Coopersville/Polkton Fire Department Firefighter Application

Coopersville/Polkton Fire Department Firefighter Application
The Coopersville/Polkton Area Fire Department is taking applications for future openings for the position of Firefighter/Medical First Responder (Paid-On-Call). You must have a high school degree or equivalent; be a U.S. citizen or are able to work in the United States; have a valid driver's license with no more than 6 points; have no felony or disqualifying criminal convictions, and be at least 18 years old. Must live in the City of Coopersville or Polkton Township.
Personal Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Date of Birth*

MonthDayYear
Date
Have you been previously employed here?*

YesNo
If yes, please list dates and supervisor names:
List any friends or relatives working here:

Basic Requirements
Are you legally entitled to work in the United States?*
Are you 18 years of age or older?*
Do you possess a valid Driver’s License and a good driving record?*
Driver's License Number*
Have you ever been charged with a misdemeanor or felony?*

YesNo
If so, where, when and nature of the offense:
Do you believe you are free of medical conditions that may preclude your participation as a volunteer firefighter?*

Education

Employment Experience (list current or most recent jobs first)

Please indicate if you have any of the following skills or training*

CPR - Cardiopulmonary resuscitationCertified Trade - mechanic, electricianFire Safety Systems - alarms, extinguishersRescue procedure - lifeguard, auto extricationFirst AidKnowledge of breathing apparatus - scuba diving, etcPAD/Defibrillation TrainingOccupational Health & SafetyOther
Previous Firefighter or Emergency Medical Experience – Explain:
References
Please provide at three professional references (do not include family members or employers)

Terms and Conditions

By signing below, agree to the terms laid out in the Authorization and Agreement and Authorization of Use of Consumer Reports for Employment Purposes.
Authorization and Agreement
Authorization of Use of Consumer Reports for Employment Purposes
Summary of Your Rights Under the Fai Credit Reporting Act
By signing below, agree to the terms laid out in the Authorization and Agreement and Authorization of Use of Consumer Reports for Employment Purposes.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Personal Information