Application for Employment

New Carlisle Fire Department

Application for Employment
Applicants for all positions are considered without regard to race, color, religion, sex, national origin, age, marital status, sexual orientation, the presence of a medical condition or disability, or any other legally protected status. Persons from all sections of the community are encouraged to apply.
Position Applying For:
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
PSID Number (If applicable)
DRIVERS LICENSE NO
DRIVERS LICENSE CLASS
DRIVERS LICENSE STATE
YESNO
YESNO
YESNO
YESNO
- 123456789101112
- Name of School
- Location of School
- YesNoGED
- College, Business, or Trade School Attended
- Location
- Degree
- Major Subject
- Semester Units
- College, Business, or Trade School Attended
- Location
- Degree
- Major Subject
- Semester Units
- Professional or Vocational Certificates or Licenses Please attach a copy to the application if required for the position you are applying for:
- Other Special Training or Skills Language office equipment machine operations etc. Please attach any certifications.
- Please attach Professional or Vocational Certificates, Specialized Training or Skills Certificates here that are pertinent to your application.
  
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- MILITARY INFORMATION:
- Yes
- Branch of Service
- Date Entered
  
  MonthDayYear
  Date
- Date Released
  
  MonthDayYear
  Date
- Rank
- Type of Discharge
- Branch of Service
- Date Entered
  
  MonthDayYear
  Date
- Date Released
  
  MonthDayYear
  Date
- Rank
- Type of Discharge
- List your present or most recent job first. A thoroughly completed application may improve your chances for employment. If you need more space, you may attach additional sheets. Show specific examples of your experience which directly relate to the job requirements. NOTE: A résumé may be attached but will not be substituted for completing this section.
- Employer Name
- Employer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Employer Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Employed From
  
  MonthDayYear
  Date
- Employed to: (Leave blank if still presently Working here)
  
  MonthDayYear
  Date
- Position / Title
- Supervisor Name
- Describe duties / Responsibilities
- Reason for leaving
- Salary per Month
- Full TimePart Time
- Employer Name
- Employer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Employer Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Employed From
  
  MonthDayYear
  Date
- Employed to: (Leave blank if still presently Working here)
  
  MonthDayYear
  Date
- Position / Title
- Supervisor Name
- Describe duties / Responsibilities
- Reason for leaving
- Salary per Month
- Full TimePart Time
- Employer Name
- Employer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Employer Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Employed From
  
  MonthDayYear
  Date
- Employed to: (Leave blank if still presently Working here)
  
  MonthDayYear
  Date
- Position / Title
- Supervisor Name
- Describe duties / Responsibilities
- Reason for leaving
- Salary per Month
- Full TimePart Time
- ADDITIONAL INFORMATION Use additional sheets if necessary Summarize any additional information you wish concerning your qualifications or interest which relates to the job for which you are applying
- AUTHORIZATION FOR BACKGROUND CHECKS
  
  After carefully reading this Background Check Disclosure and Authorization form, I authorize the Company to order my background report, including investigative consumer reports. I understand that the Company may rely on this authorization to order additional background reports, including investigative consumer reports, during my employment without asking me for my authorization again as allowed by law. I also authorize the following agencies and entities to disclose to the Background Check Company and its agents all information about or concerning me, including but not limited to: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; if applicable, worker's compensation injuries; all other private and public sector repositories of information; and any other person, organization, or agency with any information about or concerning me. Workers' compensation information will only be requested in compliance with federal Americans with Disabilities Act and/or any other applicable federal, state or local lawsand only after a conditional job offer is made. The information that can be disclosed to the Background Check Company and its agents includes, but is not limited to, information concerning my employment history, earnings history, education, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses and substance abuse testing.
  
  I agree the Company may rely on this authorization to order background reports, including investigative consumer reports, from companies other than the Background Check Company without asking me for my authorization again as allowed by law.
  
  I also agree that a copy of this form is valid like the signed original. I certify that all of the personal information | provided is true and correct.
- Name
  
  First NameMiddle NameLast Name
- Maiden/Other Names
- Years Maiden/Other Name Used
- Applicant Employee Signature
  
  Clear
- Date
  
  MonthDayYear
  Date
- DISCLOSURE AUTHORIZATION AND RELEASE
  
  "I hereby authorize any former employer, its employees, and representatives, or any person listed as a reference to provide any and all information they deem appropriate regarding my employment and job performance to the Olive Township-New Carlisle Fire Protection Territory and any of its employees, representatives, and agents. This information may be provided either verbally or in writing. In addition to authorizing the release of any information regarding my employment, I hereby fully waive any rights or claims I have or may have against any former employer, its employees, and representatives, former educational institution, or any person listed as a reference from any and all liability, claims, or damages that may directly or indirectly result from the use, disclosure, or release of such information by any person or party, whether such information is favorable or unfavorable to me.
- ApplicantEmployee Signature
  
  Clear
- Date
  
  MonthDayYear
  Date
- Print or type individuals name
- CERTIFICATE OF APPLICANT
  
  I hereby certify that all statements made in this application are true and complete to the best of my knowledge and belief, and that any false statement or misstatement of material fact may subject me to disqualification, rejection, and removal from eligibility list or dismissal. I understand the manner in which this application is completed may determine my eligibility for employment and continued employment.
- SIGNATURE
  
  Clear
- All job offers are contingent on applicants passing a job-related physical examination, including drug testing, and a comprehensive background check.
- Please upload Résumé if applicable.
  
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- Should be Empty:

New Carlisle Fire Department

MILITARY INFORMATION: