Zoneton Fire DISTRICT VOLUNTEER FIREFIGHTER  Application
Volunteer Position Applying For: (Position's Available Volunteer Firefighter, Radio Operator, Support)
General Information
Applicant's Full Name:	Phone:	Work Phone:
Address:
City:	State:	Zip:
Social Security #:	Email:	Over 18? Yes    No
Previous Address:
Background Information
Liability Statement:
As the fire district is allowed access to private property for rescue and fire suppression; operates fire apparatus and allows operation of personal vehicles during emergency response; and handles private matters, the fire district reserves the right not to employ persons who have been convicted of theft related matters, wreckless driving, and official misconduct related matters, and any other conviction the fire district administration determines as jeopardizing the liability of the fire district and the trust and integrity that the community places in the fire districts operations.
a. Have you ever been convicted of a felony offense in civilian or military court?		No Yes
b. Have you ever been convicted of Driving While Intoxicated or under the influence of illegal drugs?		No Yes
c. Have you ever been discharged from a fire department or Emergency Services position?		No Yes
d. Have you ever been discharged from any job?		No Yes
Drivers License Information
DL State: Valid? Yes  No	Classification:	Expiration Date:
a. Have you ever been forced to surrender a license from another state to that state? No  Yes Yes, Which State?
b. Have you ever had your license revoked or suspended for traffic violation? No  Yes Yes, Which State?
c. Do you currently maintain liability insurance on your automobile? No   Yes
Education
What is the highest grade completed?		Did you graduate or obtain GED? Yes No
List any Colleges or Universities Below:
List any Vocational Schools Below:
Job Task Annalysis
Why Do You want to be a Firefighter?
Why Do You want to be a Zoneton Fire Protection District Firefighter?
You and a fellow firefighter are doing an interior attack at a house and you observe your partner take a couple $1.00 bills off the kitchen table and he does not know that you observed this take place. How do you handle this situation?
Your commanding officer gives you an order to do something that in your opinion is unsafe. How do you handle this situation??
Certificates & Licenses
List any valid certificates and/or licenses which you currently hold which may be applicable to the position for which you are applying for. Include any licensing numbers, issuing agency, and address of issuing agency and provide photocopies of the same to include with this package.
Personal References
List Reference Name and Phone Number: (not previous employers or relatives) Reference 1: Reference 2: Reference 3:
Professional References
List Professional References Name and Phone Number: (people who know your work ethic) Reference 1: Reference 2: Reference 3:
a: How many days of work (school) have you missed in the last 2 years? b: How many days of work (school) have you been late to in the last 2 years? c: Have you ever been disciplined for violating company policy?
Former Fire / EMS Reference
Former Fire or EMS Chief: Department's Name: Department's Phone Name: Chief's Name: Address: City, State, Zip:
PLEASE READ THE FOLLOWING
I certify that my answers to the forgoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am emplyed, any false, misleading, or otherwise incorrect statements made on this application form or during any interview may be grounds for my immediate discharge. I hereby authorize Zoneton Fire Protection District to contact any companyor individual it deems appropriate to investigate my employment history, character, and qualifications and I give my full consent to their revealing and and all information they wish as a result of this research. In addition, I waive my right to bring any suit against these individuals for defamation, invasion of privacy or any other reason because of their statements. I agree that if I am employed by Zoneton Fire Protection District, I will abide by all policies, guides and directives of the fire district and that I will be required to submit to a physicalexamination including drug and alcohol screening as necessary, and that the district will require a criminal background check upon me being offered a position with the fire district. I understand that should I be hired me employment is "at-will" and may be terminated by myself or by the fire district at any time for any reason or no reason at all, with, or without prior notice. Check Here If You have Read and Agree