Fillable Test Application Intro Letter 2020 Fillable Pdf

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Applicant:
Thank you for applying for the position of full time and part time firefighter with the Corry
Fire Department. The City of Corry is a third class city and uses civil service procedures
to conduct our hiring process. This has an appointed board of 3 citizens who oversee all
testing and promotion exams within our department. The civil service board has all final
options in the hiring process to ensure a fair and equal hiring process.
The Civil Service Board of the City of Corry is currently accepting applications for the
position of full time and part-time firefighter. All applications must be received by the
Board on or before 1630 hours on June 1st, 2020 to be eligible for testing.
Applicants will be required to pay a nonrefundable $25.00 test administration and
processing fee at the time the application is submitted.
Due to the current situation of Covid-19 the Civil Service Board is unable to establish a
test date as of now. The Board does want to take advantage of the time applicants may
have during this situation to complete the application process and be ready to host a
test as soon as possible. They will review the Covid -19 situation and when the health
department states they can host a test the board will make all preparations as needed
to keep applicants and proctors in a safe environment during the testing process.
If you apply you will be notified as soon as possible of the test date, time and location.
A practice physical agility test will be planed into the testing process all
applicants are encouraged to do this, (remember this part of test is physical agility
not strength) this is optional for applicants to attend but highly recommended. You will
not get to run the agility test prior on test day.
Requirements to apply:
Applicants must be United States citizens, a minimum of 18 years of age at the time
application is submitted, applicants must be in excellent mental and physical condition,
be a high school graduate or equivalent (G.E.D.), applicants must be a State Certified
Interior Firefighter, have completed a State Certified Structural Burn Session, approved
Emergency Vehicle Operators Certification, certified in Hazardous Materials to the
Operations level, National Incident Management System 700 or Incident Command,
Valid State Driver’s License, prior to applying. Must have valid State of PA EMS
certification (1
st
Responder minimum) prior to hiring.
The City of Corry is an Equal Opportunity employer and does not discriminate against
persons interested in making application for employment.
If you have questions, please feel free to contact Fire Chief Jim Lathrop
Station # 814-663-2401 Ext #1
Cell # 814-462-6377
Email – jlathrop@corrypa.gov
Page 1 | 12
City of Corry Fire Department
Employment Application
Applications Returned
All applications must be received or postmarked by 4:30 pm on June 1
st
2020 with the required information and fee of
($25.00), made payable to the City of Corry, in check or money order. Completed applications need to be mailed or
dropped off at: City of Corry Administration building located at 100 S. Center St. Corry PA 16407 or be postmarked by
16:30 June 1
st
2020, Applications should be directed to: City of Corry
Attn: Civil Service Board
100 S. Center St. Corry, PA 16407.
Written Examination
All applicants will receive notification via email or in written letter form indicating if you were accepted to sit for the test
and the test date and time. Please bring with you photo identification on test day. The written test nor the physical
agility test have been given a date at this time due to the current situation (Covid -19). After applications are received
and the Civil Service Board gets the OK to host the test all applicants will be notified of the date and time. (Make sure
your address, email and phone number are correct). The Civil Service Board will make one attempt at contacting you via
email, phone and lastly mail. It is responsibility of the candidate to insure we can contact them.
Notice
Applicants must be a U.S. Citizen, 18 years of age, possess a current and valid driver’s license, High School diploma or
GED. Applicants must also be a state certified interior firefighter, possess a Hazmat Operations certification, a
recognized Emergency Vehicle Operator’s certification, NIMS 700 and at time of hiring a valid State EMS Certification.
Application for Employment
Please complete the following application. Failure to completely answer all questions herein may result in
disqualification. Please mark all questions that do not pertain to you with N/A. Answers should written legible (please
print legible, if board is unable to read it that is candidates fault). If you need additional space for any question, please
attach sheets.
1. ___________________________________________________ 2. ____________________
Last Name First Middle Date of Birth
3. _______________________________ 4. __________________________________
Phone Number email address
5. _________________________________________________________________________
Present Residential Address: Street, City, State, Zip code
6. Yes No 7. _____________________ 8. _________________________
U. S. Citizen Social Security # Driver’s License: State / number
9. ___________________________________________________________Y or N______
Military Service: if yes what branch, years served, date of discharge. (Copy of DD214 included)
Page 2 | 12
10. Residences: List all residences for the past 7 years beginning with the most recent
Month & Year Address with whom did you live?
1. __________________________________________________________________________________
2. __________________________________________________________________________________
3. __________________________________________________________________________________
4. __________________________________________________________________________________
5. __________________________________________________________________________________
6. __________________________________________________________________________________
7. __________________________________________________________________________________
11. Employment History; begin with your most recent job and list your employment history for the
past ten (10) years including part-time, temporary, seasonal employment and all periods of
unemployment.
Date Name and Address Job Title Reason for leaving
From
________________________________________________________________________
To Description of Duties
______________________________________________________________
Salary Supervisors Name Contact Number
______________________________________________________________
Date Name and Address Job Title Reason for leaving
From
________________________________________________________________________
To Description of Duties
______________________________________________________________
Salary Supervisors Name Contact Number
______________________________________________________________
Date Name and Address Job Title Reason for leaving
From
________________________________________________________________________
To Description of Duties
______________________________________________________________
Salary Supervisors Name Contact Number
______________________________________________________________
Date Name and Address Job Title Reason for leaving
From
________________________________________________________________________
To Description of Duties
______________________________________________________________
Salary Supervisors Name Contact Number
______________________________________________________________
If additional employer blocks are need, please attach sheets.
Page 3 | 12
12. Education:
A. list all schools you attended: High School, Jr or Middle School and Elementary School
School name, address and phone # years attended Graduated
1. ______________________________________________________________________
2.______________________________________________________________________
3. ______________________________________________________________________
4. ______________________________________________________________________
B. Higher Education: List any adult education you have attended (Verification will be required)
School name, address and phone # years attended Graduated
1. ______________________________________________________________________
2.______________________________________________________________________
3. ______________________________________________________________________
4. ______________________________________________________________________
C. Fire service education: List any certifications you have obtained other than the 6 required to apply
(Verification will be required at the interview stage, copies can be made on test day or at practice physical fitness test)
Course Name date Course Name date
1. _______________________________ 2. ________________________________
3._______________________________ 4. ________________________________
5. _______________________________ 6. ________________________________
7. _______________________________ 8. ________________________________
9. _______________________________ 10. _______________________________
11. ______________________________ 12. _______________________________
13.______________________________ 14. _______________________________
15. ______________________________ 16. _______________________________
17. ______________________________ 18. _______________________________
19. ______________________________ 20.________________________________
(If you run out of space please list on separate sheet and attach to end of packet Label as Section C)
D. Are you currently active in a fire department
If yes please list department name, a Leader to contact & phone number.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(If you run out of space please list on separate sheet and attach to end of packet Label as Section D)
E. Do you or have you held leadership positions in an organization? (Please list below)
(This can be fire department, social/civic organizations, government bodies and/or religious organizations)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(If you run out of space please list on separate sheet and attach to end of packet Label as Section E)
Yes
No
Page 4 | 12
F. Special Education: List any type of education or skills that may be of value to dept.
List any course, computer skills/training, learned trades that could be beneficial to department
1. ______________________________ 2. ________________________________
3._______________________________ 4. ________________________________
5. _______________________________ 6. ________________________________
7. _______________________________ 8. ________________________________
9. _______________________________ 10. _______________________________
(If you run out of space please list on separate sheet and attach to end of packet Label as Section F)
13. Character References – List 5 people who can give an honest opinion of you. Do not list former
employers.
Name Contact Number Relationship Years Known
1. _________________________________________________________________
2. _________________________________________________________________
3. _________________________________________________________________
4. _________________________________________________________________
5. _________________________________________________________________
14. Criminal Background-
1. List any vehicle violations / citations below Reason & Date
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
2. HAS YOUR DRIVERS LICENSE EVER BEEN SUSPENDED OR REVOKED? Yes __ No __
If yes list date, reason, state and jurisdiction.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
****A conviction will not necessary disqualify applicants from employment with the City. ****
****The City will make a determination as to applicant’s suitability for the position. ****
3. Have you EVER been convicted of a crime? Yes ___ No ___
If yes list convictions below, date, offense, state and jurisdiction
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Page 5 | 12
Applicant’s Statement
I certify that the answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be
necessary in arriving at an employment decision. I hereby authorize all current and former employers,
educational institutions and references to release information relevant to my application for
employment and I release the City, all current and former employers, educational institutions and
references from any and all liability related to the release of such information.
This application for employment shall be considered active through the completion of the next
examination process following submittal of the application.
I hereby understand and acknowledge that, unless otherwise defined by applicable law or collective
bargaining agreement, any employment relationship with this organization is of an “at will” nature.
Which means that the Employee may resign at any time and the Employer may discharge the
Employee at any time with or without cause.
In the event of employment, I understand that false or misleading information given in my application
or interview(s) may result in discharge. I understand, also that I am required to abide by all rules and
regulations of the employer.
________________________________________ _______________
Signature of Applicant Date
Notification Procedure Release
During the hiring process, it may become necessary to contact the applicant for further consideration.
We put great trust in the applicant to give current and correct contact information. If conventional
methods (Phone, email & mail) fail in establishing contact with the applicant, the testing process
cannot be delayed. By signing below, you are stating you understand the process and will not hold the
City of Corry, the Civil Service Board or the Fire Department liable for failed contact. It is the
responsibility of the applicant to notify the City of Corry, in writing, of any change in address, email or
phone number.
By signing below you are indicating you are fully aware of the contact procedures.
________________________________________ _______________
Signature of Applicant Date
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Page 6 | 12
Packet Review
When returning the packet, ensure all areas are filled in or marked as non-applicable.
When returning please include the following:
1. Application packet Pages #1 to 6
2. Make sure you have signed the application in both spots on page #5
3. Signed and included the Physical Agility Test Waiver page #7
Include Copies of required certifications listed below and test fee.
___ 1. State Certified interior firefighter or Essentials of firefighting or equivalent
___ 2. Certified Structure burn Class
___ 3. State approved Emergency Vehicle Operations Certification
___ 4. State approved Hazmat Operation certification
___ 5. NIMS 700 or Incident command
___ 6. Valid State Driver’s License
___ 7. High School Diploma or equivalent
___ 8. Valid State of PA EMS Certification (minimum of EMR) required time of hiring
___ 9. $25.00 application fee – checks or money orders made out to the City of Corry.
**Eligible candidates can bring non-required training certificates and education documentation on
test day or the practice physical fitness test day, to have copies made.
***Please keep the Job description (Pages 8+9) and Physical Agility Test description (Pages 10 – 12)
portion when returning application.
Page 7 | 12
CORRY FIRE DEPARTMENT
14 E. South St Corry PA 16407
PHYSICAL AGILITY TEST
WAIVER OF CLAIM FOR INJURY
This form must be signed before you will be permitted to access the Corry Fire Department Physical
Agility Test testing station or any Practice Session. This form covers all practice events and actual
test administration.
You will be asked to perform eight (8) physical tasks and will be given specific instructions (in writing
and by proctors) in the manner in which these physical tasks are to be performed. The eight (8)
physical tasks are:
1. HYDRANT DRESSING
2. HOSE LINE ADVANCEMENT
3. GROUND LADDER RAISE
4. EQUIPMENT CARRY
5. HIGH RISE PACK CARRY
6. HOSE RAISE
7. EXHAUST FAN HANG
8. VICTIM DRAG
I have read and understand the physical effort which this Corry Fire Department Physical Agility Test
involves. I am physically capable of participating in this test. I hereby waive any and all claims for or
arising out of any injury I might sustain or incur as a result of participating in the Physical Agility Test
and agree to indemnify and hold the City of Corry and the Corry Fire Department harmless for any
and all costs, or fees, including attorney's fees. I voluntarily participate as part of my application for
employment.
________________________________________________________________________
Last Name (please print) First Name MI
________________________________________________________________________
Applicant Signature Date
________________________________________________________________________
Corry Fire Department Officer Signature Date
(CFD Officer will sign on test day)
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Page 8 | 12
DEPARTMENT PART TIME FIRE FIGHTER (PTFF) JOB DESCRIPTION
I. Purpose of the Position
1. To provide a component of on duty manpower on an as needed basis to facilitate the delivery and support of
Department services and functions as assigned by the Chief. Duties shall include, but not be limited to, fire
suppression activities, delivery of pre-hospital care to the sick and injured, Hazmat services, fire prevention
activities, Department training, pre-planning, code enforcement, maintenance and administration.
II. Qualifications
In accordance with the stated intent, PTFF personnel shall possess and maintain such qualifications as determined
by the Chief and are needed to fill the purpose of the position. As a minimum, the following certifications or
equivalent listed below must be held at probationary appointment and must be maintained during employment.
1. State certified interior Firefighter / Essentials of Firefighting or Equivalent
2. Certified Structure burn class
3. State approved Emergency Vehicle Operations certification.
4. State approved Hazmat Operations certification.
5. Valid State of PA EMS Certification (minimum of EMR) At time of Hiring.
6. Possess the knowledge/skill to perform duties and functions described in NFPA Fire Fighter1001, 1992
edition, as designated by the Chief.
7. NIMS 700 certification
8. At time of application, be at least 18 years of age, possess a valid driver's license and have a high school
diploma or equivalent. Driver's license must be maintained at all times.
