Berea Volunteer Fire & Rescue Application Form

Job Application

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

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Social Security Number*
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number*
Do you have any previous firefighting experience?

YesNo
If yes, where?
Have you ever been convicted of felony?

YesNo
If yes, explain.
Education
Name of High School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What year did you start high school?
What year did you leave high school?
Did you graduate?

YesNo
If yes, diploma or GED

DiplomaGED
Did you attend college?

YesNo
Name of college?
What year did you start college?
What year did you leave college?
Did you graduate?

YesNo
If yes, type of degree?
References

Please list three professional references.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Company*
Relationship*
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Company*
Relationship*
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Company*
Relationship*
Previous Employment
Company
Address
Phone Number
Please enter a valid phone number.
Job Title
Supervisor's Name
Job Duties
What year did you start this job?
What year did you leave this job?
Reason for leaving
May we contact your previous supervisor for a reference?

YesNo
Supervisor's Email Address
Company
Address
Phone Number
Please enter a valid phone number.
Job Title
Supervisor's Name
Job Duties
What year did you start this job?
What year did you leave this job?
Reason for leaving
May we contact your previous supervisor for a reference?

YesNo
Supervisor's Email Address
Company
Address
Phone Number
Please enter a valid phone number.
Job Title
Supervisor's Name
Job Duties
What year did you start this job?
What year did you leave this job?
Reason for leaving
May we contact your previous supervisor for a reference?

YesNo
Supervisor's Email Address
Military Experience
Branch?
What year did you start?
What year did you leave?
Rank at discharge, or current rank if still employed
Type of discharge
If other than Honorable, please explain.
Disclaimer and Signature
I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that if grated membership, falsified statements on this application shall be grounds for dismissal. I also authorize the investigation of all statements contained herein and the references listed above to provide any and all information concerning my previous employment and any other pertinent information they may have and release all parties from liability from any damage that may result from furnishing the same. I also authorize Berea Volunteer Fire & Rescue to request records regarding my driving history and any criminal court action that has been taken against me. I also understand and agree that I may be subject to physical examination and/or a drug screen.
Signature*

Clear
Should be Empty:

Job Application

Education

References

Previous Employment

Military Experience

Disclaimer and Signature