Fillable CoH Firefighter Application PDF (City of Hardeeville)

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CoH Firefighter Application PDF (City of Hardeeville)

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  • 23 check-boxes
  • 246 other fields

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File type: PDF

U.S.A. forms for City of Hardeeville

BROWSE CITY OF HARDEEVILLE (SC) FORMS

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City of Hardeeville Application (Rev. 04/2013)
Please print or type.
City of Hardeeville, South Carolina
An Equal Opportunity Employer
Application for Employment
Employees of the City of Hardeeville and applicants for employment shall be afforded
equal opportunity in all aspects of employment without regard to race, color, religion,
political affiliation, national origin, disability, marital status, gender or age.
As a means of accommodation to persons with specific disabilities that prevent
them from completing this application, confidential assistance in filling out this
application may be obtained by contacting the Human Resources Division within
the Office of the City Manager.
THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE CITY OF
HARDEEVILLE, THIS DOCUMENT DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS. THE CITY RESERVES THE RIGHT TO
REVISE THE CONTENT OF THIS DOCUMENT, IN WHOLE OR IN PART. NO PROMISES OR ASSURANCES, WHETHER WRITTEN OR ORAL, WHICH
ARE CONTRARY TO OR INCONSISTENT WITH THE TERMS OF THIS PARAGRAPH CREATE ANY CONTRACT OF EMPLOYMENT.
**REASONABLE ACCOMODATIONS MAY BE AVAILABLE TO DISABLED APPLICANTS AND EMPLOYEES UNDER THE ADA/ADAA, IF GIVEN NOTICE BY THE APPLICANT
OR EMPLOYEE.**
I. POSITION APPLYING FOR:
Position applied for
Department or Office
II. CONTACT INFORMATION:
Full legal name
Maiden Name
Last
First
Middle
Mailing Address
Email Address
Address
City
State
Zip
Home Phone
( )
Alternate Phone
( )
Notification Preference
Mail
Email
III. OTHER PERSONAL INFORMATION
Do you possess a valid driver’s license? Yes No If Yes, provide State and Number:
Expiration Date:
Class (Check One) A B C D E F M G CDL
Are you willing to relocate?
Yes No
Can you, after employment, submit proof of your legal right to work in the United States?
Yes No
What type of job are you looking for?
Full Time Part Time Temporary Internship
What types of work will you accept?
Full Time Part Time
What shifts are you available for work?
Day Evening Night Rotating
Are you at least 18 years of age? Yes No Are you at least 21 years of age? Yes No (Public Safety Dept. Applicants Only)
IV. EDUCATION
Are you a high school graduate?
Yes No
Highest Grade Completed
Year Completed
If you did not complete high school, do you have a high school equivalency diploma?
Yes
No
Date Received
Check number of years of post high school education
1 2 3 4 5 6 7
Starting with High School, provide complete information on all
schools attended. Include any special courses or training school
Hrs
Degree
Received
Major or Specialty
Minor
Dates Attended
1.
2.
3.
■
■
■
■
If you expect to complete an educational program in the near future, please indicate what type of degree or program and expected and completion
date:
V. EXPERIENCE
Starting with the most recent, describe ALL paid, military and applicable voluntary experience. Highlight your knowledge, skills and abilities which best demonstrate your
qualifications for this position. A resume may not be substituted for this section. However, a resume may be attached upon full completion of the application.
You may list significantly different jobs within the same organization as separate items. May we contact your present supervisor? Yes No
1. Job Title
Duties:
Employer
Address
Phone
Type of business
Immediate supervisor
Title
Number and titles of employees you supervised
Salary (start)
(finish)
Equipment used
Dates (mo/yr)
to (mo/yr)
Reason for leaving
Full-time
Part-time
Hours/week
Your name if different from present
2. Job Title
Duties:
Employer
Address
Phone
Type of business
Immediate supervisor
Title
Number and titles of employees you supervised
Salary (start)
(finish)
Equipment used
Dates (mo/yr)
to (mo/yr)
Reason for leaving
Full-time
Part-time
Hours/week
Your name if different from present
3. Job Title
Duties:
Employer
Address
Phone
Type of business
Immediate supervisor
Title
Number and titles of employees you supervised
Salary (start)
(finish)
Equipment used
Dates (mo/yr)
to (mo/yr)
Reason for leaving
Full-time
Part-time
Hours/week
Your name if different from present
4. Job Title
Duties:
Employer
Address
Phone
Type of business
Immediate supervisor
Title
