Truckee Fire Protection District Employment Application

Truckee Fire Protection District
An Equal Opportunity Employer
Administration Office
10049 Donner Pass Rd.
Truckee, CA 96161
(530) 582-7850
Employment Application Form
Personal Information:
Full Name*

First NameMiddle NameLast Name
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Birth Date

MonthDayYear
Can you prove that you have a valid driver's license and proof of insurability?*

YesNo
After employment offer, can you submit verification of your legal right to work in the United States?

YesNo
Employment Desired:
Position Applying For
Position Applying For:*
Date You Can Start

MonthDayYear
Have You Worked Here Before?

YesNo
Have You Applied Here Before?

YesNo
Do you need reasonable accommodations to perform the essential functions of the position for which you are applying?

YesNo
If you answered yes to either of the 3 questions above, please explain
Are you related to any current TFPD employee?

YesNo
If yes, whom and their relation
How did you hear about this opening?*

Sierra Tahoe JobsSierra Sun NewspaperIndeedSocial MediaWord of mouthTruckee Jobs CollectiveOther
Education:
High School*
Name of High School Attended
Graduated?*

YesNo
Year
If not, do you posses a GED or High School Equivalency?

YesNo
College/Trade/Technical School
Name of College/Trade/Technical School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
College/Trade/Technical School
Name of College/Trade/Technical School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
College/Trade/Technical School
Name of College/Trade/Technical School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Supplemental Information:
Languages
List any languages other than English, indicate if you can: speak, read, or write
Licenses and Certificates. ** Firefighter Candidates: do not list required licenses and certifications as they are requried to be listed below **
List all valid applicable licenses and/or certificates (include type, state, number, and expiration date).
Training
List any position specific relevant specialized training.
Firefighter Applicants only:

EMS and Fire Certifications
Paramedic Certification - check all that apply

State of CaliforniaNational RegistrySierra-Sacramento Valley LEMSA Accreditation
Paramedic License #
Exp Date
S-SV EMS Accreditation #
Exp Date
PALS or Equivalent

YesNo
Exp Date
ACLS

YesNo
Exp Date
EMT Basic Certification (Part-Time Applicants only)- check all that apply

State of CaliforniaNational RegistryEnrolled in Paramedic Program*
EMT Basic #
Exp Date
S-SV EMS Accreditation #
Exp Date
*If Enrolled, Name of Paramedic Program and Start Date
Valid CPR Certification

YesNo
Exp Date
Firefighter I Certification:

State of CaliforniaIFSAC / ProBoardCalifornia Firefighter I Academy *
* If Academy List School and date completed
Part-Time Applicant Only: Do you posses a State of California Ambulance Driver Certificate

YesNo
Enter Course completion date of the following required certifications
Valid CPAT Card

YesNo
Exp Date
Copies of required Licenses and Certifications will be required at the Assessment Center.
Please briefly describe your work experience as it relates to the position you are applying for and what makes you the best candidate, or upload a cover letter and resume (see next item)
All Applicants please submit a resume.*

Upload a File

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Please submit your resume. *

Browse Files

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A Cover Letter is optional, but highly recommended.

Browse Files

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Employment History:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Supervisor
Phone Number

Area CodePhone Number
Reason for Leaving?
Start Date

MonthDayYear
May We Contact?

YesNo
Previous Employer
Name of Previous Employer
Position
Supervisor
Phone Number

Area CodePhone Number
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Previous Employer
Name of Previous Employer
Position
Supervisor
Phone Number

Area CodePhone Number
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
References:
Reference 1*
Name of Reference
Relationship
Years Acquainted
Phone Number

Area CodePhone Number
Email
Reference 2*
Name of Reference
Relationship
Years Acquainted
Phone Number

Area CodePhone Number
Email
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone Number

Area CodePhone Number
Email
Licenses & Certificates

Upload a File

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Pre-Employment Physical Examination:
All job applicants for permanent, temporary, paid-call and volunteer employment who are seriously being considered for hire shall be required to submit to a physician’s examination and drug screening at the Districts expense.

No employment commitment shall be made until a negative drug screen result is obtained and a qualified physician has certified the applicant is qualified to do the type of work required by the position being applied for.

Applicants who refuse to cooperate in the examination and testing shall not be considered further for employment.

Applicants who have a positive drug test result shall be denied employment.

When the applicant reports to the medical facility for the scheduled examination and drug testing, identification shall be provided to the said facility in the form of a photograph and a verifiable signature.

All test results shall be kept confidential. The applicant may be told he/she failed to pass the test. Only the Fire Chief shall have access to the actual test results.

Immediately prior to reporting for drug testing, all job applicants shall complete a Consent and Release Form kept in file in the Districts Office.
Authorization:
I hereby authorize the Truckee Fire Protection District to thoroughly investigate my references, work record, driving record, education, and other matters related to my suitability for employment and, further, authorize my former employers to disclose to the District any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I release the Truckee Fire Protection District, my former employers, and all other persons, from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application or conveyed during any interview, which may be granted, is intended to create an employment contract between the Truckee Fire Protection District and me. I understand that only the Fire Chief may fill the available positions with the District, and that no promise, expressed or implied by anyone other than the Fire Chief is valid.

By clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time.
Signature*

Clear
Should be Empty:

Employment Application Form

Personal Information:

Employment Desired:

Education:

Supplemental Information:

Firefighter Applicants only:

Copies of required Licenses and Certifications will be required at the Assessment Center.

Employment History:

References:

Pre-Employment Physical Examination:

Authorization: