Employment Application - Oregon Area Fire and EMS District

Employment Application

Applicant Information

Tell us about yourself

First Name

Last Name

Phone/Mobile

Address

Address Line 1

Address Line 2

City

State

Zip Code

Drivers License - State

Drivers License Number

What role are you applying for?

When did you last work for us?

What was your position?

What was the reason for leaving?

Have you ever been convicted of a felony or misdemeanor?

Yes

Please explain:

Education History

Please tell us about your education

High School Name

Dates Attended

Did you graduate?

Yes

Did you obtain your GED?

Yes

Did you attend college?

Yes

College Name

Dates Attended

Did you graduate?

Yes

Employment History

Please share your previous/current work experience.

Employer

Job Title

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Supervisor First Name

Supervisor Last Name

Supervisor Phone Number

Dates Employed

Reason for leaving

Job Responsibilities

May we contact this employer?

Yes

Do you want to add a second employer?

Yes

Employer

Job Title

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Supervisor First Name

Supervisor Last Name

Supervisor Phone Number

Dates Employed

Reason for leaving

Job Responsibilities

May we contact this employer?

Yes

Do you want to add a second employer?

Yes

Employer

Job Title

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Supervisor First Name

Supervisor Last Name

Supervisor Phone Number

Dates Employed

Reason for leaving

Job Responsibilities

May we contact this employer?

Yes

Do you want to add a second employer?

Yes

Professional References

Professional references that we can contact

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship

Phone/Mobile

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship

Phone/Mobile

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship

Phone/Mobile

Personal References

Personal references that we can contact

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship

Phone/Mobile

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship

Phone/Mobile

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship

Phone/Mobile

Professional Licenses and Certifications

Proof of completion will be required prior to employment if you select "Yes" to any of the following.

License & Certification Selection

Voluntary Information

This information is voluntary and will not be used when considering your employment.

Racial/Ethnic Background (select all that apply)

Gender

Military Service - Branch

Military Service - Rank

Military Service - Years of Service

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

I hereby give permission to the Oregon Area Fire EMS District to verify the information set forth in the application. I release all liability from people and entities seeking or providing information, whether written or verbal. A photocopy of this release shall be valid as the original and may be relied upon by all people and entities providing information.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature

Sign Here