Job Application - Trustee/Commissioner

Bensenville Fire Protection District

FIRE COMMISSIONER APPLICATION
Available Start Date:

MonthDayYear
Date
Full Name*

First NameMiddle NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone:*

Area CodePhone Number
Cell Phone:*

Area CodePhone Number
Email Address*
Birth Date*

MonthDayYear
YesNo
How did you learn about this job?

Conviction History
YesNo
List all traffic convictions and accidents you have had in the last (4) years:
Approximate Date:

MonthDayYear
Date
Violation
Disposition:
Employment History
Upload Resume Here

Browse Files

Cancelof
Present Employer:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Job Description
Dates of Employment (Month & Year)
YesNo

References
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation:
Relationship
Phone Number

Area CodePhone Number
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation:
Relationship
Phone Number

Area CodePhone Number
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation:
Relationship
Phone Number

Area CodePhone Number
Emergency Contacts
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Acknowledgement
I HEREBY CERTIFY THAT I HAVE READ THE ABOVE QUESTIONS AND STATEMENTS, AND I CERTIFY THAT THERE ARE NO MISREPRESENTATIONS, OMISSIONS, OR FALSIFICATIONS IN THIS APPLICATION, AND THAT ALL ANSWERS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT ANY MISREPRESENTATIONS, OMISSIONS, OR FALSIFICATIONS ON THIS APPLICATION OR AT ANY TIME DURING THE HIRING PROCESS MAY RESULT IN MY APPLICATION NO LONGER BEING CONSIDERED OR IN TERMINATION OF MY EMPLOYMENT WITH THE BENSENVILLE FIRE PROTECTION DISTRICT.
DATED:

MonthDayYear
Date
Signature
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. This organization is committed to the policy of equal employment opportunity in recruitment, hiring, career advancement, and all other personnel practices. Your job related experience and other qualifications will be considered without discrimination on the grounds of race, color, religion, sex, national origin, age, or physical or mental handicap. All information provided in this application will be treated confidentially and will be used to help assure the best use of your abilities if you are employed with us.
FOR OFFICE USE ONLY
INTERVIEW DATE

MonthDayYear
Date
HIRE DATE

MonthDayYear
Date

Should be Empty:

Conviction History

Employment History

References

Emergency Contacts

Acknowledgement