Private Hire Firefighter / Equipment Operator Application

Private Hire Firefighter / Equipment Operator Application
Personal Information
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
YesNo
YesNo
Firefighting Qualifications & Experience
YesNo
Please specify the types of equipment you have experience operating.*
YesNo
If yes, provide expiration date*

MonthDayYear
Date
Copy of Incident Safety Awareness for Hired Vendors course dimploma*

PDF or image files up to 10 MB
Cancelof
California State Firefighter ICalifornia State Firefighter IIParamedic CertificationEMT CertificationDriver Operator 1ADriver Operator 1BOther
List any additional firefighting or emergency response training.*
Copy of Certifications*

PDF or image files up to 10 MB
Cancelof
YesNo
YesNo
Minimum requested continuous deployment length*
Maximum requested continuous deployment length*
Driver’s License & Driving Requirements
YesNo
Copy of Driver's License*

PDF or image files up to 10 MB
Cancelof
What class of California driver’s license do you hold?*
Driver's License Endorsements*
YesNo
If yes, please explain.*
References

Please provide at least one professional reference.
Reference Name*
Contact Information*
Relationship*
Legal Disclosures & Consent
California Hiring Notice: If a conditional offer of employment is made, the employer may conduct a background check and, where permitted by law, may require a drug screening. Any required authorization will be requested in accordance with applicable California law.
If yes, please explain.*
YesNo
Equal Opportunity Employment Statement: We are an Equal Opportunity Employer and do not discriminate based on race, color, religion, sex, national origin, age, disability, or any other protected status under California and federal law.
Applicant Signature*

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Date*

MonthDayYear
Date
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Private Hire Firefighter / Equipment Operator Application

Personal Information

Firefighting Qualifications & Experience

Driver’s License & Driving Requirements

References

Legal Disclosures & Consent