III. Equipment Operated
1. All emergency response apparatus and associated equipment including personal protective gear.
2. All apparatus and equipment which provide direct or indirect support to Department emergency or non-emergency
response operations.
3. All equipment needed for the maintenance and care of Department property used by the Department.
IV. Essential Functions
1. Extinguishment of the fires, working as a member of a team using appropriate gear, tools and extinguishing
agents. This function will include, but not be limited to:
a. The donning/doffing of full turnout gear including SCBA.
b. The use of SCBA under emergency conditions with reduced visibility and limited area.
c. Advancement of charged and uncharged hand lines into structures, and up ladders to upper floors.
d. Operation of 1-3/4 inch hand line flowing 125 GPM for one minute unaided, and operation of a 2-1/2
inch line flowing 250 GPM for one minute with the assistance of one other fire fighter.
e. Ability to climb the full length of each type of ladder in the Department in full gear and perform fire
suppression and rescue functions.
f. Deployment of a 24 foot extension ladder from a pumper to a second floor window unaided in the standard
manner.
2. Provide Department related medical services according to Department of Health policy. This function will
include, but not be limited to, the following functions:
Page 9 | 12
a. Frequent lifting and moving of patients.
b. Provision of patient care.
3.Operation of Department vehicles safely through routine maneuvers such as backing into the station, pulling next
to a barrier, serpentine maneuvers and confined space turnaround.
4. Operation of Department pumps to produce effective hand line or master streams utilizing internal tank, static
and pressurized water sources so that the pump is effectively engaged and all pressure and safety devices
are properly set and monitored.
5. Maneuvering the aerial truck so it is properly positioned for use in an emergency. Ability to safely deploy and
operate the aerial ladder and associated master stream devices in a safe and effective manner.
6. Operation of Department vehicles safely through traffic in emergency/non-emergency response.
7. Conduct building inspections. Give public education classes.
8. Response to Hazmat incidents.
V. Other Responsibilities
1. Complete reports and other clerical work as directed.
2. Perform basic station and vehicle maintenance as directed.
3. Coordinate and schedule Department functions as directed.
4. Participate in Department training as directed.
5. Conduct radio communications.
6. Provide instruction on a Department wide basis as qualified.
7. Other assigned duties to fulfill the purpose of the position.
8. Ability to learn and follow department policies and procedures
VI. Physical Requirements
The job of a PTFF is physically demanding. Most essential functions require muscular strength and endurance, aerobic
capacity, flexibility, equilibrium and anaerobic power. PTFF's shall maintain sufficient physical ability to perform
essential functions. As a result of a recognized deficiency in essential functions, return after disability or sickness a
PTFF may be required to demonstrate continued ability to perform essential functions. A PTFF who demonstrates a
continued inability to perform essential job functions, or is unable to perform essential functions for a documented
medical reason, will be considered ineligible to continue as a PTFF.
VII. Probationary Period
PTFF's shall undergo a 18 month probationary period during which they shall be evaluated in all areas of job
performance, uniform appearance, care of issued PPE, ability to follow orders, and ability to provide leadership.
At a minimum, probationary PTFF must successfully complete the Department required training and orientation
program, prior to being eligible to fill shift vacancies. Probationary PTFF may be terminated at any time for
failure to obtain required qualifications or, if after evaluation, work or conduct is found to be unsatisfactory to
the Chief.
Page 10 | 12
City Of Corry
Physical Agility Test
All applicants participating in the following City of Corry Firefighter Agility Test shall wear a helmet,
properly secured using the chinstrap, a bunker coat with all closures fastened, leather firefighting
gloves, and a properly donned SCBA less the face piece. The Corry Fire Department will provide the
SCBA to be used during the agility test. The applicant is expected to provide the helmet, coat, and
gloves. If the applicant cannot provide his or her own helmet, coat, and gloves, the Corry Fire
Department can provide those items. Unfortunately, the Corry Fire Department cannot guarantee
that any PPE provided will fit properly and may cause a negative impact on the overall performance
during the Physical Agility Test. The applicant must also wear a lace up boot that covers the ankle to
participate in the Physical Agility Test. Work boots or station/duty boots would suffice.
EVENT #1: Hydrant Dressing
The applicant will dress a hydrant with the supplied items as would be expected of him/her if hired
by the Corry Fire Department.
Supplied Material:
• One (1) 25 foot (approx.) section of 4 inch supply hose with stortz couplings
• One (1) 4 ½ inch NST female to 4 inch stortz adapter
• One (1) 2 ½ inch ball valve
• One (1) hydrant wrench
The applicant will connect the supply hose to the 4 ½” outlet of the hydrant utilizing the supplied
adapter and the ball valve to the 2 ½” outlet. For this test only, the connections made will be
snugged, hand tight. The applicant will then place the hydrant wrench on top of the hydrant as if you
were preparing to open the hydrant. DO NOT OPEN THE HYDRANT! The clock shall start when the
applicant touches the hydrant, hose or any item in the bucket. The applicant can then proceed to the
next event.
