Frenchtown Rural Fire District Application

The District makes decisions regarding applicants without regard to race, color, sex, national origin, religion, marital status, age, prior industrial injury, mental or physical handicaps or any other protected classification unrelated to job performance. Please complete all parts of this application, all incomplete applications will not be considered.

Position Applied For: Resident Firefighter/EMT

Resident Application

Date
MM slash DD slash YYYY
Personal Information
Name
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone (Home)
Phone (Cell)
Email
Over 18 Years of Age?
- Yes
- No
If No, when will you turn 18?
MM slash DD slash YYYY
Education and Training
Did you graduate high school?
- Yes
- No
GED:
High School Name:
Highest Level of Education Completed
Have you ever had EMT certification?
- Yes
- No
Is your EMT certification current?
- Yes
- No
- N/A
If yes, enter date certified:
MM slash DD slash YYYY
National Registry
- Yes
- No
Registry Number:
Montana State License
- Yes
- No
State License Number:
Please describe any other education, training, qualifications, skills, or experience that you possess that are relevant to Emergency Medical Services:
Have you ever had structure firefighter I or II Certification?
- Yes
- No
Date Certified:
MM slash DD slash YYYY
IFSAC Accreditation:
- Yes
- No
Please describe any other education, training, qualifications, skills, or experience that you possess that are relevant to the Fire Service:
Have you ever had wildland firefighter I or II certification?
- Yes
- No
Date Certified:
MM slash DD slash YYYY
NWCG Accreditation:
- Yes
- No
Please describe any other education, training, qualifications, skills, or experience that you possess that are relevant to the Fire Service:
Employment History
List below your work experience (paid or unpaid) beginning with your present, or most recent job. Describe each job separately, emphasizing your specific tasks and supervisory, technical or other responsibilities. Give special attention to experience relating to the job for which you are applying. You must complete this section of the application form. Attaching a resume in lieu of a fully completed application is not acceptable. If you need additional space, attach additional sheets.
Current or Most Recent Employer:
Address
Street Address City State / Province / Region ZIP / Postal Code
Job Title
Start and End Date of Employment:
Total Time – Year/Month
Type of Employment
(mark all that apply)
Supervisor's Name
Supervisor's Phone
Duties
(be specific)
May We Contact this Employer?
- Yes
- No
Previous Employer:
Address
Street Address City State / Province / Region ZIP / Postal Code
Job Title
Start and End Date of Employment:
Total Time – Year/Month
Type of Employment
(mark all that apply)
Supervisor's Name
Supervisor's Phone
Duties
(be specific)
May We Contact this Employer?
- Yes
- No
Were you discharged for alleged misconduct or poor work performance?
- Yes
- No
If yes, please explain:
Professional References:
Name
Phone
Name
Phone
Name
Phone
Convictions:
Have you ever been convicted of a felony on or after your 18th birthday?
- Yes
- No
(Do not include minor traffic violations or arrests without convictions.)
If yes, please give a short explanation outlining the circumstances of your conviction. Please indicate date, nature and place of offense, and disposition.
Date of Offense
MM slash DD slash YYYY
Nature of Offense
Location
Disposition
Military Experience
Branch:
Discharged
- Yes
- No
Honorable?
- Yes
- No
Authorization:
Incomplete Applications Will Not Be Considered
Signature

In submitting this application, I authorize investigation of all statements contained herein, and it is understood and agreed that any misrepresentation by me in this application or in any accompanying materials may result in cancellation of the application and/or termination. By my signature placed below, I promise that the information provided in this application (and accompanying resume, if any) is true and complete. I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for dismissal from the Fire District, if discovered at a later date. I agree to notify the Fire District if convicted of a Felony or any crime involving dishonesty or breach of trust. I certify that I have read all of this application and that the information I have provided above is true and correct.
Date
MM slash DD slash YYYY
Release of Information
Signature

To Whom It May Concern: I request and authorize you to disclose to Frenchtown Rural Fire District any documents or information that it may request. I have authorized Frenchtown Rural Fire District to inquire concerning my background history in connection with an application for employment or volunteer position with the district. I agree to hold you and your agents harmless from all liability which could relate in any way to the disclosure of private information or any assessment or opinion of my suitability for employment, residency or volunteer positions that may be provided.
ADA:
Frenchtown Rural Fire District will make reasonable accommodations for the disabled. Individuals with disabilities requiring accommodation in the application process, or any future department activities, MUST provide documentation of the disability in writing to the District. Applicants needing such accommodations should document the request, including an explanation as to the type and extent of accommodations needed to perform duties associated with the position.
Are you capable of performing the firefighting or EMT duties associated with the position for which you are applying without reasonable accommodations?
- Yes
- No
If no, please attach written documentation of disability, and provide accommodation needs.
Max. file size: 50 MB.
Name
This field is for validation purposes and should be left unchanged.

Frenchtown Rural Fire District Application

Position Applied For: Resident Firefighter/EMT

Resident Application

Personal Information

Education and Training

Employment History

Professional References:

Convictions:

Military Experience

Authorization:

Release of Information

ADA: