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Fire Department Application

  1. Have you been convicted of a felony with the last 7 years?*
  2. Have you ever filed an application with us before?
  3. Have you ever been employed by us before?
  4. Do you have any relatives working for us?
  5. Did you graduate?
  6. Did you graduate?
  7. Did You Graduate
  8. Have you completed an IFSAC approved Fire Fighter I and Firefighter II course that resulted in certifications?

    Proof of Certification must be submitted upon request.

  9. Have you completed an IFSAC approved Fire Fighter I and Firefighter II course that resulted in certifications?

    Proof of Certification must be submitted upon request.

  10. Computer Skills
  11. General Computer Knowledge
  12. Do you speak, read, or write any foreign languages?
  13. Please enter the details of your last 3 employers
  14. May we contact the Supervisor?
  15. May we contact the Supervisor?
  16. May we contact the Supervisor?
  17. The Fire Department is an Equal Employment Opportunity/ Affirmative Action Employer. We consider applicants for all positions without regard to race, color, natural origin, sex, age, handicap, marital status, religion, or any other legally protected status.

    I understand that my appointment or employment will be contingent upon the results of a completed background investigation. I am aware that any omission, falsification, misstatement or misrepresentation will be the basis for my disqualification as an applicant or my dismissal from the Carthage Fire Department. I agree to the conditions and certify that all statements made by me on this application are true, correct and complete, to the best of my knowledge. I understand that this employment application shall become the property of the Carthage Fire Department.

    I further understand and agree that my employment or appointment will be contingent upon the results of a complete drug test and that I may be required to take drug test during the term of my employment or appointment with the Carthage Fire Department.

    I understand that the use of drugs and alcohol is not permitted, during work or duty time, whether paid or unpaid, in the areas, including vehicles, where work is performed by employees or appointees.

    I further authorize the Carthage Fire Department or an agent of the Carthage Fire Department, without need of further authorization, to obtain medical records allowed by law if I claim rights to payment or receipt of any benefit pursuant to state or federal law.

    I further agree to give any authorization as may be required by the Health Insurance Portability Accountability Act of 1996 (HIPAA) for health care providers to release the necessary medical information to process my application for employment.

    I understand and agree that any employment or appointment offered to me will be contingent upon my acceptance of compensatory time off, instead of cash, in payment for overtime hours that I work, to the extent allowed by law. I understand, however, that the Carthage Fire Department has the absolute discretion to periodically substitute cash, in whole or part, for my accrued compensatory time.

    I authorize any of the persons or organizations referenced in this application to furnish information, personal or otherwise, regarding my ability and fitness for employment or appointment with the Carthage Fire Department and I release all such parties from any and all liability for any damage that might result from furnishing such information to the Carthage Public.

    I agree to conform to the rules, regulations, and orders of the Carthage Fire Department and acknowledge that these rules, regulations, and orders may be changed, interpreted, withdrawn, or added to by the Carthage Fire Department, as its discretion, at any time and without any prior notice to me.

  18. You must agree to the disclosure statement provided in order for us to accept your application.*
  19. Leave This Blank:

  20. This field is not part of the form submission.