• CJCFPD Employment Application

    An Equal Opportunity Employer: It is our policy to abide by all Federal and State Laws prohibiting employment discrimination solely on the basis of a person's race, color creed, national origin, religion, ages, sex, martial status, or disability, except where a reasonable, bona fide occupational qualification exists.
  • Position & Personal Information

  • Today's Date*
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  • Date Available for Work*
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  • Format: (000) 000-0000.
  • Eligibility & Background

  • Are you 21 years of age or older?*
  • Have you worked under another name?*
  • Are you a citizen or otherwise lawfully authorized to work in the United States? (Proof of citizenship or permanent resident alien status may be required after employment)*
  • Have you been convicted of a crime (felony, misdemeanor, traffic offense) in the last ten years?*
  • Do you have any relatives working for the district?*
  • Firefighter-Specific Qualifications

  • A firefighter's position involves climbing ladders, swinging axes and carrying heavy equipment, working in adverse weather conditions, and the ability to work hard for long durations. Do you believe you can safely perform such activities?*
  • High school diploma or equivalent*
  • Firefighter I & II Certification*
  • Current EMT license*
  • If currently enrolled in a Firefighter or EMT class, expected completion date
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  • Employment History

    List most recent position first. Click 'Add Employment Entry' for additional history.
  • May we contact your present employer?*
  • Education

    Click 'Add New' for each additional school.
  • Registration/Licenses

  • License entries may be added for up to three current or previous registrations/licenses.
  • Provide complete and accurate information for each registration or license you hold.
  • If you have no registrations or licenses to report, leave this section blank.

  • Additional Experience or Training

  • References

  • Upload Documents

    Firefighter I, Firefighter II, EMT or Paramedic License, CPAT, and Fire Service Entrance Exam
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  • Applicant Acknowledgment & Signature

  • I certify that the information contained in this application is correct to the best of my knowledge, and I understand that false information in the application may result in disqualification from further consideration or dismissal from employment. I authorize investigation of all statements made in this application, and I give consent for all person contacted, including my former employers, to provide information concerning this application. I release each such person from liability for providing information.


    I also understand that an investigation consumer report may be made whereby information is obtained through personal interviews with neighbors, friends or others with whom I am acquainted. This inquiry, if made, may include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have a right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of any such investigative report that is made.

    I understand that I may be required to submit to a drug or alcohol test prior to or after employment. I understand further that if I am offered employment I may be required to undergo a medical examination before beginning work and that an offer of employment may be conditional on the results of the examination.

    I agree to conform to the rules and regulations of the Central Jackson County Fire Protection District, and I understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the District or myself.

    In accordance with the Immigration Reform and Control Act of 1986, all new employees are required to produce proof of identity and eligibility for employment in the United States immediately upon hire. I understand new employees will not be allowed to work and will not be placed on the department personnel/payroll records if the following documents are not available on the employee’s first scheduled working day.

    Native Born Citizen must produce: Original Social Security Card or Certificate of Birth in the United States (issued by state, county, or municipal authority bearing a seal or other certification) PLUS a Driver’s License or similar document containing a photograph.

    A non Native Born Citizen must produce one of the following: 1) U.S. Passport, 2) Certificate of U.S Citizenship, 3) Certificate of Naturalization, 4) unexpired foreign passport with current authorization to work in the United States, or 5) Resident Alien Card.

  • Signature Date*
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  • For Office Use Only

  • Date Received
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  • Employment Date
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  • Should be Empty: