Candidate Information Packet

Candidate Background Information Packet
PLEASE READ:

** This packet along with the required documents listed on the following pages MUST be submitted before the day of your interview.

All questions must be answered. If not applicable, indicate with "N/A" (not applicable). Only complete packets will be considered. If space provided is not sufficient for complete answers or you wish to furnish additional information, please upload additional sheets and refer to the specific question(s) being answered.

Any willful omission or misrepresentation of facts on this questionnaire may be grounds for rejection of your application or for dismissal from City employment.

Candidate Qualifications
General Requirements:
- Must be at least 18 years of age.
- Must be a high school graduate or equivalent.
- Must be a U.S. citizen or legally eligible to be employed.
- Must agree to sign a No Tobacco Use agreement, which prevents an individual from using any tobacco products at any time, on or off the job, while employed by the City.
I have read and understand the General Requirements.
Driving Requirements:
- Must have a point balance of minus eight (-8) or better (or equivalent, if a non-Virginia resident) on their Department of Motor Vehicles (DMV) record in order to apply.
- Must Not have been convicted of driving under the influence of alcohol or drugs, convicted of a felony or assigned to any alcohol safety action program or driver alcohol rehabilitation program. hit and run, reckless driving or operating on a suspended or revoked license with the past three (3) years.
- Must Not have been convicted of more than one (1) drunk driving or driving under the influence in their lifetime.
- Must Not have been convicted of driving while license is suspended / revoked during the previous three (3) years.
- Must Not be considered uninsurable (i.e., if the Virginia Division of Motor Vehicles driving record report indicates that the applicant is an uninsured motorist.
I have read and understand the Driving Requirements.
Drug Usage Requirement:
- Must Not be a current illegal drug user OR have ever illegally possessed in the past three (3) years any drug or controlled substance which would constitute a felony, to include illegal use of prescription medication.
- Must Not have been convicted or found guilty of any crime involving the use, possession, or distribution of illegal drugs except that the person is eligible for affiliation (5) five years after the date of final release if no additional crimes of this type have been committed during that time which is located on the Virginia Code website (Office of Emergency Medical Services).
I have read and understand the Drug Usage Disqualifiers.
Conviction:
- Must Not possess any conviction under the Office of Emergency Medical Services disqualifiers located on the Virginia Code website (Office of Emergency Medical Services).
I have read and understand the Conviction Disqualifiers.

Required Documents To Be Submitted With Packet
All of the below documents MUST be uploaded with this packet
1. High School Diploma or GED (or college/university diploma or transcript)
2. Current transcript of driving history record from the Division of Motor Vehicles
3. Copies of any Current EMS-related certifications or Current fire-related certificates (if applicable)
4. DD-214 (if applicable)

Personal Information
Name*

First NameLast Name
Middle Name*
Other Names Used (maiden name, nicknames, aliases, former names changed legally or otherwise)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com

Driving Information
Required: Current Driving Transcript of your driving history record from the Division of Motor Vehicles in the state that currently holds your operator's license(s (The Virginia transcript should cost $8 DMV record needs to be no older than 30 days from the last day of the application period. When submitting the DMV record, the record must note "end of transmission." If a request is made on-line, the record may not identify "end of transmission."
Please upload driving record.*

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Operator's License Number:*
State*
Expiration Date*

MonthDayYear

Military Service
YesNo
Please attach a copy of your DD-214 Service Record.

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Branch of service
Service #
Date of entry

MonthDayYear
Date
Date of discharge

MonthDayYear
Date
Rank upon entry
Rank upon discharge
Military awards and citations received
YesNo
Please give details to include dates, command location, nature of charge, and disposition.

EDUCATION/EXPERIENCE
Please upload a copy of your High School Diploma or GED. (A college/university diploma or official transcript indicating a degree was conferred may be substituted for high school/GED diploma)*

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YesNo
List ANY EMS or Fire certificates you hold.
Please upload current EMS-related certifications you possess, including but not limited to EMT-Intermediate, EMT-Paramedic, EMT, ACLS, BTLS, CPR, etc. Copies of Current fire-related certificates for any schools, courses, and academies attended and completed.

