PANTEGO FIRE RESCUE

1614 S Bowen Rd.

PANTEGO, TEXAS 76013

 

APPLICATION FOR EMPLOYMENT

 

**PRINT THIS APPLICATION BEFORE COMPLETING. MAIL APPLICATION TO THE ADDRESS ABOVE**

 

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

We are an Equal Opportunity Employer

 

(Please print)

Position applied for:

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How did you learn about us? If on the Internet, what site, link, or keyword?

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Last Name:                                           First:                                         Middle/Maiden

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Address:                       Number Street               City                  State                Zip

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Telephone Numbers: Home                                 Cell                               Pager

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Date of Birth                                          DL#/State                                  Social Security

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What is your current TDH EMS Certification

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What is the best time and method to contact you?

 

Have you ever filed an application with us before?                       Yes [ ]      No [  ]

If so when?_______________________________

 

Have you ever been employed with us before?                             Yes [ ]      No [  ]

Do any of your relatives, other than a spouse, work here?           Yes [ ]      No [  ]

Are you currently employed?                                                           Yes [ ]      No [  ]

May we contact your present employer?                                        Yes [ ]      No [  ]

 

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?  Proof of citizenship or immigration status will be required upon employment?                                                             Yes [ ]      No [  ]

 

Date available for work ? __________

What is your desired salary range ?_____________

Are you available to work:    [ ] Full time      (indicate 1  2  3 shift)

                                                [ ] Part-time    (indicate Morning, Afternoon, Evening)

                                                [ ] Temporary (indicate dates available ___________)

 

Are you currently on lay-off status an subject to recall?     Yes [ ]    No [  ]

Can you travel if the job requires it?                                    Yes [ ]     No [  ]

Drivers License?                                                                    Yes [ ]     No [  ]

D.L. #, state of issue and class ______________________________

 

EDUCATION______________________________________________________

                                                Name and Address of School Course of Study      Years completed    Diploma or Degree

Elementary School___________________________________________________________

 

High School___________________________________________________________

 

Undergraduate College__________________________________________________________

 

Graduate Professional______________________________________________________

 

Other (Specify)_________________________________________________________

 

Describe any specialized training, apprenticeship, skills, and extra-curricular activities.

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Describe any job-related training received in the United States military.

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PREVIOUS EMPLOYMENT

 

 

 

 

 

 

 

 

 

ORGANIZATIONS:  List professional, trade, business, or civic activities or offices held.

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ADDITIONAL INFORMATION________________________________________

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SPECIALIZED SKILLS

 

Hazmat Tech [   ]    Fire Inspector [  ]    Arson Investigator [   ]

Firefighter Basic [  ]    Firefighter Intermediate [  ]    Firefighter Advanced [  ]

 

Other ____________________________________________________________________________

Please indicates your level of EMS certification/licensure.

 

EMT-Basic [  ]     EMT-Intermediate [  ]    EMT-Paramedic [  ]    

 

Please give any additional information you feel may be helpful to us in considering your application.

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Note to Applicants:  DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?  A review of the activities involved in such a job or occupation has been given.

                                                [ ] YES   [ ] NO

REFERENCES:

          Name:                                                                            Address                                        Contact Numbers

1._______________________________________________________________

 

2._______________________________________________________________

 

3._______________________________________________________________

 

APPLICANT’S STATEMENT_________________________________________

 

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without  cause.  It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the Employer.

 

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Signature of Applicant                                                        Date

 

FOR PERSONNEL DEPARTMENT USE ONLY__________________________

 

Position(s) Applied for is open:       [ ] Yes  [ ]  No

Position(s) Considered for ___________________________________________

 

__________________________________________Date__________________

 

Arrange Interview:  [ ] Yes     [ ]  No

 

Remarks:

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Employed     [ ] Yes   [ ]  No              Date of Employment_____________________

 

Job Title                                   Salary                                                      Department

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By:

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Name and Title                                                                                         Date