APPLICATION

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Application Date * +

Position Applying For *

First Name *

Middle Name *

Last Name *

Street Address *

Address 2

City *

State *

Postal Code *

Primary Phone *

Cell Phone *

Email Address *

Social Security # *

If necessary, best time to call you at home is

May we contact you at work? *

Yes

No

If yes, what is your work number

Are you 18 years of age or older? *

Yes

No

Have you been employed by the PVVFD before? *

Yes

No

If yes, give dates

Are you legally authorized to work in the United States? * 🛈

Yes

No

Date available to start work * +

Do you have Military experience? *

Yes

No

Have you been convicted of a felony in the last (7) years? * 🛈

Yes

No

If yes, please explain.

Do you have a valid drivers license? *

Yes

No

Drivers License # *

State *

Drivers License Type * 🛈

Are you related by blood, adoption, or marriage to any current PVVFD employee or official? *

Yes

No

If yes, to whom?

What is your relationship?

How did you learn about this employment opportunity? *

Employment History

Employer

Address

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Summarize the nature of the work performed and job responsibilities.

Supervisor/Manager

Reason for Leaving

May we contact for reference?

Yes

No

Employer

Address

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Summarize the nature of the work performed and job responsibilities.

Supervisor/Manager

Reason for Leaving

May we contact for reference?

Yes

No

Employer

Address

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Summarize the nature of the work performed and job responsibilities.

Supervisor/Manager

Reason for Leaving

May we contact for reference?

Yes

No

Comments: (Include any gaps in employment)

Skills, Qualifications, or Certifications: * 🛈

Educational Background

School/College/University *

Number of years completed? *

Degree/Diploma

Major/Minor

School/College/University

Number of years completed?

Degree/Diploma

Major/Minor

School/College/University

Number of years completed?

Degree/Diploma

Major/Minor

References

Name 🛈

Title

Phone

Email Address

Name

Title

Phone

Email Address

Name

Title

Phone

Email Address

Organizational References

Organization Name 🛈

Offices Held

Organization Name

Offices Held

Organization Name

Offices Held

Additional Skills

List any additional skills that you would like to mention.

The Pleasant View Volunteer Fire Department is an equal opportunity employer and does not discriminate on the basis of sex, race, color, religion, national origin, age, disability or veteran status in employment opportunities and benefits.

The employment application is but one part of the hiring process, which may include an interview, and employment examination or test and a demonstration of an ability to perform the essential functions of the job. If you need an accommodation in order to complete any part of the hiring and employment process, please contact the PVFD Administration.

I certify that, to the best of my knowledge and belief, all of the information and statements provided by me in and with this application are true, correct, complete, and provided in good faith.

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed.

I give the PVFD the right to investigate all references and to secure additional information about me. I consent to the release of information to the PVFD about my ability and fitness for employment by employers, schools, law enforcement agencies and other individuals and organizations. I hereby release from liability the PVFD and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

I understand that just as I am free to resign at any time, the PVFD reserves the right to terminate my employment pursuant to the Department’s Personnel Rules and Regulations. I understand that no representative of the PVFD has the authority to make any assurances to the contrary.

Furthermore, I also authorize an investigation of my driving record and criminal offense record as required for active membership in the Pleasant View Volunteer Fire Department. The Pleasant View Volunteer Fire Department is a drug-free/tobacco-free employer and I am subject to mandatory and random drug testing. I understand that I am a pro-bono or volunteer employee, subjected to a probationary period and that all of the preceding statement on this application are true to the best of my knowledge. Furthermore, I understand that any falsification on this application will result in immediate termination of membership from the Pleasant View Volunteer Fire Department.

I have read and understand the above statements *

Agree

Disagree

Signature: *

clear

Witness

clear

Please submit a copy of your resume.