Employment Application
Erie Valley Fire and Rescue
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Are you at least 18 years old?
Yes
No
Date of Birth
-
Month
-
Day
Year
Date
Do you live within 6 miles of Erie Valley Fire and Rescue?
Yes
No
Are you currently certified as a firefighter in the state of Ohio?
Please Select
No
Yes - 36
Yes - 120
Yes - 240
Are you currently certified as an EMT in the state of Ohio?
Please Select
No
Yes - EMT-B
Yes - EMT-A
Yes - Paramedic
Are you able to get certified within the next 18 months?
Yes
No
Not Applicable
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Past Employment
Rows
Company Name
Position Held
Company Phone Number
Hire Date
End
Date
Employer 1
Employer 2
References
Rows
Name
Phone Number
Company
Relationship
Reference 1
Reference 2
Reference 3
Submit
Should be Empty: