Application - Schaeferville Fire Protection District

First Middle and Last Name *

Drivers License Number (****-****-****) *

Enter your drivers license number

Date of Birth (**/**/****) *

Current Address *

Number Street City State Zip

Previous Addresses *

Enter any previous addresses you have lived at within the last 10 years, including County and State. If none enter N/A.

Email *

Email

Confirm Email

Phone Number *

Current Employer *

Name, Address, Telephone Number; if none enter none

Last two Previous Employers *

Name, Address, Telephone Number; if none enter none

Do you have a GED or High School Diploma? *

Illinois fire and ems certifications require a high school diploma or GED equivalent.

Name of Highschool and Graduation Year *

Reference #1 *

Name, Address, Phone Number for someone who has known you at least 2 years and is not related to you

Reference #2 *

Name, Address, Phone Number for someone who has known you at least 2 years and is not related to you

Reference #3 *

Name, Address, Phone Number for someone who has known you at least 2 years and is not related to you

Physical Abilities *

I can stand for prolonged periods.
I can sit for prolonged periods.
I can reach above my shoulders.
I can lift 75 pounds.
I can work on slippery and/or uneven surfaces.
I can work protracted or irregular hours.

Check all that apply.

Criminal/Traffic History

I have been convicted of a misdemeanor or felony offense.
I have received an ordinance violation or ticket for a drug or alcohol related offense.
I have charges currently pending against me.
I have received a traffic ticket within the last two years.
None of the above apply to me.

Check any that apply, and enter details below.

Criminal/Traffic History Information *

Include City, County and State of all Infractions if none put N/A

List any illegal or recreational drug use within the last 10 years including cannabis *

Enter N/A if none

I understand a drug test may be performed as part of the hiring process or at any time during employment. *

I understand a criminal background check will be performed as part of the hiring process, and may be performed periodically during employment. *

I understand that any misrepresentation, falsification, or deliberate omission of information on this application may result in my failure to be offered a position at the Schaeferville Fire Protection District. Furthermore, information found to be misrepresented, false, or omitted after being hired by the Schaeferville Fire Protection District may lead to immediate dismissal. *

Sign by typing your Full Name including Middle name(Ex John Joe Smith)