APPLICATION FOR EMPLOYMENT
Roaring Fork Fire and Rescue Authority
Statement of Policy
Employment with the Roaring Fork Fire and Rescue Authority is based on individual merit.
Employment opportunities are open to all, without regard to Race, Color, Creed, Religion, Gender, Age,
Marital Status, National Origin, Ancestry, Citizenship status, Physical or Mental Disability, Sexual
Orientation, Genetic information, Physical and Mental Disability or any other status that is protected by
state or federal law. EOE
Note to Applicants
The careful and thoughtful completion of this application is an important step in our consideration of
individuals for employment. Therefore, you must complete the entire application fully and honestly. If
you do not, you will not be considered for employment. It is understood that false statements on this
application may, at any time during your employment if you are employed, result in your termination.
Your application must specify the position for which you are applying. Please complete the fillable
portions of each question. If you need additional space for any of your answers, please use the backs of
the pages of the application and indicate in the space provided for your answer that it is continued of a
separate page.
Position Applying For (Use Specific Title):
Today’s D
ate:
Applicants Name:
Mailing Address:
Physical Address:
Email Address:
Work Phone:
Home Phone:
Cell Phone:
Are you
legally eligible for employment in the United States?
(If offered employment, you will be required to provide documentation to verify eligibility.)
Are you over 18 years old?
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APPLICATION FOR EMPLOYMENT
Employment History Include your last ten (10) years of employment history or last four (4) employers,
including periods of unemployment (please do not include any medical information), starting with the
most recent and working backwards in time. Incomplete information could disqualify you form further
consideration. ATTACH ADDITIONAL SHEET/RESUME IF NEEDED.
Employer: Te
lephone:
From
Name of Last Supervisor:
To
Telephone:
From To
Name of Last Supervisor:
Address:
Position:
Dates of Employment: (month and year):
Title:
Reason for Leaving:
Description of Duties:
Employer:
Address:
Position:
Dates of Employment (month and year):
Title:
Reason for Leaving:
Description of Duties:
APPLICATION FOR EMPLOYMENT
Emp
loyer: Telephone:
Addr
ess:
Posi
tion:
Date
s of Employment (month and year): From To
Title: Name of Last Supervisor:
Rea
son for Leaving:
Des
cription of Duties:
Emp
loyer: Telephone:
Address:
Posi
tion:
Date
s of Employment (month and year): From To
Title
: Name of Last Supervisor:
Rea
son for Leaving:
Description of Duties:
If presently employed, may we contact your employer?
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APPLICATION FOR EMPLOYMENT
FIRST RESPONDERS ONLY
Rele
vant Fire and EMS Experience Answer only the specific inquiries below which are relevant to the
position for which you are applying. Feel free to supplement your answers with a resume and/or other
pertinent documents.
Level of Emergency Medical Technician Training:
Attach a copy of the certificate
Basic I
ntermediate Paramedic Expiration Date:
Level o
f structural firefighting training:
Attach a copy of the certificate
Firefi
ghter I Firefighter II FireOfficer I
Other E
xpiration Date:
Have you
completed hazardous materials training? Level
Attach a copy of the certificate
Please list any licenses or certifications
that you hold which would be use
ful in thi
s position:
Descri
be nature and extent of fire experience:
Desc
ribe nature and extent of emergency medical experience:
Desc
ribe nature and extent of leadership experience:
Describe your volunteer responder experience:
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APPLICATION FOR EMPLOYMENT
NON-RESPONDERS
Plea
se list any licenses or certifications that you hold which would useful in this position:
Describe the office equipment and computer programs that you are familiar with:
Desc
ribe any other skills or experience you have which you feel is relevant to the position for which you are
applying:
EDUCATION
High
est Grade Completed: High School Diploma or GED Some College
Associate’s Degree Bachelor’s Degree Master’s Doctorate
Scho
ol Name and Location
High S
chool:
Graduated:
College/University:
Grad
uated: Degree/Certificate:
Cour
se of Study:
Vocati
onal/Technical:
Graduated: Degree/Certificate:
Cour
se of Study:
PROFESSIONAL LICENSE OR MEMBERSHIPS
Type of Li
cense(s) Held
License Number License Expiration Date
Professional Memberships
Choose One
Choose One
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APPLICATION FOR EMPLOYMENT
(You need not
disclose memberships in professional organizations that may reveal information regarding Race, Color,
Creed, Religion, Gender, Age, Marital Status, National Origin, Ancestry, Citizenship status, Physical or Mental Disability,
Sexual Orientation, Genetic information, Physical and Mental Disability or any other status that is protected by state or
federal law.)
PERSONAL REFERENCES
Supply the names of individuals who can give the District information regarding your work character, abilities and
experience.
1. Name: Phone
Number:
Relationship: Years Acquainted:
2. Name: Phone
Number:
Relationship: Years Acquainted:
3. Name: Phone
Number:
Relationship: Years Acquainted:
ADDITIONAL INFORMATION
This space allows for additional information that you may not have had the opportunity to enter above.
APPLICATION FOR EMPLOYMENT
AF
FIDAVIT: Please read each statement carefully before signing.
The
information contained in this application and supporting employment documents is true to the best of my
knowledge and belief. I understand and agree that, if in the opinion of the Fire Districts, I have made any
misrepresentations or false statements in connection with the application and supporting employment
documents, the Fire Districts may reject my application or, dismissal at any time if employed.
I understand that all information furnished in this application and supporting employment documents may be
verified. I hereby authorize all individuals and organizations named and referred to in this application and
supporting employment documents and any laws enforcement organization to release any and all information
relative to such verification and hereby release such individuals, organizations and the Fire Districts from and all
liability for any claim or damage resulting therefrom.
I u
nderstand that, following an offer of employment, employment may will be contingent upon successfully
completing a, background check, drug screen, medical physical, fitness testing and functional movement test
(responders), or background check, drug screen, medical physical and functional movement test (non-responders).
I consent to the release of any or all personal and/or professional and/or medical information as may be deemed
necessary to judge my capability to do the work for which I am applying.
In
accordance with the Immigration Reform and Control Act of 1986, I understand that I will be required to provide
documentation as to my identity and authorization to work in the U.S. should employment be offered to me.
I unde
rstand that this application or subsequent employment does not create a contract of employment nor
guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will
of the employer and my employment may be terminated at any time, with or without cause and with or without
notice.
I state that I have made no willfully false or misleading statements in this application or otherwise and that I will
make no willfully false or misleading statements about my ability to perform if I am selected to continue in the
interview/selection process.
Th
is application will remain active no more than six (6) months from the date it was submitted.
I understand that should I be offered employment, it may be conditioned upon the contents of my driving record
as provided by the Department of Motor Vehicles.
Ap
plicants Signature:
Da
te:
click to sign
signature
click to edit