West Columbia Fire Department
610 N. 12
TH
Street
West Columbia, South Carolina 29169
Phone (803)791-4440 Fax (803)359-2622
EMPLOYMENT APPLICATION COVER SHEET
Name: ______________________________________________________________
Home Address: ____________________________________________________________________
Telephone Number: (______) ________________ Email Address: ____________________________
(NOTE: Application status updates will be sent to the email address listed above.)
Required Documents: Please check each box to indicate the required document is included with your application.
Do not include copies of any other certificates you may have, however please do include in detail other certifications you may possess in
the application package or on a resume.
Completed West Columbia Fire Department Application Package
Valid Driver’s License
10 Year Driving Record from the State of Issued Driver’s License
High School Diploma or GED Certificate or College Diploma
DD214 (Only Applicable to U.S. Military Veterans)
Firefighter Certificate (If Applicable)
Current First Aid or EMR, CPR and AED Qualification Cards or EMT Certificates (If Applicable)
** Failure to include copies of the above listed required items or not fully completing the employment
application may result in your application not being processed for consideration. **
City of West Columbia
Bridging Past, Present and Future
Application for Employment
Last Name First Name Middle Name
Address (Number/Street) City State Zip Code
Social Security Number Telephone Number(s)
(Home) (Other)
Date of Application Position Applied For
THE CITY OF WEST COLUMBIA IS AN EQUAL OPPORTUNITY EMPLOYER AND A DRUG FREE WORKPLACE
State and federal laws require all applicants to be considered for all positions without
regard to race, color, religion, creed, gender, national origin, age, disability, marital or
veteran status, or any other legally protected status.
Are you currently employed?
May we contact your present
employer?
Yes No Yes No
Have you ever applied for a
position with us before? If Yes,
give date__________
Have you ever been employed
with us before? If Yes, give
date__________
Are you available to work
Full-time?
Are you currently on lay-off
status and subject to be recalled?
Can you travel if a job requires it?
Are any of your relatives or
friends employed with us?
If you are under 18 years of age,
can you provide required proof
of your eligibility to work?
Are you prevented from lawfully
becoming employed in this
country because of Visa or
Immigration Status?
Date Available for Work Desired Salary Range
Best time to contact you at home
__________ AM _________ PM
How did you learn about us?
PLEASE PRINT
In completing this application, you may exclude any organization or membership which would
reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.
In the space furnished below give a record of every position held. START WITH YOUR PRESENT POSITION AND WORK BACK.
Account for all periods of employment. Summarize the work performed and job responsibilities.
Employer
Address
Telephone Number
Job Title
Reason for Leaving
Work performed and job responsibilities:
Dates of Employment
From To
$
Per
Supervisor
Employment History
Employer
Address
Telephone Number
Job Title
Reason for Leaving
Work performed and job responsibilities:
Dates of Employment
From
To
Salary / Hourly Rate
$
Per
Supervisor
Employer
Address
Telephone Number
Job Title
Reason for Leaving
Work performed and job responsibilities:
Dates of Employment
From
To
Salary / Hourly Rate
$
Per
Supervisor
Employer
Address
Telephone Number
Job Title
Reason for Leaving
Work performed and job responsibilities:
Dates of Employment
From
To
Salary / Hourly Rate
$
Per
Supervisor
If you need additional space, please continue on a separate sheet of paper.
Describe any job-related training received in past employment.
Additional Information
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Education
Terminal
PC/MAC
Typewriter (WPM _____ )
Spreadsheet
Word Processing
Shorthand (WPM _____ )
Specialized Skills
Name and Address of School Course of Study
Years
Completed
Diploma / Degree
Elementary School
High School
Undergraduate College
Graduate Professional
List professional, trade, business or civic activities and offices held.
Other Qualifications - Summarize special job-related skills and qualifications acquired from employment or other experience.
Other (list)
Include any additional information you feel may be helpful to us in considering your application.
I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment, and hereby release the City from any
claims, causes of action or liability arising out of any investigation conducted by the City. This application is considered to be
made for the position listed, and is not considered active after 45 days. Applicants seeking positions beyond this time period must
fill out an updated application.
I understand that the City may require criminal history checks, background checks covered by the Fair Credit Reporting Act,
and/or pre-employment drug testing. I acknowledge that such tests/investigations may be made and that employment is
contingent upon the results of such checks and tests.
I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT ALL EMPLOYEES OF THE CITY ARE
EMPLOYEES-AT-WILL WHO MAY QUIT AT ANY TIME FOR ANY REASON AND WHO MAY BE TERMINATED
AT ANY TIME FOR ANY OR NO REASON. NO ONE OTHER THAN THE CITY MAY MAKE ANY PROMISES OR
ASSURANCES OR ENTER INTO ANY CONTRACT, WHETHER ORAL OR WRITTEN, EXPRESS OR IMPLIED,
THAT IN ANY WAY IS CONTRARY TO OR INCONSISTENT WITH THE LIMITATIONS SET FORTH IN THIS
PARAGRAPH, AND ANY SUCH PROMISES, ASSURANCES, OR PURPORTED CONTRACTS SHALL BE INVALID
AND NOT BINDING ON THE CITY UNLESS ADOPTED, ENDORSED, OR AGREED TO IN WRITING BY THE
CITY ADMINISTRATOR AND APPROVED BY THE MAYOR.
In the event of employment, I understand that incomplete, false or misleading information given in my application or interview(s)
may result is discharge.
References
Name
Address
City, State, Zip Code
Telephone Number
Read Carefully and Sign
Signature of Applicant Date
Applicant's Statement
Note to Applicants: DO NOT ANSWER THESE QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE
REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the
job or occupation for which you have applied? _____ YES _____ NO
A review of the activities involved in such a job or occupation has been given. _____ YES _____ NO
Name
Address
City, State, Zip Code
Telephone Number
Name
Address
City, State, Zip Code
Telephone Number
Have you ever been convicted of a crime other than minor traffic offenses? _____ YES _____ NO
For purposes of this question, "convicted" includes a finding of guilty by a judge or court, pleas of nolo contendere or "no
contest", and guilty pleas. List details of every conviction, including date convicted, court, offense charged, and sentence imposed.
Date Convicted Court Offense Charged Sentence Imposed
City of West Columbia Employment Application
Applicant Demographic Data
Federal regulations require the City of West Columbia to collect data regarding an
applicant’s race, sex and national origin for purposes of complying with federal non-discrimination
laws. We are asking you to voluntarily disclose this data to help the city comply with this
obligation. Completion of this portion of the application is voluntary. This data will not be
considered by the City in evaluating your application, nor will your refusal to fill out this
portion of the application be held against you. This portion of the application will be removed
from the application prior to your being considered for employment.
Please indicate your gender: ________ Male ________ Female
Please indicate your ethnicity (race or national origin):
________ White ________ Hispanic or Latino ________ Black or African-American
________ American Indian or Alaskan Native ________ Asian
________ Native Hawaiian or Other Pacific Islander ________ Two or More Races
________ I do not wish to volunteer any demographic data information.