EVENT #2: Hose Line Advancement
The applicant will advance a charged hose line 100 feet. The hose line will consist of 150 feet of 1
¾ inch hose charged to 100psi with the nozzle lying on the starting line. The applicant will grab and
hold at or near the nozzle while advancing the hose line past the designated finish line. Upon
passing the finish line, the applicant will gently lay the nozzle is down on the ground. Note: When
the nozzle is put on the ground, the nozzle must be completely across the finish line. If the nozzle is
not completely across the finish line, it will be an automatic failure. The applicant can then proceed to
the next event.
Page 11 | 12
EVENT #3: Ground Ladder Raise
The applicant will find a 24 foot 2 fly extension ladder which will be lying flat on the ground and
perpendicular to the wall of a structure. The applicant will proceed to properly raise the ladder to the
building and position it to where it would be considered safe for a firefighter to ascend. There will be a
line painted on the ground indicating where to place the butt of the ladder to achieve that safe angle.
DO NOT CLIMB THE LADDER! If the applicant drops the ladder during this event, it will be an
automatic failure. (Refer to the Essentials of Firefighting 6
th
Edition Manual). The applicant can then
proceed to the next event.
EVENT #4: Saw Carry
The applicant will find two (2) saws resting on a platform approximately 46” high. The applicant
will remove the saws safely, one at a time, and place them on the floor. Then, using proper lifting
techniques, lift both saws and carry them along the designated pathway. Upon reaching the end of
the pathway, carefully set both saws down on the floor, again using proper lifting/lowering techniques.
The applicant will then place the saws back on the platform one at a time safely. The applicant can
then proceed to the next event.
EVENT #5: High Rise Pack Carry
The applicant will lift and shoulder carry a high-rise pack similar to what is carried by the City of
Corry Fire Department. The applicant will carry the high-rise pack through the designated area of the
station and then proceed upstairs. The applicant MUST use every step. Do not skip any steps.
Doing so will be considered an automatic failure. Once the applicant reaches the top of the stairs,
he/she will set the high-rise pack down at the base of the cone to the left of the stairs and proceed to
the next event.
EVENT #6: Hose Raise
The applicant will stop in front of the designated window and allow a safety line to be attached to
the hook on the waist strap of their SCBA. The proctor will verbalize to the applicant that they can
proceed as soon as the safety line is attached. The applicant shall then lean out the window and
grasp the rope which is attached to a 50-foot section of rolled 1 ¾ inch hose. The applicant shall
hoist the rolled hose up to and in the window. The applicant will then set the hose down onto the
floor. At no point in time shall the applicant allow the rope to drag across the window sill as this will
cause damage to the rope and will be considered an automatic failure. If the applicant drops the hose
during this event, it will be considered an automatic failure. The applicant shall allow the safety line to
be detached and then may proceed downstairs to the next event. You must use every step. Do not
skip any steps. Doing so will be considered an automatic failure.
Page 12 | 12
EVENT #7: Exhaust Fan Hang
There will be a pre-hung bar in a doorway approximately 72 inches high. The applicant must lift
the fan, using proper lifting techniques, and hang it from the bar by both hooks. Once the fan is hung
securely, the applicant will remove both hands from the fan and place them at his or her sides. Upon
receiving the proctors “OK,” the applicant may then remove the fan from the bar and gently set it on
the floor, again, using proper lifting/lowering techniques. If the applicant drops the fan during the
event, it will be considered an automatic failure. The applicant can then proceed to the next event.
EVENT #8: Victim Drag
The applicant must drag an approximate 135 pound dummy a distance of 50 feet. The applicant
will use the incline drag, commonly referred to as the one-man drag, grasping the dummy from the
back and place the applicant’s arms under the dummy’s and locking hands, (Refer to the Essentials
of Firefighting 6
th
Edition Manual). All parts of the dummy and the applicant must be completely
across the finish line to complete this event. At this point, the proctor will stop the clock.
TIME PARAMETERS
The maximum time allowed to complete this agility test is seven (7) minutes. Any applicant who
exceeds seven (7) minutes will be considered as obtaining a failing time. Each applicant must
complete every event and each event must be completed as previously described. The proctor will
document how the applicant completes the event, including both positive and negative aspects. This
documentation will be used during the final selection process.
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