BCESD #2 Firefighter Application

Firefighter Employment Application

Equal Opportunity Employer: Bastrop County Emergency Services District No. 2 does not discriminate based on race, color, national origin, sex, religion, age, disability, or military service in employment or the provision of services.
Personal Information
Date*

MonthDayYear
Date
Applicant Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Contact Number*
Please enter a valid phone number.
Contact Email*
example@example.com
Driver's License Number*
Driver's License State*
Drivers License Type/Class*

Class AClass BClass C
Driver's License Expiration*

MonthDayYear
Date

Medical / Physical
Can you perform all of the functions and duties for the position you are applying for?*

Yes, I have no known limitations.I have known limitations. (please identify in the next field)
Limiting Conditions:
Name of Doctor (Primary Care Physician)*
Physician Phone Number*
Please enter a valid phone number.
Physician Address*

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact (Name & Relationship)*
Emergency Contact Phone Number*
Please enter a valid phone number.

Employment History

Please list your previous employers covering the last ten years.
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState

Zip Code
Direct Supervisor*
Summary of duties and responsibilities.*
Date Started*

MonthDayYear
Date
Date Ended*

MonthDayYear
Date
Reason for leaving.
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState

Zip Code
Direct Supervisor*
Summary of duties and responsibilities.*
Date Started*

MonthDayYear
Date
Date Ended*

MonthDayYear
Date
Reason for leaving.
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState

Zip Code
Direct Supervisor*
Summary of duties and responsibilities.*
Date Started*

MonthDayYear
Date
Date Ended*

MonthDayYear
Date
Reason for leaving.

Work Experience
List relevant or related experience and/or qualifications that apply to the position you are applying for. *

Criminal History

NOTE: Disclosing previous arrests and history does not automatically disqualify an applicant. Failure to disclose all previous arrests WILL disqualify the application.
Have you ever been convicted of crime involving life or property?*

Yes (please explain in the next field)No
Please explain any convictions in detail. (If none, type NONE)*

Driving History
Has your license ever been suspended or revoked?*

YesNo
List any citations or accidents within the last three years. (If none, type NONE)*

EMT and CPR Certifications
Please check the following (highest level) certifications you have obtained and submitted.*

EMT BasicEMT AdvancedEMT ParamedicEMT Licensed ParamedicCPR Certification
Upload copies of your EMT and CPR certifications here.*

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NIMS Certifications
Select the certifications you have obtained.*

NIMS ICS 100NIMS ICS 200NIMS ICS 300NIMS ICS 400NIMS ICS 700NIMS ICS 800
Upload copies of your NIMS certifications here. *

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Texas DPS Driving History (TYPE AR) & Driver's License

You will be required to provide a copy of your Texas Department of Public Safety - Certified Abstracts of Driving Record (Type AR). This record can be found here: (copy and paste the following link into your browser.) https://txapps.texas.gov/tolapp/txldrcdr/TXDPSLicenseeManager
Upload a copy of your TYPE AR driving record and a copy of your driver's license here. *

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Resume

If you have a resume you would like to upload, please do so here.
Upload a copy of your resume and any additional certifications relevant to your application here. (Ex. NWCG, Water Rescue, IAFF, Blue Card...)*

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Application Checklist

Check the fields below to confirm your understanding and completion of the application process.
The following steps are required for your application to be accepted. Please use check the following fields to confirm you have completed all of the needed steps.*

I certify that I have uploaded a current and valid TCFP Structural Firefighter certification.I certify that I have uploaded current and valid EMT and CPR certifications.I certify that I have uploaded all copies of your NIMS 100, 200, 700, and 800 certifications.I certify that I have uploaded a copy of my DPS Type AR driving record.I certify that I have uploaded a copy of my Driver's License.I certify that I have uploaded a copy of my resume.I certify that I have uploaded copies of my additional certifications. (If applicable)

Legal Understanding

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION. YOUR WRITTEN AUTHORIZATION IS NECESSARY FOR COMPLETION OF THE APPLICATION PROCESS.
I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Bastrop County Emergency Service District No. 2 to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and driving background investigation, and/or drug screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of Bastrop County ESD No. 2 serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States.
Name*

First NameLast Name
Signature*

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Date*

MonthDayYear
Date

Authorization for Background Check

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION. YOUR WRITTEN AUTHORIZATION IS NECESSARY FOR COMPLETION OF THE APPLICATION PROCESS.
I hereby authorize Bastrop County Emergency Service District No. 2 to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that Bastrop County Emergency Service District No. 2 may utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.
Name*

First NameLast Name
Signature*

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Date*

MonthDayYear
Date
Should be Empty:

Firefighter Employment Application

Personal Information

Medical / Physical

Employment History

Work Experience

Criminal History

Driving History

TCFP Certifications

EMT and CPR Certifications

NIMS Certifications

Texas DPS Driving History (TYPE AR) & Driver's License

Resume

Application Checklist

Legal Understanding

Authorization for Background Check