Fillable CCA Fire Fighter Academy Application (Community College of Aurora)

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CCA Fire Fighter Academy Application (Community College of Aurora)

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The CCA Fire Fighter Academy Application (Community College of Aurora) form is 7 pages long and contains:

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  • 25 check-boxes
  • 274 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Community College of Aurora

BROWSE COMMUNITY COLLEGE OF AURORA FORMS

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1
CCA FIRE FIGHTER ACADEMY APPLICATION
PERSONAL INFORMATION
LAST NAME
FIRST NAME
MIDDLE
SOCIAL SECURITY NUMBER
OTHER NAMES (Including nicknames, maiden, former married, name changes etc.)
DRIVERS LICENSE NUMBER
STREET ADDRESS
CITY, STATE, ZIP
HOME PHONE
DATE OF BIRTH
PLACE OF BIRTH
WORK PHONE
WEIGHT
HAIR COLOR
EYE COLOR
CELLULAR PHONE
SCARS, TATOOS OR OTHER DISTINGUISHING MARKS
EMAIL
ARE YOU A CITIZEN OF THE UNITED STATES YES _____ NO _____
IF NATURALIZED, PLEASE BRING YOUR CITIZENSHIP CERTIFICATE WITH YOU FOR VERFICATION BY OFFICE STAFF.
LIST ALL RESIDENCES FOR THE LAST 10 YEARS BEGINNING WITH CURRENT ADDRESS.
ADDRESS
CITY/STATE/ZIP
FROM
MO / YR
TO
MO / YR
LANDLORD NAME/
PHONE NUMBER
2
EDUCATION AND TRAINING
SCHOOL
NAME AND LOCATION
COURSE OF STUDY
NO. OF YEARS
COMPLETED
DID YOU
GRADUATE
DIPLOMA OR
DEGREE
HIGH
SCHOOL
G.E.D.
CERTIFICATE NUMBER
DATE PASSED
COLLEGE
OR UNIV.
COLLEGE
OR UNIV.
List any foreign languages you are fluent in:
Apprenticeships, Correspondence Courses, or other Special Training:
Have you ever been suspended or expelled from any school? Yes _____ No _____ If “Yes”, explain:
PERSONAL CHARACTER REFRENCES
IT IS MANDATORY THAT YOU LIST AT LEAST THREE (3) PERSONS WHO HAVE PERSONAL KNOWLEDGE OF YOUR
CHARACTER, REPUTATION AND MORALS. DO NOT LIST RELATIVES OR EMPLOYERS, PAST OR PRESENT.
NAME
HOME PHONE
WORK PHONE
ADDRESS
TITLE
YEARS KNOWN
NAME
HOME PHONE
WORK PHONE
ADDRESS
TITLE
YEARS KNOWN
NAME
HOME PHONE
WORK PHONE
ADDRESS
TITLE
YEARS KNOWN
3
MILITARY SERVICE
Have you ever served in the armed forces, military reserve or National Guard? Yes ٱ No ٱ
If “Yes”, please supply the following information:
Branch of Service Service Number
Dates of Service From To Type of Discharge
If less than an honorable discharge please explain:
Are you currently in a military reserve or National Guard Program? Yes ٱ No ٱ
Have you ever been the subject of any judicial or non-judicial disciplinary action while in the armed forces, military reserves or
National Guard? Yes ٱ No ٱ
If “Yes”, give details (include branch of service, when, where, circumstances):
Past commanding officers or military acquaintances who know you well enough to provide accurate information about you:
NAME
ADDRESS
(FACILITY/STREET/CITY/ZIP)
TELEPHONE
YEARS KNOWN
FROM / TO
4
EXPERIENCE AND EMPLOYMENT
Beginning with your most current employment, please list all jobs (including part-time, temporary, and voluntary positions) you have
held in the last 5 years. If you have had intervening periods of military service or unemployment, please list those periods in sequence.
Company Name
Phone Number
Address
Employed FROM TO
City, State, Zip
May we Contact
Yes ٱ No ٱ
Full-time ٱ
Part-time ٱ
Name & Title of Supervisor
Reason for Leaving:
Your Job Title & Duties
Company Name
Phone Number
Address
Employed FROM TO
City, State, Zip
May we Contact
Yes ٱ No ٱ
Full-time ٱ
Part-time ٱ
Name & Title of Supervisor
Reason for Leaving:
Your Job Title & Duties
Company Name
Phone Number
Address
Employed FROM TO
City, State, Zip
May we Contact
Yes ٱ No ٱ
Full-time ٱ
Part-time ٱ
Name & Title of Supervisor
Reason for Leaving:
Your Job Title & Duties
Company Name
Phone Number
Address
Employed FROM TO
City, State, Zip
May we Contact
Yes ٱ No ٱ
Full-time ٱ
Part-time ٱ
Name & Title of Supervisor
Reason for Leaving:
Your Job Title & Duties
Company Name
Phone Number
Address
Employed FROM TO
City, State, Zip
May we Contact
Yes ٱ No ٱ
Full-time ٱ
Part-time ٱ
Name & Title of Supervisor
Reason for Leaving:
Your Job Title & Duties
5
EXPERIENCE AND EMPLOYMENT
Company Name
Phone Number
Address
Employed FROM TO
City, State, Zip
May we Contact
Yes ٱ No ٱ
Full-time ٱ
Part-time ٱ
Name & Title of Supervisor
Reason for Leaving:
Your Job Title & Duties
Company Name
Phone Number
Address
Employed FROM TO
City, State, Zip
May we Contact
Yes ٱ No ٱ
Full-time ٱ
Part-time ٱ
Name & Title of Supervisor
Reason for Leaving:
Your Job Title & Duties
Company Name
Phone Number
Address
Employed FROM TO
City, State, Zip
May we Contact
Yes ٱ No ٱ
Full-time ٱ
Part-time ٱ
Name & Title of Supervisor
Reason for Leaving:
Your Job Title & Duties
Company Name
Phone Number
Address
Employed FROM TO
City, State, Zip
May we Contact
Yes ٱ No ٱ
Full-time ٱ
Part-time ٱ
Name & Title of Supervisor
Reason for Leaving:
Your Job Title & Duties
If you have had no prior employment, please explain:
Have you ever been terminated or fired from a job, asked to resign, or resigned after being informed that you were to be fired, or resigned for similar reasons:
Yes ٱ No ٱ If “Yes”, explain:
Have you had any extended work absences for reasons other than earned vacation?
Yes ٱ No ٱ If “Yes”, explain:
Have you ever been a successful or unsuccessful candidate for another position requiring fire fighter certification?
Yes ٱ No ٱ If “Yes”, explain:
6
LEGAL
Have you ever been arrested, convicted of or plead guilty to any crime, or received a deferred judgment to any crime? (Include military service and significant traffic
arrests.) Yes ٱ No ٱ
If “Yes”, please give details. Include when, where, approximate date, police agency and circumstances. The fact that your record may have been affected by an
expungement, restriction, sealing or pardon has specific legal implications as to how you should answer this question.
Have you ever been placed on court probation as an adult? Yes ٱ No ٱ
If “Yes”, please give details (include when, where, why).
Were you ever required to appear before a juvenile court for an act which would have been a crime if committed by an adult? Yes ٱ No ٱ
If “Yes”, please give details (include when, where, why).
Have you ever been asked to leave a position as a firefighter, whether employed, or as a volunteer/cadet/explorer? Yes ٱ No ٱ
If “Yes”, please give details (include date, law enforcement agency, circumstances).
Are you now or have you ever been involved as a plaintiff or defendant in any civil court action, including a temporary or permanent restraining order?
Yes ٱ No ٱ
If “Yes”, please give details (include when, where, name and location of court, circumstances).
Are you currently making any court ordered payments? Yes ٱ No ٱ
If “Yes”, please explain.
7
ALCOHOL AND DRUG USE
Do you drink alcoholic beverages? Yes ٱ No ٱ
If “Yes”, please state how many and how often:
Understanding that you will be tested for illegal drug use prior to admittance, have you ever illegally tried, experimented with, or used marijuana or any other controlled
substance without prescription, including steroids? Yes ٱ No ٱ
If “Yes”, complete the following:
NAME AND TYPE OF DRUG
MONTH/YEAR FIRST
TRIED OR USED
MONTH/YEAR LAST
TRIED OF USED
TOTAL TIME(S)
TRIED OR USED
Have you ever illegally sold or given to others, marijuana or any other controlled substance? Yes ٱ No ٱ
If “Yes” explain what kind, how much, how often and when?
OTHER: Information you believe has not been covered within this form and is relevant to the Community College of Aurora regarding this application:
BEFORE SIGNING: PLEASE CHECK APPLICATION FOR ERRORS OR EMISSIONS AND READ THE FOLLOWING
CAREFULLY.
I understand that the submission of any false information or the omission of any material information in connection with my application
for acceptance, whether on this document or otherwise, will constitute grounds for disqualification of my application or will be cause for
immediate discharge at any time thereafter should I be accepted to the CCA Fire Fighter Training Academy.
I HAVE ALSO READ THROUGH THE ACCOMPANYING ACADEMY APPLICATION MATERIALS IN SECTION A AND SECTION B AND HAVE
SUBMITTED THE REQUIRED DOCUMENTATION ALSO MENTIONED IN SECTION C.
_____________________________________________________________________________ _______________________________________
SIGNATURE OF APPLICANT DATE
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CCA Fire Fighter Academy Application (Community College of Aurora)

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Completed 3 February 2021

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