Rock Hill Fire
Corp.
Employment
Application
Personal
Information
Last
Name______________________ First Name_________________ M.I.________
Present
Address ________________________________________
________________________________________
________________________________________
Social
Security Number__________________________________
Phone
Numbers
Home
__________________________________
Work
__________________________________
Cell
__________________________________
Pager
__________________________________
email __________________________________
Driver’s
License
State
________CDL? Yes__NO_ Number___________________________
Class
______________________
Expires ___________________________
Is
there anything preventing you from getting a CDL? NO___ YES___(explain)
_______________________________________________________________________
Date
of Birth _______/_____/________
U.S. Citizen YES_____
NO_________
Education
High
School________________________ Did you graduate?
YES___ NO___
If NO, highest
grade completed:
___________________
College____________________________________
Graduate? YES___ NO___
If NO, highest
grade completed:___________________
Other
Education (list)_______________________________________________
__________________________________________________________________
__________________________________________________________________
Service Record
Branch
of Service:_______________________ Discharge Date _____________
Are
you presently a member of National Guard or Reserves?
Yes___ NO___
If
Yes, describe your obligations:_____________________________________
Have
you ever been convicted of any crime? NO____ YES_____ (explain)_________
__________________________________________________________________
__________________________________________________________________
Employment
History: (present or
most recent first)
Previous
Employer_______________________________________________
Address _______________________________________________
________________________________________________
Phone number________________________ Contact______________
Starting date______________ Leaving Date_____________________
Reason for leaving___________________________________________
Job Title __________________________________________________
Duties_____________________________________________________
Previous
Employer_______________________________________________
Address _______________________________________________
_______________________________________________
Phone number________________________ Contact______________
Starting date______________ Leaving Date____________________
Reason for leaving__________________________________________
Job Title __________________________________________________
Duties_____________________________________________________
Previous
Employer________________________________________________
Address _______________________________________________
________________________________________________
Phone number________________________ Contact_______________
Starting date______________ Leaving Date_____________________
Reason for leaving___________________________________________
Job Title ___________________________________________________
Duties_____________________________________________________
Employment
Desired
Position
applying for:_________________________ Desired pay:___________
Date
you can start work: _____________________________
Training
(check any received and date completed)
FF1
Structure_________________________
FF2
Structure_________________________
First
Responder________________________
EMT_________________________________
Paramedic
____________________________
NWCG
FF1 __________________________
NWCG
FF2 __________________________
Single
Resource Boss___________________
engine____ crew_____ other_______
Strike
Team Leader_____________________
Training
continued;
Division
Supervisor______________________
ARFF
_________________________________
Intermediate
Fire Behavior _______________
Advanced
Fire Behavior __________________
Urban
Interface _________________________
Sawyer
_________________ level ___________
Helitack
________________________________
Pumps
__________________________________
Ignition
Specialist ________________________
IC
type (____) ___________________________
Other
__________________________________
__________________________________
__________________________________
List
any other additional skills that you may have
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Fire
Fighting Experience: list most recent first, location, days worked, job duties,
employer, etc. in the following blank space.
References
Please
give the names of 3 persons not related to you that you have known at least 3
years.
Name
___________________________________________
Business
_________________________________________
Phone
# __________________________________________
Name
___________________________________________
Business
_________________________________________
Phone
# __________________________________________
Name
___________________________________________
Business
_________________________________________
Phone
# __________________________________________
Essay
Question #1
Briefly
describe the importance of teamwork and describe why it may be important to a
Company like Rock Hill Fire.
Essay
Question #2
Briefly
describe why you want to be a wildland firefighter and tell us of any goals you
have for yourself, whether fire related or not.
Emergency
Contact Information;
Please
list the names, addresses, and phone numbers of someone you would want us to
contact in case of emergency;
1.
Name ________________________________________
address _______________________________________
________________________________________
phone # ________________________________________
relationship _____________________________________
2.
Name ________________________________________
address _______________________________________
________________________________________
phone # ________________________________________
relationship _____________________________________
I
certify that the facts contained in this application are true and complete to
the best of my knowledge, and if employed, falsified statements shall be grounds
for dismissal.
________________________________________________
___________________
signature
date
Return this
document via US mail to:
Rock Hill Fire Corp.
6520 Fredenberg Lake Rd
Duluth, MN 55803
Be sure to
include copies of all certificates of wildland classes attended.
Engine boss positions and higher should photocopy and include task books.
Also include
2 ID type photos of yourself, not
larger than 1”x1”