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At this time we are hiring forSquad Personal EMT B, EMT I and Paramedic. Must have good Driving record and go thru a backround check.
Applications can be pickup at the Fire Station or printed off line below and sent to the station or dropped off.
Spirit of 76 Fire/EMS Department
53890 Key-Bellaire Road
Bellaire, Ohio 43906
Phone: 740-676-1551
Fax: 740-676-1608
Web Page: Spiritof76VFD.comcastbiz.net
EMPLOYMENT APPLICATION
Spirit of 76 Fire/EMS Department is an equal opportunity employer and does not discriminate against any individual
in any phase of employment in accordance with the requirements of local, state, and federal law.
**Incomlplete applications will not be processed**
Type of work desired:_____Full-time _____Part-time _____Casual _____Temporary
Application Date: ________________________ Date Available: _______________________
Position (s) Applied For 1. ____________________________ Salary Expectations $____________________
Position (s) Applied For 2. ____________________________ Salary Expectations $____________________
(We will not accept application unless there is a specified type of job listed.)
PERSONAL INFORMATION
Name: Last_____________________________ First____________________ Middle____________________
Previous Names: ________________________________________________
Social Security Number:__________ - __________ - __________
Present Address: (Number, street)_____________________________________________________________
City:_______________________________County:___________________State:_____________Zip Code:___________
Home Phone:_________________________________ Cell Phone:_____________________________________
Emergency Phone Home:____________________________ Work:_________________________________
1. Will you work overtime if required? ______ Yes ______ No
2. Is there any day or shift you can not work? _____________________________________________________
3. Have you ever applied for employment with Spirit of 76 Fire/EMS Department? ______ Yes ______ No
4. Have you ever been employed with Spirit of 76 Fire/EMS Department? ______ Yes ______ No
If so, When? _______________________ What position? _________________________________
5. If hired, can you furnish proof that you are legally entitled to work in the United States? ______ Yes ______ No
6. Do you have any relatives employed at Spirit of 76 Fire/EMS Department? ______ Yes ______ No
7. Can you furnish proof that you are of legal age to perform the job for which you are applying? ______Yes ______No
8. Are you licensed to drive a car? ______ Yes ______ No
Is the license valid in this state? ______ Yes ______ No
9. Have you ever been convicted of a crime within the last seven (7) years? (Answer "no" for expunged and sealed
records or minor traffic offenses) If yes, give more information:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. Are you currently awaiting trail for a felony? ______ Yes ______ No (A conviction or pending trail will not
disqualify you from the position for which you are applying.)
11. Have you ever been terminated / dismissed from a former position or job? _____Yes _____No If yes, please
explain the details including names of employers: _____________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
12. How did you find out about a position? ___________________If referred, who referred you? _________________
EDUCATION RECORD / BACKGROUND
1. High School (s) ________________________________________No. of Years _______________________
Location _____________________________________________ GPA ___________
Graduate? _____Yes _____No Degree or Certificate Fields or Major/Minor____________________________
2. College (s) or Universities ________________________________No. of Years _______________________
Location _____________________________________________ GPA ___________
Graduate? _____Yes _____No Degree or Certificate Fields or Major/Minor____________________________
3. Business or Trade Schools (including military) ________________No. of Years_______________________
Location _____________________________________________ GPA ___________
Graduate? _____Yes _____No Degree or Certificate Fields or Major/Minor____________________________
4. Special Course or Other Training __________________________No. of Years________________________
Location _____________________________________________ GPA ___________
Graduate? _____Yes _____No Degree or Certificate Fields or Major/Minor____________________________
EMPLOYMENT HISTORY (Show most recent first)
1. Employer__________________________________________ Type of Business_____________________________
Address_________________________________City________________________ State________ Zip___________
Phone_________________________ Dates of employment (month / year) From__________ To__________
Beginning Salary___________________________ Ending Salary___________________________
Title (s) and responsibilities_________________________________Supervisor's Name______________________
Reason (s) for leaving (or reason you wish to leave) __________________________________________________
____________________________________________________________________________________________
2. Employer__________________________________________ Type of Business_____________________________
Address_________________________________City________________________ State________ Zip___________
Phone_________________________ Dates of employment (month / year) From__________ To__________
Beginning Salary___________________________ Ending Salary___________________________
Title (s) and responsibilities_________________________________Supervisor's Name______________________
Reason (s) for leaving (or reason you wish to leave) __________________________________________________
____________________________________________________________________________________________
3. Employer__________________________________________ Type of Business_____________________________
Address_________________________________City________________________ State________ Zip___________
Phone_________________________ Dates of employment (month / year) From__________ To__________
Beginning Salary___________________________ Ending Salary___________________________
Title (s) and responsibilities_________________________________Supervisor's Name______________________
Reason (s) for leaving (or reason you wish to leave) __________________________________________________
____________________________________________________________________________________________
PROFESSIONAL LICENSES AND/OR CERTIFICATIONS
Are you currently: ______Registered ______Licensed ______Certified
Eligible for: ______Registration ______Licensure ______Certification
IF LICENSED, REGISTRATION, OR CERTIFIED:
Type_______________ National/State Issued ______________ Date/Expiration__________ Number____________
Type_______________ National/State Issued ______________ Date/Expiration__________ Number____________
Type_______________ National/State Issued ______________ Date/Expiration__________ Number____________
Has your license, registration or certification ever been suspended or revoked? ______ Yes ______ No
If yes, please explain: ____________________________________________________________________________
______________________________________________________________________________________________
GENERAL
List any special skill or interest you have (typing, shorthand, mechanical, computer software, etc.)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Please give any additional information which you feel would be helpful in evaluating your qualifications or employment:
________________________________________________________________________________________________
________________________________________________________________________________________________
I authorize the employers, organizations, and personers stated on this application to give Spirit of 76 Fire/EMS/Transport
Department (including all related entities) any and all information (except information which cannot be obtained as a
matter of law) and records concerning my previous employment and education, and I release said employers,
organizations or persons from all claims and damages arising out of the provision of this information and/or records
to Spirit of 76 Fire/EMS/Transport Department.
I acknowledge that, if hired, my employment will be at will and therefore can be terminated with or without cause,
and with or without notice, at any time, at the option of either Spirit of 76 Fire/EMS/Transport Department or myself.
I also understand that Spirit of 76 Fire/EMS/Transport Department at its sole discretion, may alter, amend or eliminate
its existing employment policies, procedures, practices, compensation systems and other privileges and benefits at
any time, with or without cause and/or notice (except where notice is required by law).
Applicant's Signature:_____________________________________________________Date______________________
