Kewanee Fire Department-Entry Level Fire Fighter Application

KEWANEE FIRE DEPARTMENT FIRE FIGHTER APPLICATION

401 East Third Street Kewanee, Illinois 61443 PHONE(309) 852-2115 EMAIL swelgat@cityofkewanee.net
Basic Qualifications

*Candidates for entry level fire fighter must be at least 21 years of age and under 36 years of age upon hire date *Must be a United States Citizen *Must have a high school diploma or equivalent *Must possess a valid Illinois driver's license (must get by hire date if currently licensed in another state) *No felony convictions or certain misdemeanors Deadline: Completed applications are due by 5:00 pm on Friday, March 17th, 2023. Those candidates whose applications are accepted shall furnish a copy of his/her Military Service Record, EMS Certifications, CPAT Certification, Fire Certifications, Discharge Papers, Social Security Card, Birth Certificate, High School Diploma or G.E.D. Certificate, a copy of his College or University Degree and, if requested, a copy of a certified transcript of his course work from an accredited College or University. These additional forms must be turned in before the testing date. The testing date is Saturday, March 25th, 2023 for the physical test, written test, and oral interviews. Attendance and a passing score are mandatory for all phases of testing.
Personal Information
Full Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number*
Are you a United States Citizen?*

YesNo
Have you ever been enrolled in an education institution or employed under any other name, such as a prior legal name or maiden name? If yes, please give the name(s) you used.*

YesNo
Prior legal name or maiden name
Job Information
How did you hear about the fire fighter application for the Kewanee Fire Department? (tv, radio, newspaper, friend or relative, college, social media, recruit website)*
Available Start Date*

MonthDayYear
Date
Do You Have an EMS Certification?*

YesNo
If You Have an EMS Certification, What Level?
Do You Have a Fire Certification?*

YesNo
If You Have a Fire Certification, What Level?
Employment History

(List most recent employer first)
Employer 1 (Type N/A if none)*

Name/Address/Phone Number of Employer

Job Title

Start DateEnd Date

Reason for leaving
Employer 2 (Type N/A if none)*

Name/Address/Phone Number of Employer

Job Title

Start DateEnd Date

Reason for leaving
Employer 3 (Type N/A if none)

Name/Address/Phone Number of Employer

Job Title

Start DateEnd Date

Reason for leaving
Military Information
Have you ever served in the United States armed forces? If yes, complete the following:*

YesNo
Military History (Type N/A if none)*

Branch of Service

Job Title

Enlistment DateDischarge Date

Type of Discharge
Criminal and Financial Information

(If you answer yes to any of the following five questions, explain in detail in the box provided)
With the exception of actions that have been annulled, expunged, or sealed by a court, have you ever been convicted, found guilty, or pleaded guilty to a crime in criminal, civil, or military court?*

YesNo
Have you ever been fined, placed on probation, or forfeited collateral for breach or violation of any law, ordinance, police, or traffic regulation, including moving and equipment violations?*

YesNo
Do you now have any charges pending against you?*

YesNo
Have you ever declared bankruptcy or are you now in any type of bankruptcy proceedings?*

YesNo
Have you ever had your wages garnished or are there proceedings now underway that may result in your wages being garnished?*

YesNo
Include date, court & location, nature of offense or violation, disposition of case, and Penalty or fines imposed. (Type N/A if none)*
Education Information
High School*

Name of High School

Address of High School

Start DateGraduation or End Date

List Degree or Diploma if Graduated
College 1 (Type N/A if none)*

Name of College

Address of College

Start DateGraduation or End Date

List Degree or Diploma if Graduated
College 2 (Type N/A if none)*

Name of College

Address of College

Start DateGraduation or End Date

List Degree or Diploma if Graduated
College 3 (Type N/A if none)*

Name of College

Address of College

Start DateGraduation or End Date

List Degree or Diploma if Graduated
Personal References

(List below three personal references that are not former employers or relatives)
Reference 1*

Name of Reference

Address of Reference

Phone NumberOccupation
Reference 2*

Name of Reference

Address of Reference

Phone NumberOccupation
Reference 3*

Name of Reference

Address of Reference

Phone NumberOccupation
UNDERSTANDING AND AUTHORIZATION FOR RELEASE: I understand that this application is not intended to be a contract of employment nor does this application obligate the employer in any way if the employer decides to employ me. No one other than the City Manager, or his authorized agent, has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in a writing signed by the City Manager, or his authorized agent. I authorize the City of Kewanee to make such investigations and inquiries as to my character, personal history, financial and credit record, employment record, and conviction record as may be necessary in arriving at an employment decision. I hereby release employers, schools, law enforcement agencies, and persons from all liability for any damages whatsoever that may ensue from furnishing the same to the City of Kewanee.*

Agree
CERTIFICATE OF APPLICANT: I certify that all answers and statements contained in this application are true to the best of my knowledge and belief. I understand that misstatements or omissions of material fact will subject me to disqualification or dismissal. I approve the above authorization for release.*

Agree
Should be Empty: