Job Application

Name*
Occupation
Address*
Street Address Address Line 2 City State
Home Phone
Cell Phone
Email*
Enter Email Confirm Email
Age*
Date of Birth*
MM slash DD slash YYYY
Driver's licence
Social Security
Dependent
Spouse name
Beneficiary
Station Applying for*
Position Applying for*
Formal Education
High School
Address
College
Address
Working Experience
Name of Organization
Job Title
Length of Service
Name of Organization
Job Title
Length of Service
Name of Organization
Job Title
Length of Service
Fire Service Experience
ARE YOU A MEMBER (PA ID OR VOLUNTEER) OF ANY OTHER FIRE DEPARTMENT ?
if So, Explain
DO YOU HAVE ANY DRIVING VIOLATIONS WITHIN THE PAST THREE YEARS?
if So, Explain
PHYSICAL AILMENTS OR DISABILITIES
ARE YOU WILLING TO TAKE A PHYSICAL EXAMINATION IF REQUIRED?
HAVE YOU EVER BEEN ARRESTED, SUMMON ED INTO COURT AS A DEFENDANT, INDICTED, CONVICTED, FINED, IMPRISONED, OR PLACED ON PROBATION?
if So, Explain
DO YOU CONSENT FOR SOUTH LYNCHES FIRE DEPARTMEN T TO OBTAIN A CRIMINAL BACKGROUND CHECK FROM THE SOUTH CAROLINA LAW ENFORCEMENT DIVISION, AS REQUIRED BY STATE LAW?
REFERENCES: (WORK RELATED, NO RELATIVES)
Name
Address
Phone
Name
Address
Phone
Name
Address
Phone
LIST A CURRENT FIRE DEPARTMENT ACQUAINTANCE, IF POSSIBLE_
*IN COMPLIANCE WITH FEDERAL AND STATE EQUAL OPPORTUNITY LAWS, QUALIFIED APPLICANTS ARE CONS IDERED FOR VOLUNTEER MEMBERSHIP WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE , MARITAL STATUS, OR THE PRESENCE OF NON -JOB MEDICAL CONDITION OR DISABILITY.
*ANY VOLUNTEER WHO IS A MINOR AT THE TIME OF SIGNING THIS APPLICATION MUST SUBMIT A PARENTAL CONSENT FORM IN ORDER TO PARTICIPATE IN THE VOLUNTEER PROGRAM.
*I ACKNOWLEDGE THAT ALL STATEMENTS ON THIS FORM ARE TRUE AND ACCURATE, AND UNDERSTAND THAT ANY MISREPRESENTATIONS OR OMISSION OF FACTS MAY RESULT IN MY DISQUALIFICATION TO PROVIDE VOLUNTEER SERVICES FOR SOUTH LYNCHES FIRE DEPARTMENT
Full Name*
Today's Date*
MM slash DD slash YYYY
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