Current General Information Employment Experience and References Educational Background Authorization Preview Complete INSTRUCTIONS TO THE APPLICANT: We deeply appreciate your interest in employment with the Elizabeth Fire Protection District ("District"). Please print clearly in black or blue ink, and answer each question fully and accurately. The District will not consider your application until all of the questions have been answered. Sign and date this form. Thank you for taking the time to complete this application. Date of Application Additional Qualifications EMT Paramedic Firefighter I Can you perform the essential functions of the job with or without reasonable accommodation? Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. Those issues may be addressed at a later stage to the extent permitted by law. Yes No If no, please describe. Name First Middle Last Suffix Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Home Phone Cell Pager Other Email Why do you want to work for the Elizabeth Fire Protection District? Are you legally eligible for employment in the U.S.? Proof of eligibility to work in the U.S. will be required upon employment for all applicants. Yes No Are you over the age of eighteen? Yes No Have you ever served in the military? Yes No Have you ever been employed by the District before? Yes No If yes, give dates: Do you know anyone who works at the District? Yes No If yes, please provide name and relationship: Have you ever been fired or asked to resign from a job? Yes No If yes, please explain: Next Page > Leave this field blank
