APPLICATION FOR EMPLOYMENT
Fill out the Information below to Submit Your Application.

Position:  

First Name:    Last Name:

Middle Initial:

Date of Birth:

Social Security Number:

State: Driver's License Number:

Street Address:

Address 2:

City:   State:  

Zip Code:

Country:

Home Phone *include area code*:

Cell Number:

E-mail Address:


EDUCATION:

High School  
High School Name & Location:

Years Attended:

Did You Graduate?:

College
 College Attended & Location:

Years Attended:

Did You Graduate?:

Trade, Business or Correspondence School  
Name & Location:

Years Attended:

Did You Graduate?:


JOB RELATED TRAINING
List All South Carolina Fire Academy, National Fire Academy, or NFPA Course Numbers

Certification 1:

Certification 2:

Certification 3:

Certification 4:

Certification 5:

Certification 6:

Certification 7:

Certification 8:

Certification 9:

Certification 10:


Desired Employment:

Date You Can Start: Salary Range Desired:

Are You Employed Now: Yes No

May We Inquire Your Present Employer: Yes No

Employed Date:

Reason For Leaving:

How Did You Hear About US?

Have You Ever Been CONVICTED Of A Criminal Offense Where Punishment Could Exceed
Imprisonment For More Than Six Months Or A Fine Of More Than $500.00?
Yes No

If Yes, Please Explain:

Specialized Training NOT Listed Above:
 

Other Courses and Seminars (Business, Computer, Management etc):
 

Reference 1 (List Name, Address, Telephone):
 

Reference 2 (List Name, Address, Telephone):
 

Reference 3 (List Name, Address, Telephone):

SERVICE RECORD:
 IN THE SPACE BELOW LIST MILITARY HISTORY (INCLUDING BRANCH OF SERVICE, DISCHARGE DATE, AND RANK)

PERSONAL INFORMATION:
IN THE SPACE BELOW EXPRESS YOUR HOBBIES AND INTEREST:

NARRATIVE:
 IN 150 WORDS OR LESS TELL US WHY YOU WOULD LIKE TO WORK FOR OUR DISTRICT, AND HOW YOU WOULD BE AN ASSET TO OUR DISTRICT.

READ CAREFULLY BEFORE SUBMITTING

     I CERTIFY THAT ALL MY ANSWERS IN THIS EMPLOYMENT APPLICATION ARE TRUE AND COMPLETE TO MY BEST KNOWLEDGE, AND I UNDERSTAND THAT THIS APPLICATION WILL REMAIN ACTIVE FOR NINETY (90) DAYS ONLY.
     I AUTHORIZE THE BELMONT FIRE & SANITATION DISTRICT TO INVESTIGATE AND VERIFY MY ANSWERS AND I GIVE SAID DISTRICT PERMISSION TO CONTACT SCHOOLS, PREVIOUS EMPLOYERS, REFERENCES, AND OTHERS IN ITS INVESTIGATION.  I RELEASE THE DISTRICT AND THE PARTY PROVIDING THE INFORMATION FROM ANY LIABILITY FOR THIS PURPOSE.
     I ALSO AUTHORIZE THE DISTRICT TO SECURE FINANCIAL AND CREDIT INFORMATION THROUGH A CONSUMER REPORTING AGENCY, AND I UNDERSTAND THAT, UPON MY WRITTEN REQUEST MADE WITHIN A REASONABLE TIME, THE CONSUMER REPORTING AGENCY WILL PROVIDE ME WITH ADDITIONAL INFORMATION CONCERNING THE NATURE AND SCOPE OF ANY CREDIT REPORT INVESTIGATION.  I ALSO AGREE TO PARTICIPATE IN ANY ASSESSMENT TESTING, PHYSICAL FITNESS TESTING, AND A HEALTH SCREEN PHYSICAL, AND ANY OTHER DISTRICT REQUIREMENTS WHICH ARE CONDITIONS OF EMPLOYMENT.
     I UNDERSTAND THAT ANY FALSE OR MISLEADING ANSWERS IN THIS EMPLOYMENT APPLICATION OR OTHER PRE-EMPLOYMENT INQUIRY IS GROUNDS FOR REJECTION OF MY APPLICATION OR IMMEDIATE TERMINATION IF I HAVE BEEN EMPLOYED.
     IF EMPLOYED, I WILL COMPLY WITH ALL DISTRICT POLICIES AND RULES FOUND IN THE DISTRICT POLICY MANUAL, EMPLOYMENT HANDBOOK,  OR OTHER COMMUNICATIONS FROM THE DISTRICT.  I UNDERSTAND THE DISTRICT MAY CHANGE ITS POLICIES AND RULES IN THE FUTURE WITHOUT GIVING NOTICE TO ME.
     I UNDERSTAND THAT THE DISTRICT REQUIRES DRUG TESTING AND ALCOHOL TESTING AS A CONDITION OF EMPLOYMENT, SUBJECT TO APPLICABLE FEDERAL AND STATE LAWS, AND I CONSENT TO ANY SUCH TESTING.
     I UNDERSTAND THAT EMPLOYMENT WITH THE DISTRICT WILL BE  TERMINABLE AT WILL. THAT NO EMPLOYMENT CONTRACT PROVIDING FOR ANY EMPLOYMENT OTHER THAN "AT WILL" EMPLOYMENT WILL BE VALID UNLESS MADE IN WRITING AND SIGNED BY THE DISTRICT'S BOARD OF COMMISSIONERS, AND THAT MY EMPLOYMENT MAY BE ENDED AT ANY TIME, INCLUDING THE PROBATIONARY PERIOD FOR ANY REASON, BY ME OR THE DISTRICT.  IF EMPLOYED I FURTHER UNDERSTAND THAT MY FIRST NINETY (90) DAYS ARE A PROBATIONARY PERIOD (WHICH MAY BE EXTENDED AT THE DISTRICTS DISCRETION) TO DETERMINE WHETHER MY EMPLOYMENT IS DESIRED.


        I HAVE READ AND UNDERSTAND THE ABOVE:      Yes No

Date: