Fire and Rescue Service Experience
Have you had Fire and/or Rescue Service experience?	Yes       No
Name of Organization:
Address of Organization:
Phone Number:
Contact Person:
Dates Served From:
Dates Served To:
At the time of your departure, what were your general responsibilities?
What skills, qualifications and/or certifications do you possess?

 

Education History
	School	Course	Did you graduate?		Year
High School			Yes	No
College			Yes	No
Other			Yes	No

 

Work Experience (last or current company that you worked for)
Name of Company:
Address of Company:
Phone Number:
Supervisor:
Dates Employed From:
Dates Employed To:
Reason for Leaving:

 

Work Experience (previous company that you worked for)
Name of Company:
Address of Company:
Phone Number:
Supervisor:
Dates Employed From:
Dates Employed To:
Reason for Leaving:

 

Military Service
Branch of Service:
Discharge Date:
National Guard/Reserve:	Yes       No
Date obligation ends:
Special training received:

 

Reference #1 Name: Relationship: Phone Number (home): Phone Number (work): Phone Number (cell): Pager Number:

Reference #2 Name: Relationship: Phone Number (home): Phone Number (work): Phone Number (cell): Pager Number:

 

Reference #3 Name: Relationship: Phone Number (home): Phone Number (work): Phone Number (cell): Pager Number:

 

I acknowledge that the District is relying on the information given and I certify that the information on this application is true to the best of my knowledge. I authorize the District to obtain information from any person named above and I release all concerned from any liability in connection with obtaining and releasing such information.

 

In the event that I am offered a position with the Wellington Fire Protection District I will submit to a drug test which will be completed within 48 hours of the offer.

 

Signature of Applicant:
Date: