app Today's Date *Full name *Date of birth *Email Address *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodePhone *Are you at least 18 years or older? *YesNoDrivers license #Check each item of documentation you can provide *Driver LicenseEMT LicenseFirefighter IFirefighter IIHazmat Operations CertificateHazmat Awareness CertificateCPAT CardAre you a citizen of the United States *YesNoIf no, are you authorized to work in the U.S.? *YesNoWhat areas of the fire service/public service interest you? Such as firefighting, medical services, technical rescue (such as water rescue), supportive functions, or other.Do you have any activities, commitments, or responsibilities that may prevent you from meeting attendance guidelines?YesNoIf yes, please explain:Where do you see yourself in five years as it relates to your future in the fire service/public service?WORK EXPERIENCE(Start with the most recent )Employer *Position *Address *Phone *From *To *Why did you leave? *Supervisor *Responsibilities *May we contact your present employer? *(If No Please state the reason)YesNoOtherWORK EXPERIENCEEmployerPositionAddressPhoneFromToWhy did you leave?SupervisorResponsibilitiesWORK EXPERIENCEEmployerPositionAddressPhoneFromToWhy did you leave?SupervisorResponsibilitiesEDUCATION / TRAININGName of School/College *High School, College/University, OtherDid you graduate? *YesNoDegree *Major *Legal BehaviorHave you been fined for a criminal (misdemeanor or felony) offense within the past 7 years? *YesNoHave you been arrested for any crime within the past 7 years? *YesNoHave you been cited and released for a criminal (misdemeanor or felony) offense within the past 7 years? *YesNoHave you ever been sentenced to jail or prison? *YesNoHave you had your driver’s license suspended or revoked within the past 7 years? *YesNoHave you ever been refused a security clearance of bond? *YesNoUnderstanding of RequirementsCertification *In making this application, it is understood that an investigation may be made, whereby, information is obtained through personal interviews with third parties, such as employers, business associates, law enforcement, friends, or others with whom you are acquainted. This inquiry may include information as to your character, general reputation and personal characteristics, whichever may be applicable. I certify that the answers given by me to all questions on this application are true and correct to the best of my knowledge and belief. I understand that is accepted, false statements or omission of facts on this application shall be considered sufficient cause for termination from service. I authorize you to make any reasonable inquiry of my associates, employer, and law enforcement agency to fully investigate my criminal records history. This application is not a job offer or promise of employment from Fire District No. 21. I hereby release the information contained within this application and any supplementary documents to Snohomish County Fire Districts’ No. 21.APPLICANTS MUST (Check each box to acknowledge requirement and agree to the paragraph above.)Be at least eighteen (18) years of age at time of applicationPossess a high school diploma or GED equivalency.Have a current Washington State Driver’s License.Sign and complete in-full this application packet.Applicant's E-Signature *Submit