Number and titles of employees you supervised
Salary (start)
(finish)
Equipment used
Dates (mo/yr)
to (mo/yr)
Reason for leaving
Full-time
Part-time
Hours/week
Your name if different from present
■
VI. ADDITIONAL INFORMATION
Use this space for any additional information you think would help us evaluate your application, including training, seminars, workshops,
and special achievements or specialized skills:
Licenses, certificates, or other authorization to practice a trade or profession.
Type
License Number
Granted by (licensing board)
VII. REFERENCES
List names, addresses and relationships of three persons not related to you who know your qualifications:
Name
Address
Phone
Relationship
VIII. ADDITIONAL INFORMATION
Have you ever been convicted for any violation(s) of law, including moving traffic violations. Yes No. If YES, please provide the following:
Charges
Location
Date
Disposition / Status
Do you have any relatives employed with the City of Hardeeville? Yes No. If YES, please provide the name and relationship of the relative:
Have you ever been discharged or forced to resign from any job? Yes No. If YES, please explain below:
IX. CONSENT TO CONDUCT CERTAIN BACKGROUND CHECKS
By providing the information below and by my signature, I consent to allow authorized officers, agents, and employees of the City of Hardeeville, South Carolina to conduct
certain background checks to include, but not limited to, law enforcement , a criminal records check, a credit check, a driving records check and other background investigations
as applicable. I release the organization, educational entity, present and former employers, law enforcement organizations, and all third parties from any and all claims of
whatever nature that I may have as a result of any inquiry or response given to such inquiries made in connection with may application for employment. I understand that
providing my identification information below is optional, but may be required prior to being offered employment with the City of Hardeeville, South Carolina. Failure to
submit your date of birth and social security number on this form will not prohibit employment consideration.
Date of Birth:
Social Security Number:
Date
Applicant Signature
X. CERTIFICATIONS – All applications must be signed to be considered
AUTHORITY TO RELEASE INFORMATION—By my signature, I consent to the release of information that may be lawful obtained to authorized officers, agents, and
employees of the City of Hardeeville, South Carolina which may include but not be limited to information concerning my past and present work; including my official personnel
files; attendance records; evaluations; educational records including transcripts; military service records; law enforcement records; and any personnel record deemed necessary. In
addition, I consent to authorize appropriate officers, agents, and employees of the City of Hardeeville, South Carolina to make inquiries of third parties. I further release the
organization, educational entity, present and former employers, law enforcement organizations, all third parties from any and all claims of whatever nature that I may have as a
result of any inquiry or response given to such inquiries made in connection with may application for employment.
Date
Applicant Signature
CERTIFICATION OF APPLICANT—By my signature, I affirm, agree, and understand that all statements on this form are true and accurate. Any misrepresentations,
falsification, or material omission of information or data on this application may result in exclusion from further consideration or, if hired, termination of employment. If I have
requested herein that my present employer not be contacted, an offer of employment may be conditioned upon acceptable information and verification from such employer prior
to beginning work.
Date
Applicant Signature
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City of Hardeeville Application (Rev. 04/2013)
Please print or type.
City of Hardeeville, South Carolina
An Equal Opportunity Employer
Application for Employment
Employees of the City of Hardeeville and applicants for employment
shall be afforded equal opportunity in all aspects of employment
without regard to race, color, religion, political affiliation, national
origin, disability, marital status, gender or age.
As a means of accommodation to persons with specific disabilities
that prevent them from completing this application, confidential
assistance in filling out this application may be obtained by
contacting the Human Resources Division within the Office of the
City Manager.
THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE
