FT/PT EMS/Firefighter Personnel

Applicant Information:

First Name: (required)

Last Name: (required)

Physical Address: (required)

City, State, Zip: (required)

Mailing Address (if different):

Phone: (required)

Email Address: (required)

Date Available: (required)

Position Applying For: (required)

FT EMS/Firefighter

PT EMS/Firefighter

Background Information:

Are you at least 21 years of age? (required)

Yes

Military Experience? (If yes, please upload your DD214 documentation) (required)

Yes

Upload DD214:

High School Attended (name of school, city, state): (required)

Did you Graduate? (required)

Yes

College Attended (name of school, city, state):

Did you Graduate?

Yes

Are you a U.S. Citizen? If not, upload documentation authorizing work: (required)

Yes

Upload Non-Citizen Authority to Work document:

Are you related to or residing with anyone working or currently applying for employment with DFPD? (required)

Yes

If yes, please give details:

Certifications (Must be State of Colorado and must be current):

Firefighter Certification: (required)

FF I

FF II

Upload Firefighter Cert:

EMT Certification Type: (required)

EMT Basic

EMT Intermediate

EMT Paramedic

Uploade EMT Cert(s):

Please upload copies of any of these certifications.

NWCG Certfications (List): (required)

Upload NWCG Certs:

Criminal/Civil Action Background Information. Please be sure to respond accurately, providing all requested information. Failure to disclose requested details will be counted as an omission of relevant facts:

Have you ever been arrested, received a Notice to Appear, been charged, convicted, pleaded Nollo Contendere, or plead guilty to any criminal violation? (required)

Yes

If yes, please give details and disposition:

Have you ever been accused of a civil action of wrongful injury, assault and/or battery? (required)

Yes

If yes, please give the outcome of the situation(s):

Employment. Begin with your most recent employment, including self-employment, part-time employment, and military service. Describe your paid work experiences for at least 10 years, or if applicable, list your last three employers:

Employer #1 Name/Company: (required)

Employer #1 Address: (required)

Employer #1 City, State, Zip: (required)

Employer #1 Supervisor: (required)

Employer #1 Contact Info (phone and/or email): (required)

Your Position: (required)

Your Duties & Responsibilities: (required)

Your Final Salary: (required)

Your Reason for Leaving: (required)

May We Contact Your Present Employer? (required)

Employer #2 Name/Company:

Employer #2 Address:

Employer #2 City, State, Zip:

Employer #2 Supervisor:

Employer #2 Contact Info (phone and/or email):

Your Position:

Your Duties & Responsibilities:

Your Final Salary:

Your Reason for Leaving:

Employer #3 Name/Company:

Employer #3 Address:

Employer #3 City, State, Zip:

Employer #3 Supervisor:

Employer #3 Contact Info (phone and/or email):

Your Position:

Your Duties & Responsibilities:

Your Final Salary:

Your Reason for Leaving:

Have you ever been fired, forced to resign, or resigned in lieu of termination? (required)

Yes

If yes, explain:

List all special skills, computer programs, office machines, equipment, tools, etc. you are familiar using: (required)

List Three References

Reference #1 Name: (required)

Reference #1 Contact Information (address and/or phone and/or email): (required)

Reference #2 Name: (required)

Reference #2 Contact Information (address and/or phone and/or email): (required)

Reference #3 Name: (required)

Reference #3 Contact Information (address and/or phone and/or email): (required)

Applicant's Statements:

I hereby certify that all statements made in this application are true and complete. Further, I understand that misrepresentation or omission of information by me shall serve as a basis for termination for my employment with DFPD. Permission is granted to DFPD to investigate and verify any information provided on this and successive documents completed for the purposes of employment consideration. In return for consideration of my application, I release any person who provides information pertaining to me from all claims or liabilities that might otherwise result from such information or opinions. I understand that if I am employed by DFPD, some employer may in the future contact DFPD concerning my work record and performance with the District. I hereby consent to and authorize persons employed by DFPD to divulge any and all information they consider to be revelant to any person representing themselves to be an employer of mine or potential employer of mine with respect to my work record and the performance of my job at DFPD. (required)

Yes

I understand that in connection with my Application for Employment with DFPD, my driving record and a criminal background will be obtained. (required)

Yes

I understand that DFPD may conduct pre-employment drug testing, employment drug testing, and physicals. (required)

Yes

Date of Application (also signifies date of signing of Applicant's Statements): (required)

Signature Statement: By submitting this application for employment with DFPD, I agree I am electronically signing this document and verifying all information I have provided in said application: (required)

Yes

Upload other Pertinent Documents:

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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Please complete the following application for a FT or PT EMS/Firefighter Position.

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