Member Application

Ballardsville Fire & Rescue Application

Please complete the form below to apply for a position with us.
Personal Information:
Full Name*

First NameMiddle NameLast Name
Preferred Name
Birth Date*

MonthDayYear
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email Address*
example@example.com
Phone Number*
Are you a U.S. Citizen?*

YesNo
Have you ever been convicted of a Felony?*

NoYes
KY Firefighter Number
Driver's License
Driver's License State*

Street Address

Street Address Line 2

CityState

Zip Code
Driver's License #*
Exp. Date*

MonthDayYear
Date
Employment Desired:
Position Applied*
How did you hear about us
Have you worked here before?*

YesNo
Have you applied here before?*

YesNo
Available Start Date

MonthDayYear
Date
Education:
High School*
Name of High School Attended
Graduated?*

YesNoCurrently Enrolled
College
Name of college/university attended
Graduated?

YesNoCurrently Enrolled
Area of Study/Degree?
Skills/Qualifications:
Skills*
List any relevant Skills
Qualifications*
List any relevant certifications or qualifications
Current Employment:
Current Employer*
Name of current employer or NONE if not employed
Position
Reason for Leaving?
Previous Employment:
Previous Employer
Name of previous employer
Position
Reason for Leaving?
Previous Employer
Name of previous employer
Position
Reason for Leaving?
Previous Employer
Name of previous employer
Position
Reason for Leaving?
References:
Reference 1*
Name of reference
Relationship*
Years Acquainted*
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Reference 2*
Name of reference
Relationship*
Years Acquainted*
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Reference 3*
Name of reference
Relationship*
Years Acquainted*
Phone Number*
Please enter a valid phone number.
Email
example@example.com
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Certificates

Any relevant certificates
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Send Application:
By signing and clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the department's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the department.
Signature*

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Ballardsville Fire & Rescue Application

Personal Information:

Driver's License

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Send Application: