective factual findings and any required subjective determination shall be in accordance with the aforementioned policy and conducted in such a manner as not to discriminate on the basis of race, sex, religion, creed, national origin, ancestry, as defined by law, political affiliation, or on the basis of age. Signature * Clear I understand that as a part of Bargersville Community Fire Protection District procedure a routine inquiry will be made, which will provide applicable information concerning character, general reputation, personal characteristics, and mode of living. This will include, but is not limited to inquires of my driving record, criminal record, employment record, or medical record. Unless otherwise stated herein, I give Bargersville Community Fire Protection District full permission and the right to make a thorough investigation of my employment and all other activities. I release from all liability, all persons, companies, and corporations supplying such information. I understand that any deliberately false answer or statement made by me on this application or other required documents shall be considered sufficient cause for denial of membership and/or termination at any time. If you are human, leave this field blank. SubmitΔ
