Employment Application

Employment Application

Complete all sections of the employment application. Preserve the original structure and use a clean web form layout.
Personal Information and Eligibility
Position Applied For
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Legal Name

First NameMiddle NameLast Name
Preferred Name
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City / State / ZIP
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Driver's License State / Class
Best Method of Contact
Are you legally authorized to work in the United States?
Are you at least 18 years of age?
Have you previously worked for this department / ESD?
If yes, dates and position
Can you perform the essential functions of the position, with or without reasonable accommodation?
TCFP certification(s) / level(s)
EMS certification(s) / level(s)
Other job-related licenses or certifications
Fire academy / training institution and graduation date
Current department memberships or relevant public-safety experience
Education
Education Entries
Employment History
Employer Name 1
Phone 1
Please enter a valid phone number.Format: (000) 000-0000.
Address 1
Dates Employed 1
Position/Rank 1
Immediate Supervisor 1
Reason for Leaving 1
Eligible for Rehire? 1
May we contact this employer? 1
If no, explain 1
Supervisor/HR Email 1
example@example.com
Employer Name 2
Phone 2
Please enter a valid phone number.Format: (000) 000-0000.
Address 2
Dates Employed 2
Position/Rank 2
Immediate Supervisor 2
Reason for Leaving 2
Eligible for Rehire? 2
May we contact this employer? 2
If no, explain 2
Supervisor/HR Email 2
example@example.com
Employer Name 3
Phone 3
Please enter a valid phone number.Format: (000) 000-0000.
Address 3
Dates Employed 3
Position/Rank 3
Immediate Supervisor 3
Reason for Leaving 3
Eligible for Rehire? 3
May we contact this employer? 3
If no, explain 3
Supervisor/HR Email 3
example@example.com
Professional and Character References
Professional Reference 1 - Name

First NameLast Name
Professional Reference 1 - Relationship / Organization
Professional Reference 1 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Professional Reference 1 - Email
example@example.com
Professional Reference 1 - Years Known
Professional Reference 2 - Name

First NameLast Name
Professional Reference 2 - Relationship / Organization
Professional Reference 2 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Professional Reference 2 - Email
example@example.com
Professional Reference 2 - Years Known
Professional Reference 3 - Name

First NameLast Name
Professional Reference 3 - Relationship / Organization
Professional Reference 3 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Professional Reference 3 - Email
example@example.com
Professional Reference 3 - Years Known
Professional Reference 4 - Name

First NameLast Name
Professional Reference 4 - Relationship / Organization
Professional Reference 4 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Professional Reference 4 - Email
example@example.com
Professional Reference 4 - Years Known
Personal Reference 1 - Name

First NameLast Name
Personal Reference 1 - Relationship
Personal Reference 1 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Personal Reference 1 - Email
example@example.com
Personal Reference 1 - Years Known
Personal Reference 2 - Name

First NameLast Name
Personal Reference 2 - Relationship
Personal Reference 2 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Personal Reference 2 - Email
example@example.com
Personal Reference 2 - Years Known
Personal Reference 3 - Name

First NameLast Name
Personal Reference 3 - Relationship
Personal Reference 3 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Personal Reference 3 - Email
example@example.com
Personal Reference 3 - Years Known
Personal Reference 4 - Name

First NameLast Name
Personal Reference 4 - Relationship
Personal Reference 4 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Personal Reference 4 - Email
example@example.com
Personal Reference 4 - Years Known
Applicant Acknowledgments and Signatures
Applicant Signature - Authorization to Contact References
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Printed Name

First NameLast Name
Mission, Vision, and Core Values
Applicant Signature - Mission/Vision/Core Values Acknowledgment
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Printed Name

First NameLast Name
Should be Empty:

Employment Application

Personal Information and Eligibility

Education

Employment History

Professional and Character References

Applicant Acknowledgments and Signatures

Mission, Vision, and Core Values