Columbus Day News

TOWN OF INGLIS FIRE RESCUE APPLICATION FOR EMPLOYMENT (Please Print) Date: Name (Last, First, Middle Initial): Social Security #: Present Address: E-Mail Address: How Long? Previous Address: How Long? Telephone No.: Cell Phone No.: Are you over the age of 18 years? Yes No Have you ever filed an application with this company before? Yes No If yes, give date Are you now employed? Yes No If so, may we inquire of your present employer? Yes No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment. Yes No On what date would you be available for work? Position applied for: Rate of pay expected: EDUCATION School Name and Address of School Course of Study Years Completed High School College Vocational Other MILITARY Have you ever been in the Armed Forces? Yes No Are you now a member of the National Guard? Yes No Branch of Service: Rank: If yes, give dates: From: To: List duties: Are you subject to being called back into active military service? Yes No EXPERIENCE List below all present and past employment, starting with your most recent employer. Employer Dates Employed From To Address Salary Position Reason for Leaving Employer Dates Employed From To Address Salary Position Reason for Leaving Employer Dates Employed From To Address Salary Position Reason for Leaving Do you have any other experience, skills, or qualifications, which you feel would especially fit you for work with this company? Summarize special job-related skills and qualifications: List professional, trade, or civic activities and offices held: You may exclude memberships that would reveal race, color, religion, sex, national origin, age, ancestry, handicap, or other protected status. REFERENCES Give name, address, and telephone number of three references who are not related to you and are not previous employers. Name Address Telephone Number Name Address Telephone Number Name Address Telephone Number In case of emergency, who should be notified? Name Address Telephone Number Driver’s License Number State Certifications: Yes No Have you ever been convicted of a felony? If yes, explain: Answering yes to this question does not necessarily disqualify you from employment. The Town of Inglis is an Equal Opportunity Employer. We do not discriminate on the basis of race, religion, color, sex, age, national origin, or disability. I certify that all the information provided in this application is true and complete to the best of my knowledge, and I authorize the company to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries connected with my application, and I specifically authorize the release of information by any school, employer, or health care provider, listed in my application. In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules of the company. Signature of Applicant Date DO NOT WRITE BELOW THIS LINE Hired Yes No Date Employed Department Position Salary/Wage By Approved Department Head Date Approved Mayor Date