APPLICANT AND THE CITY OF HARDEEVILLE, THIS DOCUMENT DOES NOT CREATE ANY CONTRACTUAL
RIGHTS OR ENTITLEMENTS. THE CITY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS DOCUMENT,
IN WHOLE OR IN PART. NO PROMISES OR ASSURANCES, WHETHER WRITTEN OR ORAL, WHICH ARE
CONTRARY TO OR INCONSISTENT WITH THE TERMS OF THIS PARAGRAPH CREATE ANY CONTRACT OF
EMPLOYMENT.
**REASONABLE ACCOMODATIONS MAY BE AVAILABLE TO DISABLED APPLICANTS AND EMPLOYEES UNDER THE ADA/ADAA, IF GIVEN NOTICE BY THE APPLICANT
OR EMPLOYEE.**
INSTRUCTIONS TO APPLICANTS
TO BE CONSIDERED FOR CITY EMPLOYMENT, YOU MUST ANSWER ALL QUESTIONS AND COMPLETE ALL SECTIONS OF THIS APPLICATION
FORM NOT OTHERWISE LISTED AS OPTIONAL.
WHEN COMPLE
TING THIS APPLICATION, PLEASE MAKE SURE YOU
• APPLY FOR ONE VACANCY PER APPLICATION. RESUMES MAY BE SUBMITTED WITH, BUT NOT IN LIEU OF APPLICATION.
• GIVE COMPLETE I
NFORMATION ON YOUR EDUCATION AND WORK HISTORY (“SEE RESUME” IS NOT ACCEPTABLE). INCOMPLETE
APPLICATIONS WILL NOT BE ACCEPTED.
• SEPARATELY LIST EACH JOB HELD AND YOUR DUTIES FOR EACH POSITION WHEN YOU WORKED FOR ONE EMPLOYER AND HELD
MORE THAN ONE POSITION.
• AS YOU DESCRIBE YOUR WORK H
ISTORY, MAKE SURE YOU HIGHLIGHT YOUR COMPETENCIES (KNOWLEDGE, SKILLS, ABILITIES AND
WORK BEHAVIORS) WHICH DEMONSTRATE YOUR QUALIFICATIONS FOR THE POSITION FOR WHICH YOU ARE APPLYING.
• CHECK FOR ACCURACY
, SIGN AND DATE YOUR APPLICATION.
THANK YOU FOR YOUR I
NTEREST IN CITY GOVERNMENT. THE CITY OF HARDEEVILLE WANTS TO FIND THE BEST QUALIFIED PEOPLE AVAILABLE
TO SERVE ITS CITIZENS. ALTHOUGH EVERYONE WHO APPLIES CANNOT BE HIRED, YOUR APPLICATION WILL BE GIVEN EVERY CONSIDERATION.
IF YOU WILL NEED REASONABLE ACCOMMODATIONS TO PARTICIPATE IN THE SELECTION PROCEDURES (E.G., INTERVIEW, WRITTEN TESTS, OR
JOB DEMONSTRATION), THEN PLEASE CONTACT THE DIVISION HUMAN RESOURCES IN THE OFFICE OF THE CITY MANAGER.
Mailing
Address: Division of Human Resources Physical Address for Division Human Resources
Office of the City Manager Non-Postal Delivery: Office of the City Manager
PO Box 609 205 East Main Street
Hardeeville, SC 29927 Hardeeville, SC 29927
Phone: 843-784-2231 Fax: 843-784-6384 www.cityofhardeeville.com
South Carolina Firefighter Registration Act
Request for Criminal Record Review
Name: (Full Given Name)
Address:
City State Zip
Employee ID #
Date of Birth ____/___/______
Driver's License: State
Number
Race:
Sex: Male Female
*********************************************************************************
I, do hereby grant approval for the
(Print Name)
to inquire and receive any and all
(Name of Fire Department or Employer)
criminal information pertaining to me.
(Applicant Signature) (Date)
(Authorized Signature) (Date)
Mail Request To:
S.L.E.D. Records
PO Box 21398
Columbia, SC 299221-1398
Phone: (803)737-9000
Fax: (803)896-7022
S.L.E.D. Should Return Information
To:
Reports should be returned to the *Note to Fire Departments: Please
Fire Department - Not to the include a self-addressed envelope
Fire Marshal's Office. for return of report from SLED.
FR2 12/12/12
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South Carolina Firefighter Registration Form
South Carolina State Fire Marshal's Office
141 Monticello Trail
Columbia, SC 29203
A. Name:
First Middle
- Date of Birth ____/___/______
Month Day Year
State:
Class D/L:
Zip C
ode:
FDID# :
Last
Home Address:
Social Security # -
Driver's
License Number:
Name of Employing Fire Department :
Fire Department Mailing Address:
City:
Telephone Number: - -
Status: Paid
Volunteer
Background Check Completed Employed Prior to July 1, 2001
Date: Employment Date:
(Necessary if Employed on or After July 1, 2001)
By Signature I certify that the above named individual is eligible for registration under the provisions
of Title 40, Chapter 80, South Carolina Code of Laws.
Fire Chief (Print Name) Date
Fire Chief (Signature) Date
B. ACTION TAKEN
Please Check (For All Actions Taken On or After July 1, 2002)
Employment Date (See Section 40-80-10.B.2) Effective Date:
Termination Effective Date:
Voluntary Separation Effective Date:
Retirement Effective Date:
Inactive Effective Date:
Member of Multiple Departments - List:
Other (Explain)
C. Do Not Write Below This Line
(For SCFM Use Only)
The named individual is
Registered as a firefighter in the State of South Carolina
Registration Number: Date:
Denied registration based on:
FR1 7/1/01 Authorized Signature
■
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CoH Firefighter Application PDF (City of Hardeeville)

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Completed 23 January 2021

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