Application Open Application Application It is the Policy of the Gateway-Unaweep Fire Protection District to hire and promote the best qualified individual(s) available. To this end, the District provides equal employment and service opportunities to all members and applicants without regard to race, color, religion, sex, national origin, age, disability, marital status, military status or veteran status, or status in any other group protected by federal, state or local law. PERSONAL INFORMATION First Name * Middle Name Last Name * Primary Phone Number * (###) ### #### Secondary Phone Number (###) ### #### Email * Date of Birth * MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Are you eligible to work in the United States? Yes No EDUCATIONAL BACKGROUND Did you graduate high school? Yes No Did you attend college? Yes No Please list any graduate school, trade, business or special schools attended and any other certificate/diploma/degree obtained. SERVICE RECORD Are you currently a member of any branch of military or a veteran? Yes No If you answered no to the question above skip to the CERTIFICATIONS / SPECIAL SKILLS / EXPERIENCE portion. If you are a veteran what was your discharge status Honorable Other than Honorable Dishorable Medical If you are a veteran which branch of the military did you serve in? Army Navy Marines Air Force Space Force Coast Guard What was your M.O.S. CERTIFICATIONS / SPECIAL SKILLS / EXPERIENCE Please list certifications, special skills or experience as they relate to the position for which you are applying. If you are called for the next step in the interview process you will be expected to bring in copies of any certificates listed. Certificates held: What languages do you speak fluently? Do you currently possess a valid driver’s License? Yes No Have you had your driver’s license suspended or revoked in the last 3 years? Yes No Have you ever been convicted of any law violation? Include any plea of “guilty” or “no contest.” (Exclude minor traffic violations.) Yes No If you answered yes to the question above please explain. PERSONAL REFERENCES Give three personal references who are not related to you, and who are not former employers Personal Reference #1 Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Relationship Years aquatinted Personal Reference #2 Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Relationship Years Acquainted Personal Reference #3 Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Relationship Years Acquainted EMPLOYMENT HISTORY List your last three employers, starting with the most recent one first. 1. Name of employer, city and state Start Date MM DD YYYY Leave date MM DD YYYY Final salary $ Name of supervisor First Name Last Name Phone (###) ### #### Position held Reason for leaving May we contact this employer? Yes No 2. Name of employer, city and state Start date MM DD YYYY Leave date MM DD YYYY Final salary $ Name of supervisor First Name Last Name Phone (###) ### #### Position held Reason for leaving May we contact this employer? Yes No 3. Name of employer, city and state Start date MM DD YYYY Leave date MM DD YYYY Final salary $ Name of supervisor First Name Last Name Phone (###) ### #### Position held Reason for leaving May we contact this employer? Yes No AVAILABILITY Earliest date you are available for a telephone interview MM DD YYYY Select one or more of the following classification status(es) you are interested in Volunteer Per-diem (minimum of two (2) twenty-four (24) hour shifts per month Part-time (minimum of four (4) twenty-four (24) hour shifts per month Full-time (rotating schedule of approximately 10 days per month) Check which day(s) of the week you are available to work Sunday Monday Tuesday Wensday Thursday Friday Saturday Thank you! Job Describtion Volunteer Describtion
