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Fire Department Part-Time Application

  1. Are You An Adult?*

  2. Have you ever applied to or been employed by the state, a county, or any political subdivision thereof in Ohio? *

  3. Do you have any commitments (e.g., second job, school, etc.) which might interfere with, or adversely affect, your employment should we select you for a position? *

  4. Are you employed now?*

  5. If so, may we contact your present employer?

  6. Are you on layoff and subject to recall?*

  7. If employed, does your employment require you to continue working for your current employer, or restrict your activities after leaving your current employment, for any period of time?

  8. Are you prevented from becoming lawfully employed in this country because of VISA or immigration status? (Proof of citizenship or immigration status is required by federal law upon employment.)*

  9. Do you possess a valid driver's license?*

  10. If no, can you obtain a driver’s license prior to employment?

  11. Are you a resident of Ohio?*

  12. Are you a veteran of the U.S. Military service? (Voluntary)

  13. EMPLOYMENT HISTORY AND WORK EXPERIENCE

    IN THIS SECTION, LIST ALL EMPLOYMENT HISTORY AND WORK EXPERIENCE IN DATE ORDER. BEGIN WITH YOUR CURRENT EMPLOYER. FAILURE TO INCLUDE ALL EMPLOYMENT MAY BE GROUNDS FOR DISQUALIFICATION. ADDITIONAL EMPLOYERS CAN BE ADDED ON RESUME AT YOUR INTERVIEW.

  14. EDUCATION AND TRAINING

    THIS SECTION IS INTENDED TO GIVE THE EMPLOYER INFORMATION ABOUT THE EDUCATION AND TRAINING THAT THE APPLICANT HAS COMPLETED, AND TO DEMONSTRATE THE SKILLS, KNOWLEDGE, AND ABILITIES OF THE APPLICANT TO PERFORM THE JOB DUTIES OF THE POSITION. YOU MAY PROVIDE ADDITIONAL EDUCATIONAL BACKGROUND ON RESUME AT YOUR INTERVIEW.

  15. REFERENCES: Give the names of three (3) professional references, not related to you, whom you have known at least one (1) year.

  16. PLEASE READ EACH OF THE FOLLOWING PARAGRAPHS CAREFULLY. INDICATE YOUR UNDERSTANDING OF, AND CONSENT TO, THE CONTENTS AND CONDITIONS OF EACH PARAGRAPH BY PLACING YOUR INITIALS AT THE END OF EACH PARAGRAPH. IF YOU HAVE ANY QUESTIONS REGARDING THESE PARAGRAPHS, CONTACT THE EMPLOYER BEFORE INITIALING THE PARAGRAPH.

  17. I SOLEMNLY SWEAR THAT ALL OF THE INFORMATION FURNISHED IN THIS EMPLOYMENT APPLICATION IS TRUE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT ANY MISREPRESENTATION OR FALSIFICATION OF THE INFORMATION PROVIDED MAY LEAD TO WITHDRAWAL OF AN EMPLOYMENT OFFER OR TERMINATION FOLLOWING EMPLOYMENT. I RECOGNIZE THAT MY FUTURE EMPLOYMENT WITH THE EMPLOYER WILL BE JEOPARDIZED IF I ENGAGE IN SUBSTANCE ABUSE, ILLEGAL DRUG USE, OR ALCOHOL ABUSE.

  18. ***PLEASE READ CAREFULLY BEFORE SIGNING***

  19. I AGREE THAT ANY CLAIM OR LAWSUIT RELATING TO MY EMPLOYMENT WITH THE TOWNSHIP OR ONE OF THE DEPARTMENTS MUST BE FILED NO MORE THAN SIX (6) MONTHS AFTER THE DATE OF THE EMPLOYMENT ACTION THAT IS THE SUBJECT OF THE CLAIM OR LAWSUIT. I WAIVE ANY STATUTE OF LIMITATIONS TO THE CONTRARY.

  20. EEO DATA: VOLUNTARY DISCLOSURE FORM

  21. Regulations of the Equal Employment Opportunity Commission (EEOC) require employers to compile data regarding the nature and make-up of their work forces in order to further the goals of Title VII of the Civil Rights Act of 1964, as amended. Your responses to the following questions will help the employer comply with this requirement. Completion of this questionnaire is entirely voluntary on your part. Should you opt to complete the questionnaire, your response will be used by the employer solely for the purposes of preparing the reports required by the EEOC. Your response will be kept confidential, and will play no part in the employer’s evaluation of your employment performance or status, or your treatment as an employee. The completed questionnaire will be kept separate from your personnel file.

  22. RACIAL AND ETHNIC CATEGORIES:

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