CCFR 20.5 (2/17)
Job Title: Starting Salary: Ending Salary:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference? YES NO
Rank at Discharge: From: To:
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result
in my release.
1. Complete application.
2. Acquire the needed Georgia Criminal Background Check pay the $50.00 fee and present receipt with
3. Sign and have witness sign the Physical Agility Waiver.
4. Upon being contacted arrive on time for assessment on date given
a. Written Assessment
b. Physical Agility Assessment
c. Interview Assessment
5. Assessment Results will be presented to the Fire Board of Charlton County for confirmation.
6. You will be advised in writing as to the results and next part of the process.