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YesNo
Please provide information below about your experience:

From/To
Agency
Location (City/State)
Reason for leaving:
From/To
Agency
Location (City/State)
Reason for leaving:
From/To
Agency
Location (City/State)
Reason for leaving:

Employment
YesNo
Please list employment experience to include: military service, any volunteer work which has provided experience and that would help you qualify and any periods of unemployment. ALL FIELDS MUST BE COMPLETED.

Date Start:
Date End:
Full Time or Part Time:
Position Title:
Employer:
Starting Salary:
Ending Salary:
City:       State:
Phone Number:
Supervisor Name:      Supervisor Title:
Duties:
Reason for leaving:
May we contact for reference:
Date Start:
Date End:
Full Time or Part Time:
Position Title:
Employer:
Starting Salary:
Ending Salary:
City:       State:
Phone Number:
Supervisor Name:      Supervisor Title:
Duties:
Reason for leaving:
May we contact for reference:
Date Start:
Date End:
Full Time or Part Time:
Position Title:
Employer:
Starting Salary:
Ending Salary:
City:       State:
Phone Number:
Supervisor Name:      Supervisor Title:
Duties:
Reason for leaving:
May we contact for reference:
YesNo
Please list employment experience to include: military service, any volunteer work which has provided experience and that would help you qualify and any periods of unemployment. ALL FIELDS MUST BE COMPLETED.

Date Start:
Date End:
Full Time or Part Time:
Position Title:
Employer:
Starting Salary:
Ending Salary:
City:       State:
Phone Number:
Supervisor Name:      Supervisor Title:
Duties:
Reason for leaving:
May we contact for reference:
Date Start:
Date End:
Full Time or Part Time:
Position Title:
Employer:
Starting Salary:
Ending Salary:
City:       State:
Phone Number:
Supervisor Name:      Supervisor Title:
Duties:
Reason for leaving:
May we contact for reference:
Date Start:
Date End:
Full Time or Part Time:
Position Title:
Employer:
Starting Salary:
Ending Salary:
City:       State:
Phone Number:
Supervisor Name:      Supervisor Title:
Duties:
Reason for leaving:
May we contact for reference:

References
If you are selected to proceed to the polygraph examination, your job references will be contacted via email. Below. please provide the email addresses for three work references. The information you provide below must match the employers you have listed on your application and/or resume. The listed individuals should have supervised you or may be the HR representative for the organization. Co-workers ARE NOT considered to be a reference. If the current supervisor's information is not provided, you will be asked to supply your most current performance evaluation.

The Department reserves the right to contact your current employer if the Department provides you with a conditional job offer.
Current Employer:   Type a label
Supervisor Name:   Type a label*
Supervisor's Email Address:
Employer #2:   *
Supervisor Name:   Type a label*
Supervisor's Email Address:   *
Employer #3:   *
Supervisor Name:   Type a label*
Supervisor's Email Address:   *

Additional Information
Please upload any additional relevant information

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Acknowledgement
I understand that the position for which I have applied is for both a Firefighter and Medic and that the expectation is that I operate in both capacities.
Before signing this form, be sure that all of the information you have disclosed to the Newport News Fire Department represents the entire truth as it relates to the questions asked. Any misrepresentation given by you will be immediate grounds for disqualification from the recruitment process or termination from employment if you are offered a position.
I certify that the information given is true and accurate to the best of my knowledge.
Signature of Applicant*
Date

MonthDayYear
Date
Should be Empty:

Candidate Background Information Packet

Candidate Qualifications

Required Documents To Be Submitted With Packet

Personal Information

Driving Information

Military Service

Legal History

EDUCATION/EXPERIENCE

Employment

References

Additional Information

Acknowledgement