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Reserve Firefighter Program Application
Reserve Firefighter Program Application
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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 -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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:
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