Employment Application Form

South Greenville Fire District

Employment Application
This application is not an employment contract but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, mental status, national origin, citizenship, disability, veteran status or any other status protected under state and federal law. It is also the policy of the company to have the option of conducting pre-employment screenings before a job offer is made. Employment may be contingent upon the successful completion of a medical examination which may include providing body substance samples and the successful completion of an agility test. This application will remain active for the period of one year.
Today's Date

MonthDayYear
Date
Personal Information:
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Mobile Phone*

Area CodePhone Number
E-mail*
Are you at least 18 years of age?

YesNo
Employment Desired:
Position Applying For*
Date You Can Start*

MonthDayYear
Salary Desired
Have You Worked Here Before?*

YesNo
Have You Had a FD Physical In The Last 12 Months?*

YesNo
Have You Applied Here Before?*

YesNo
Have You Ever Been Discharged Or Asked to Resign From A Job?

YesNo
If Yes To Above Question Please Explain.
Education:
High School
Name of High School Attended
Number of Years Attended
Graduated?

Yes
College
Name of College/University Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Graduate School
Name of Graduate School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Classes/Skills/Qualifications:
Please Select Current Certifications:

CTC FF 1CTC FF 2SCFA 1152 Fundamentals of FirefightingSCFA 1153 IFSAC FF1SCFA 1154 IFSAC FF2Emergency Medical ResponderEMT - BasicEMT - Paramedic
Skills
List any relevant skills
Other SCFA/FEMA Classes
List any relevant certifications or qualifications
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Salary
Reason for Leaving?
Start Date

MonthDayYear
May We Contact?

YesNo
Previous Employment:
Previous Employer
Name of Previous Employer
Position
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Previous Employer
Name of Previous Employer
Position
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
References:
Reference 1
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone
Email
Cover Letter & Resume (Optional):
Cover Letter

Upload a File

Cancelof
Resume

Upload a File

Cancelof
SCDLLR Firefighter Registration Information

Name Based Criminal Records Check Request Additional Information The "South Carolina Firefighters Employment and RegistrationAct" requires a criminal records check prior to employment of a paid or volunteer firefighter. No later than 60 days after the start of his employment date as a paid or volunteer firefighter, each firefighter must be registered with the Office of the State Fire Marshal (OSFM) by his fire chief or other employer. The criminal background check must be conducted before registration. After June 30, 2001, a person may not perform firefighting duties in South Carolina if the person has been convicted of, or pled guilty to, or pled nolo contendere to: (a) a felony; (b) arson or another offense provided in Article 3, Chapter 11 of Title 16; or (c) an offense involving a controlled substance as provided for in Chapter 53 of Title 44. The prohibition applies for 10 years after the conviction or plea of guilty or nolo contendere.
Birth Date*

MonthDayYear
Social Security Number*
xxx-xx-xxxx
Name*

PrefixFirst NameMiddle NameLast NameSuffix
Aliases
Any known aliases
Driver's License Number and State of Issue*
DL# and State of Issue
Mailing Address *

Street Address or PO Box

Street Address Line 2

CityState / Province

Postal / Zip Code
Please verify that you are human*
Send Application:
By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement 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 compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company'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 company.
Should be Empty:

South Greenville Fire District

Personal Information:

Employment Desired:

Education:

Classes/Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume (Optional):

SCDLLR Firefighter Registration Information

Send Application: