Officer Application Form
Emergency Services District 4
Personal Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Residence Address
*
Street Address
Street Address Line 2
City
State
Zip Code
I am applying for:
Please Select
Fire Chief
Deputy Assistant Chief
Captain
Basic Requirements
Are you legally entitled to work in the United States?
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Are you 18 years of age or older?
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Do you possess a valid Class A or B Texas Exempt Driver’s License and a good driving record?
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Do you believe you are free of medical conditions that may preclude your participation as a Officer in the Tool Fire Department?
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Are you willing to participate in a medical check required of potential firefighters?
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Do you understand that a background check will be performed to include a driver's record, criminal history, and drug & alcohol checks
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Do you understand that firefighters are expected to be in good physical condition, and do you feel you are physically able to participate in a physical fitness related test as part of the selection process?
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Do you understand that successful applicants are required to remain without facial hair to ensure a self-contained breathing apparatus, (SCBA), mask will form a positive seal on the face?
*
Additional Comments
Availability
Please select your availability for the given days and time phases
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Monday - Days
Monday - Nights
Tuesday - Days
Tuesday - Nights
Wednesday - Days
Wednesday - Nights
Thursday - Days
Thursday - Nights
Friday - Days
Friday - Nights
Saturday - Days
Saturday - Nights
Sunday - Days
Sunday - Nights
If accepted by ESD 4, you will be required to attend regular weekly Monday night meetings (approximately 6:30PM to 9:30PM). Can you meet this requirement?
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Are you willing and able to retain and wear an emergency radio & pager and respond to emergencies?
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Are you willing and able to participate in the occasional weekend training program?
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Do you understand that in order to be available for emergency call-outs, you must be able to arrive at the fire station promptly and have abstained from alcohol and drugs for the previous 8 hours?
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Skills and Experience
Please indicate if you have any of the following trainings or certifications.
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Fire Academy
CPR - Cardiopulmonary resuscitation
Fire Safety Systems - alarms, extinguishers
Rescue procedure - lifeguard, auto extrication
First Aid
Knowledge of breathing apparatus - SCBA
Occupational Health & Safety
Fire Fighter - Professional Ethics
Fire Fighter I
Fire Fighter II
Hazmat
Instructor I
Instructor II
Officer I
Officer II
Engine - Pumper Operation
EMT A or B - Emergency Medical Technician
Paramedic
Other
Previous Emergency Medical Experience - Explain:
Previous Firefighter Experience – Explain:
References
Enter your Reference and then click Add New Reference.
*
Upload Resume
Browse Files
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Upload Certifications
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Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Electronic Signature:
*
By typing your name you agree this is your electronic signature and you have truthfully answered all information listed above and is correct and factual. Emergency Services District 4 is an Equal Opportunity Employer.
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