Fillable Application for Employment

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Application for Employment

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01/2020
Page 1 of 6
Application for Employment
1974 Fircrest Drive SE • Port Orchard, WA 98366-2639 360-871-2411 • FAX 360-925-3818
EQUAL OPPORTUNITY: South Kitsap Fire and Rescue of Port Orchard, Washington is an equal opportunity employer. We hire, train and promote without
discrimination due to race, color, religion, gender, national origin, ancestry, marital status, age, sexual orientation or disability. South Kitsap Fire and Rescue
affirmatively seeks to employ and advance qualified Vietnam veterans and disabled veterans. Hiring, promotions, lay-offs, discharge, rates of pay, training
and other employment activities will be consistent with this Equal Opportunity Statement.
INSTRUCTIONS: Print or type all information. The application must be filled out accurately and completely. Answer all questions. Do not leave an item
blank. If an item does not apply, write N/A (not applicable). If you need additional space to answer a question fully, you may use full sheets of paper that are
the same size as this page. On each additional page, include your name, the position title for which you are applying, and the specific section of this application
form that you are continuing to an additional page. You may also attach copies of résumés, documents or certificates, which support your application. All
materials submitted become the property of South Kitsap Fire and Rescue and will not be returned. Nothing can be added to your application after the
announcement period has closed. All statements made on the application are subject to verification. Failure to follow these instructions may be cause for
rejection of the application. Illegible or incomplete applications may be rejected. Exaggerated, false, or misleading statements may be cause for rejection of
the application and/or termination of employment. My initials at the end of this sentence affirm that I have read and understand these instructions.
Personal Information
Last Name First M.I. Other names by which you have been known:
Mailing Address City State Zip Code
Residence Address, if different from above: City State Zip Code
Email Address
Social Security Number Telephone Number
Alternate number where you may be reached:
(
)
(
)
Are you 18 years of age or older?
Yes No
Do you have a legal right to work in the United States? If offered employment you will be required to present
evidence of your right to work.
Yes No
Have you previously applied for employment with South Kitsap Fire and Rescue?
Yes No
Have you previously been employed by South Kitsap Fire and Rescue? If yes, complete the following information:
Yes No
Job Title/Department
Dates: From
To
List any relatives or members of your household who are employed by South Kitsap Fire and Rescue.
Name
Job Title/Department
DRIVER’S LICENSE if the position for which you are applying will require you to operate a vehicle: (1) you must possess a valid driver’s
license. (2) Any special endorsements must be current and valid. (3) If you are offered employment by South Kitsap Fire and Rescue, and if
your driver’s license is from another state you will be required, as a condition of employment, to obtain a valid Washington State Driver’s
License before you can begin work.
Driver’s License Number
State Expiration Date Classification
Do you authorize South Kitsap Fire and Rescue to investigate your driving record? If yes, South Kitsap Fire and
Rescue may, at its discretion, obtain an abstract of your driving record from the applicable Department of Drivers
Licensing.
Yes No
01/2020
Page 2 of 6
Employment Desired
Position or type of work for which you are applying:
How did you learn about the position for which you are applying?
Do you wish to work:
Full Time Part Time Temporary Summer
If part time, specify days and hours per week.
What is your minimum salary requirement? $ per Date available for work:
Do you have any commitments to another employer that might affect your employment with us? Specify
commitments.
Yes No
Education Educational qualifications are subject to verification. If an offer of employment is made, you may
be asked to provide dates of attendance to facilitate verification.
Do you have a high school diploma or equivalent? Yes No
What post-secondary degree(s) do you hold?
Major / Minor degree, field or program of study?
Name and location of colleges or universities attended.
List special fire or related training (business, trade, vocational, armed forces schools, etc.).
Employment History
Fire Service Experience
(including volunteer)
Employer
From To Total Time Address
Mo. Yr. Mo. Yr. Yrs. Mos. Telephone Number
Your Job Title
Hours per week Supervisor’s Name & Title
Reason for Leaving Position
Specific Duties:
Number of employees supervised (if applicable).
May we contact your present employer regarding your record of employment? Yes No
Job (1) Present or Most Recent Job
Employer
From To Total Time Address
Mo. Yr. Mo. Yr. Yrs. Mos. Telephone Number
Your Job Title
Hours per week Supervisor’s Name & Title
Reason for Leaving Position
01/2020
Page 3 of 6
Specific Duties:
Number of employees supervised (if applicable).
Job (2) Present or Most Recent Job
Employer
From To Total Time Address
Mo. Yr. Mo. Yr. Yrs. Mos. Telephone Number
Your Job Title
Hours per week Supervisor’s Name & Title
Reason for Leaving Position
Specific Duties:
Number of employees supervised (if applicable).
Job (3) Present or Most Recent Job
Employer
From To Total Time Address
Mo. Yr. Mo. Yr. Yrs. Mos. Telephone Number
Your Job Title
Hours per week Supervisor’s Name & Title
Reason for Leaving Position
Specific Duties:
Number of employees supervised (if applicable).
Job (4) Present or Most Recent Job
Employer
From To Total Time Address
Mo. Yr. Mo. Yr. Yrs. Mos. Telephone Number
Your Job Title
Hours per week Supervisor’s Name & Title
Reason for Leaving Position
Specific Duties:
Number of employees supervised (if applicable).
01/2020
Page 4 of 6
Military Service
Dates of U.S. Military Service
Branch of Service Rank at Separation
From To
Mo. Yr. Mo. Yr. If you are claiming preference as a veteran or disabled veteran, you must
attach a copy of your DD-214 form and/or your V.A. disability letter and
claim number.
Veteran’s points
claimed:
5 10
List any specialized training received in the military.
Optional: List any medals, commendations, or awards received in the military.
Misc. Questions
Have you had a positive or a refusal to test result on a pre-employment drug test in the past 2 years?
Yes
☐ No
If yes, have you completed a Return to Duty process? ☐
Yes ☐ No
What computer experience (including computer software) do you have?
Other skills:
01/2020
Page 5 of 6
Miscellaneous Information
If offered a job, are you willing to undergo a pre-employment physical examination? Yes No
If offered a job, are you willing to undergo a pre-employment drug screening test? Yes No
Can you perform the bona fide occupational qualifications of the job you have applied for (with or without
accommodations)?
Yes No
Within the last seven years, have you been convicted of, or are you presently charged with, a crime (other than
minor traffic violations). A “yes” reply does not automatically disqualify you.
Yes No
Professional References List three professional or business references who are not your relatives
or employees of South Kitsap Fire and Rescue. State the nature of your business relationship (i.e., co-worker, supervisor,
and associate).
Name Address Phone Relationship
Years
Known
Personal References List three personal references who are not your relatives or employees of
South Kitsap Fire and Rescue. State the nature of your relationship (i.e., friend, landlord, etc.).
Name Address Phone Relationship
Years
Known
Important: Read each section below carefully and completely. If you do not understand any portion of the statements below, ask for
clarification. Your signature indicates that you have read and understand each of the provisions listed and that you agree to abide by the
conditions stated herein.
Notice to persons with disabilities: Testing arrangements to accommodate persons with disabilities will be made upon request of the
applicant. If accommodation is requested, the applicant will be required to state what accommodation is needed.
How to apply: Applications for employment should be submitted on official application forms to South Kitsap Fire and Rescue in person or at
the address or fax number shown on page 1 of this application form or via email to vallen@skfr.org. Submit one application for each position.
It is your responsibility to keep your application up to date. An application may be rejected which is received unsigned, incomplete, or after
the closing date specified on the job announcement.
Examination procedure: You will be notified within four weeks of the closing date of the job announcement regarding any testing procedures
which may be involved in the hiring process. Any part of the announced examination may be eliminated if there is an insufficient number of
applicants to justify giving the complete examination.
Pre-employment medical examination: Applicants selected for employment may be required to pass a medical examination given by a
physician designated by South Kitsap Fire and Rescue as well as a pre-employment drug screen.
Compensation: New employees ordinarily start at the minimum rate in the salary range.
Probationary period: Employees serve a probationary period as determined by South Kitsap Fire and Rescue policy or by any applicable
collective bargaining agreement. Termination of employment during the probationary period may be with or without cause and is not subject
to any appeal process nor the grievance procedure of any applicable collective bargaining agreement.
Drug policy: It is the policy of South Kitsap Fire and Rescue to maintain a drug free workplace. Employees who are observed in possession
of or using controlled substances (drugs) will be terminated and may have criminal actions filed against them. Employees in certain positions
are subject to Federal laws requiring pre-employment, post-accident, and random drug testing.
01/2020
Page 6 of 6
Agreement: I certify that the information contained in this application is correct to the best of my knowledge and I understand that any
falsification, misrepresentation, or omission on this application is grounds for refusal to hire; or if hired, is grounds for termination. I authorize
any of the persons or organizations referenced in this application to give South Kitsap Fire and Rescue any and all information concerning my
previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered
by this application. I authorize South Kitsap Fire and Rescue to request and receive such information.
I understand that my employment can be terminated at any time for any reason that is not violative of law, at the discretion of either South
Kitsap Fire and Rescue or myself. I understand that no management official other than the chief executive officer has any authority to enter
into any agreement contrary to the foregoing or make any oral assurance or promise of continued employment
I agree to comply with South Kitsap Fire and Rescue rules, regulations, and policies and acknowledge that these rules, regulations, and
policies may be changed, interpreted, withdrawn, or supplemented at any time and without prior notice to me.
I understand that this application and any other documents which I may receive are not contracts of employment.
Release: I hereby release and hold harmless any person, corporation, company, or other entity from any and all possible damages, direct or
consequential, immediate or remote, of all forms or types, that I may sustain or allege to sustain by virtue of that person, corporation, company,
or other entity complying with my request to fully and completely comply with the investigation, inquiry, or interests of South Kitsap Fire and
Rescue, to whom I have made an application of employment and is the bearer of this authorization.
Signature:
Date:
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Application for Employment

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Completed 22 December 2020

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