Fire Department – Job Opportunities

Applicant Information

Name(Required)

First M.I. Last

Date of Birth(Required)

Address(Required)

Street Address Apartment/Unit # City State ZIP Code

Phone(Required)

Email(Required)

Drivers License #(Required)

State(Required)

Expiration Date(Required)

Position Applied For(Required)

Are You a Citizen of the United States?(Required)

Yes

No

PSID #(Required)

Have You Ever Applied for a Position Here?(Required)

Yes

No

If Yes, When?(Required)

Have you been convicted of a felony?(Required)

Yes

No

If yes, explain:(Required)

Type of Employment Requested(Required)

Full Time

Part Time

Education

High School(Required)

High School Address(Required)

Street Address Address Line 2 City State ZIP Code

From(Required)

To(Required)

Did you graduate?(Required)

Yes

No

Diploma(Required)

Did you attend a college?(Required)

Yes

No

College Attended(Required)

College Address(Required)

Street Address Address Line 2 City State ZIP Code

From(Required)

To(Required)

Did you graduate?(Required)

Yes

No

Degree(s)(Required)

Other Education

Other Education Address

Street Address Address Line 2 City State ZIP Code

From

To

Did you graduate?

Yes

No

Degree(s)

Military Service

Military service?(Required)

Yes

No

Branch(Required)

From(Required)

Rank at Discharge(Required)

Type of Discharge(Required)

If other than honorable, explain:(Required)

Certifications

Are you Firefighter I/II Certified?(Required)

Yes

No

Are you EMT-B Certified?(Required)

Yes

No

Paramedic?(Required)

Yes

No

List any additional applicable certifications:

Disclaimer and Signature

I, the undersigned, certify the information contained on this document to be true to the best of my knowledge. I understand that efforts will be made to verify the information. I further understand that falsification of information may result in elimination from further consideration for employment. If falsification herein is discovered after employment with the Mooresville Fire Department, it may result in termination of that employment.

Signature(Required)

Date(Required)

Fire Department - Job Opportunities

Mooresville Fire Department Employment Application

Applicant Information

Education

References

Current Employment

Previous Employment

Previous Employment cont.

Military Service

Certifications

Disclaimer and Signature

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Matt Dalton

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