• Image field 135

  • Application for Employment

    Firefighter/Paramedic for the City of Belvidere, Illinois

  • Personal Information

  • Gender*
  • Format: (000) 000-0000.
  • Birth Date*
     - -
  • Are you authorized to work in Illinois?*
  • Are you lawfully permitted to become employed in this country?*
  • Do you have a valid driver's license?*
  • Expiration date of driver's license *
     - -
  • Have you ever been employed as a peace officer or a firefighter?*
  • Have you ever been convicted of a felony?*
  • Are there any criminal charges pending against you in any court of law?*

  • Military Service Record

  • Did you register with the Selective Service?*
  • Did you serve in the U.S. Military?*
  • Are you now, or were you ever a member of any branch of the U.S. Reserve Forces?
  • If yes,
  • Are you now, or were you ever a member of the National Guard?
  • If yes,

  • Education Information

  • Rows

  • Employment History

    List your four (4) previous employers, including any military service. Begin with your current or most recent employer.
  • Are you currently employed

  • Employer:
    Address:              
    Telephone:      
    Supervisors Name & Title:    
    Title:   
    Duties:    
    From:   Pick a Date   To   Pick a Date   
             
    Reason for leaving:   

  • Employer:
    Address:              
    Telephone:      
    Supervisors Name & Title:    
    Title:   
    Duties:    
    From:   Pick a Date   To   Pick a Date   
             
    Reason for leaving:   

  • Employer:
    Address:              
    Telephone:      
    Supervisors Name & Title:    
    Title:   
    Duties:    
    From:   Pick a Date   To   Pick a Date   
             
    Reason for leaving:   

  • Employer:
    Address:              
    Telephone:      
    Supervisors Name & Title:    
    Title:   
    Duties:    
    From:   Pick a Date   To   Pick a Date   
             
    Reason for leaving:   

  • References

    Please list a minimum of three (3) adults not related to you and not current employers, who you have known for at least three (3) years. All persons to who you refer will be asked to appraise your character, ability, experience, personality and qualities.

  • Name:   *   *   
    Address:*      *   *   *   
    Home Phone: *
    Cell Phone:          
    Occupation:   *   
    Years Known: *         
    Relationship:   *   

  • Name:   *   *   
    Address:*      *   *   *   
    Home Phone: *
    Cell Phone:          
    Occupation:   *   
    Years Known: *         
    Relationship:   *   

  • Name:   *   *   
    Address:*      *   *   *   
    Home Phone: *
    Cell Phone:          
    Occupation:   *   
    Years Known: *         
    Relationship:   *   

  • Name:         
    Address:               
    Home Phone:
    Cell Phone:          
    Occupation:      
    Years Known:          
    Relationship:      

  • Name:         
    Address:               
    Home Phone:
    Cell Phone:          
    Occupation:      
    Years Known:          
    Relationship:      

  • Name:         
    Address:               
    Home Phone:
    Cell Phone:          
    Occupation:      
    Years Known:          
    Relationship:      

  • APPLICANTS STATEMENT

  • I hereby certify that there are no willful misrepresentation, or falsifications on this questionnaire or supporting documents and that all of my answers are true and correct to the best of my knowledge and belief.

    It is understood and agreed upon that any misrepresentation or omission by me on this application will be sufficient cause for cancellation of this application and/or separation from this employer's service if I have been employed.

    I give the employer the right to investigate all contacts listed and others to secure information about me and to use the information in the decision making process regarding my request for employment. I further release from liability the employer and its representatives for seeking such information and all other persons or corporations for furnishing such information.

    I understand that neither this document, nor any offer of employment from the employer constitute an employment contract unless a specific document to that effects is executed by the employer and employee in writing.

    By entering my name and date below I verify my acknowledgement of, and agreement to, the above statements.

  • Date*
     - -

  • It is the express policy of the City of Belvidere to consider all applicants for employment without regard to race, color, religion, gender, age, physical disability, political affiliation or national origin (except where a bona fide occupational qualification exists). 

  • DISCLOSURE REGARDING BACKGROUND INVESTIGATION

  • The City of Belvidere (City) may obtain information about you from a third-party consumer reporting agency for employment purposes. This information may be obtained in the form of a “consumer report” and/or an “investigative consumer report” (commonly known as background reports). These reports may contain information regarding your criminal history, social security verification, motor vehicle records, credit history, verification of your education and employment history, drug screening and other background checks. This information may be obtained from private and public record sources. The reports may contain information about your general character and reputation and may involve personal interviews with individuals or companies.
    Any criminal history, consumer report, investigative consumer report, or other background information will be obtained and used only as permitted by applicable law. By executing below, I acknowledge receipt and review of this NOTICE.

  • Date*
     - -

  • Once your application has been submitted, you will be directed to complete and sign the Release of Records and Information Form.

    All required documents must also be uploaded through the document upload button on our website, and you must complete the written test by June 30, 2026.

    Thank you, and good luck.

    Next Steps:

    1. Submit all required documents.
    2. Complete the written test.
    3. Regularly check your email for an invitation to an online interview if you pass the written test.

  • Should be Empty: