REIDVILLE AREA FIRE DISTRICT

PO BOX 115, REIDVILLE, SC 29375

STREET ADDRESS: 7450 REIDVILLE ROAD

APPLICATION INFORMATION EQUAL OPPORTUNITY EMPLOYER

Type of Position Desired:

Full-Time

Part-Time

Volunteer

Personal Information:

First name

Last name

Social Security Number

Address

Address 2

City

State

Zip

Home#

Mobile#

Birthday

Emergency Contact Name & Number:

General Information (Please check all appropriate boxes)

HAVE YOU EVER BEEN A MEMBER OF ANOTHER FIRE OR EMS DEPARTMENT?

Yes

IF YES, GIVE NAME /ADDRESS/CONTACT PERSON:

ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THIS COUNTRY?

Yes

IF NO, PLEASE EXPLAIN:

HAVE YOU EVER BEEN BONDED?

Yes

HAVE YOU EVER BEEN REFUSED BOND?

Yes

IF YES, PLEASE EXPLAIN: (DATE & DETAILS)

HAVE YOU EVER BEEN CONVICTED OF ANY CRIMES – (misdemeanors or felonies)

Yes

IF YES, PLEASE EXPLAIN: (DATE & DETAILS)

CAN YOU PERFORM THE DUTIES OF THE JOB YOU ARE APPLYING FOR?

Yes

IF NO, PLEASE EXPLAIN: (List)

HAVE YOU EVER RECEIVED HEPATITIS B VACCINE?

Yes

IF YES, RECORDS MUST BE PROVIDED – Requirement for All Fire Positions unless waiver is signed.

HAS YOUR DRIVERS LICENSE EVER BEEN REVOKED?

Yes

IF YES, PLEASE EXPLAIN: (DATE & DETAILS)

Driver's License Number:

State:

Class:

Expiration Date:

A COPY OF YOUR DRIVERS LICENSE AND A COPY OF YOUR DRIVING RECORD FROM THE DMV MUST BE PROVIDED TO BE FOR DRIVING ELIGIBILITY INSURANCE PURPOSES.

Employment History: (Provide Most recent First)

Employment History:

Skills and Qualifications:

Interior Firefighter

EMT

Paramedic

First Responder

Other: (Please Explain)

Education: (Highest Level Completed)

College Bachelor's Degree

College Associate's Degree

Some College

High School

Name of School and Years Attended:

Fire/EMS Schools: (Courses and Dates Completed)

Reference 1: (Please provide 3)

Reference 2:

Reference 3:

PLEASE READ BEFORE SIGNING:

With completion of this Application for Employment an investigative consumer report may be prepared whereby information is obtained through reference interviews with your former employers and friends, or other acquaintances. Such an inquiry would include information as to character, general reputation and personal characteristics. You have the right to make these request (whether oral or written) within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.

I authorize you to communicate with persons listed as references, former employers, and any others with whom you desire to check, unless I specifically state such persons as current employers not to contact that may cause tension with my employment. YOU ARE HEREBY AUTHORIZED TO MAKE ANY INVESTIGATION OF MY PERSONAL EMPLOYMENT, FINANCIAL OR ANY OTHER RELATED MATTERS CONSIDERED NECESSARY. I HEREBY RELEASE EMPLOYERS, SCHOOLS, PHYSICANS OR PERSONS FROM ALL LIABLITY IN RESPONDING TO INQUIRIES IN CONNECTION WITH MY APPLICATION – this will be done in compliance with the Fair Credit Reporting Act of 1970 and the Consumer Credit Reporting Reform Act Of 1996. I also understand that a SLED check will be completed prior to my employment offer. Under the Code of Laws for SC, I understand I must comply with Title 40 Chapter 80 Section 40-80-20 of the Code of Laws of South Carolina for Employment of Firefighters.

I also understand I must supply a copy of my driver’s license and driving record for purposes of insurability to drive Reidville Area Fire District’s Emergency Apparatus.

If employed, I agree to engage in no outside activity which would involve a material conflict of interest with, or which could reflect adversely on Reidville Area Fire District (here after known as “the Company”). I understand this decision is to rest with the Company.

If employed, I agree to hold in strictest confidence any information concerning the Company which may come to my knowledge. In consideration of my employment, if I am employed, I agree to conform to the employment policies of the Company, and I understand that my employment and compensation can be terminated, with or without notice, at any time, at the option of either the Company or myself.

I understand that completion of this Application for Employment does not guarantee that I have been employed by the Company.

I hereby affirm that my answers to these statements and questions are true and correct to the best of my knowledge. I have not knowingly withheld any fact or circumstance that would, if disclosed, affect my application unfavorably.

I understand that any misrepresentation, deception, or false statement made in this Employment Application may result in my not being considered for employment, and if not discovered by the Company until after my becoming employed, is grounds for, and may result in, my immediate termination.

I understand that the Company requires the successful completion of a urinalysis for drug testing purposes and/or a blood alcohol test as a condition of employment. By submitting this Application for Employment, I hereby consent to either or both of said tests, at the Company's discretion.

I UNDERSTAND THAT THIS APPLICATION WILL REMAIN ACTIVE FOR SIX (6) MONTHS.

Signature

Date

COPIES CAN BE MADE OF ANY APPLICABLE CERTIFICATIONS AND ATTACHED TO THIS APPLICATION.