Job Application REDINGS MILL FIRE PROTECTION DISTRICT 344 REDINGS MILL ROAD 417-624-2715 * Position Applying For (choose one) Full-Time Employment Part-Time Employment Volunteer Firefighter Resident Firefighter APPLICANT INFORMATION * First Name * Last Name * Middle Initial * Date of Birth * Address Street Address Address Line 2 City Alabama Alaska Arizona Arkansas 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 ZIP Code * Phone * Email * SSN * DL Number / CDL? * DL State * Do you or have you served in any branch of the U.S. Military? Yes No If so, please explain: * Emergency Contact EDUCATION High School Education Graduate High School/Year High School Equivalancy Test/Year ADDITIONAL EDUCATION Completion Date Course Study Semesters or Units Completed Name/Location of University, College or Trade School attended Title of Degree/Certificate Received Completion Date Course Study Semesters or Units Completed Name/Location of University, College or Trade School attended Title of Degree/ Certificate Received Completion Date Course Study Semesters or Units Completed Name/Location of University, College or Trade School attended Title of Degree/ Certificate Received Completion Date Course Study Semester or Units Completed Name/Location of University, College or Trade School attended Title of Degree/ Certificate Received Completion Date Course Study Semesters or Units Completed Name/Location of University, College or Trade School attended Title of Degree/ Certificate Received Completion Date Course Study Semesters or Units Completed Name/Location of University, College or Trade School attended Title of Degree/ Certificate Received SPECIAL SKILLS OR QUALIFICATIONS Summarize special skills and qualifications you have acquired from employment, pervious volunteer work, or through other activities, that may benefit Redings Mill Fire Protection District EMPLOYMENT HISTORY List below, your past or recent employment. If more than one position or classification has been held within a given organization, list each position or classification as a separate period of employment. If you have more than three (3) places of employment in the past five years, fill out a blank sheet in the same form as outlined below. This information may be included in your resume. Present or Last Employer Dates Employed Total Years Employed Full Time / Part Time Full Time Part Time Your Title / Specific Duties Reason for Leaving Previous Employer Dates Employed Total Years Employed Full Time / Part Time Full Time Part Time Your Title / Specific Duties Reason for Leaving Previous Employer Dates Employed Total Years Employed Full Time / Part Time Full Time Part Time Your Title / Specific Duties Reason for Leaving LAST THREE RESIDENCES Residence 1: Address City, ST Owner/Landlord Phone Number Residence 2: Address City, ST Owner/Landlord Phone Number Residence 3: Address City, ST Owner/Landlord Phone Number PROVIDE AT LEAST THREE PROFESSIONAL REFERENCES BELOW * Reference 1: Name * Address * Phone * Relationship * Reference 2: Name * Address * Phone * Relationship * Reference 3: Name * Address * Phone * Relationship PREVIOUS EMERGENCY SERVICE EXPERIENCE Department Name Supervisor Dates Served Position Held Reason for Leaving Department Name Supervisor Dates Served Position Held Reason for Leaving LEGAL HISTORY Please provide information below for any legal history you may have; Driving/Traffic Violations, Felonies/Misdemeanor Convictions Charge Date County/City/State Occurred in Disposition Charge Date County/City/State Occurred in Disposition Charge Date County/City/State Occurred in Disposition Charge Date County/City/State Occurred in Disposition * NARRATIVE STATEMENT Information provided on this application, and any supportive documents, will be checked and verified, including references provided. Falsifying any information on an application will be considered grounds for not hiring applicant, or if already hired, will be grounds for dismissal. EQUAL OPPORTUNITY EMPLOYER The Redings Mill Fire Protection District will not discriminate in the hiring or promotion process based on sex, religion, race, color, or national origin. The same principal applies to handicapped persons if the handicap does not hinder the ability to perform the necessary requirement for the position that the individual has applied for. * By submitting this form: I grant permission to the Redings Mill Fire Protection District to perform a criminal background check.
