Resumes are not accepted in place of applications. Resumes may be submitted in addition to a completed application.

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Jodie Hamilton
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1 Employment, Volunteer & uxiliary membership application for the Swannanoa Fire Department pplication Revision 04/01/2004 he Swannanoa Volunteer Fire Department & Rescue Squad nc. s an equal opportunity employer and does not discriminate on the basis of sex, race, color, age, religion, handicap or nationality. Resumes are not accepted in place of applications. Resumes may be submitted in addition to a completed application. When applying for a full time position a cut off date for accepting applications will be set by the Swannanoa Fire Department board of directors. fter this date the applications will be reviewed and selected for interviews. Volunteer Firefighter applications are accepted daily and reviewed by the fficers, generally on the first Monday of every month for membership. uxiliary applications are accepted daily and reviewed by the leadership of the uxiliary, generally on the first hursday of every month for membership. ll applicants must complete each appropriate section (look at the left column throughout the application) of the application and complete the SVFD otification and Release statement, which is required for us to conduct your background check. Fire Department use only for Firefighter applications pplication received by: Date Gotice & release statement complete GCriminal Background check results attached Gll references contacted Reviewed on / / and was Gccepted GDelayed GRejected otified by: Reviewed on / / and was Gccepted GDelayed GRejected otified by: dditional: Fire Department use only for uxiliary applications pplication received by: Date Gotice & release statement complete GCriminal Background check results attached Gll references contacted Reviewed on / / and was Gccepted GDelayed GRejected otified by: Reviewed on / / and was Gccepted GDelayed GRejected otified by: dditional:

2 pplying for? Fire Chief aid Firefighter art-time aid Firefighter Volunteer Firefighter uxiliary Member C S U X ame: (ast) (First) (Middle) ge: Date of birth: / / Social Security umber: - -.C. Driver s icense number: Class: Street ddress: City: Zip Code: Mailing ddress: City: Zip Code: elephone umber (Home): (Work): (ager): Marital Status: ame of Spouse: Social Security umber: - - Spouse Employer: elephone umber (Work): nsurance Carrier: Children, ames & ges: Education High School ttended: ddress: City: Circle Highest Grade Completed: G.E.D College ttended: ddress: City: (Major): Graduate: es o ears ttended: ech College ttended: ddress: City: (Major): Graduate: es o ears ttended: ther Education (Explain): f you have ever been a member of another Fire department, Rescue Squad, paid or volunteer, list your immediate supervisors name, address and telephone number: While with this organization did you hold any type of officers rank, if so what rank and for how long?

3 D E S U X C S Specialized Fire & Rescue related raining & Experience Medical ther State? Exp. Date Fire Related ther State? Exp. Date Search & Rescue gency? G CR G C FF1 G SR ech evel G First id (RC) G C FF2 G SR evel G First Responder G C Driver perator G pen Water Diver G mb ttendant G C FF nstructor G dvanced Diver G WFR G C Fire nvestigator G Rescue Diver G WEM G C ER G Divemaster G C EM G C FS 1 G Dive nstructor G C EM-B G C FS 2 G Mantracking G C EM-D G C FS 3 G Managing Search G C EM-V G S-130, S-190 G C EM- G S-212 G C EM- G S-205, S-231 lso any other Fire/Rescue training that you would like to mention: G rintout of a training record is attached G Copies of certificates for the above training or other classes is attached ther specialized training, skills or experience that would be useful to the Fire Department ist other skills in blank spaces below the sections anguage abilities Computer skills echnical skills Spanish, Russian, French, German, Sign etc. Word processing, Web design, Databases, rogramming, Repair etc. Construction, Masonry, carpentry, roofing etc. Mechanical, Deisel, foreign or domestic, large vehicle etc

4 Employment history Current or most recent Company ame: Supervisor: ddress: City: Zip: elephone umber: Date Employed: Date Separated: itle of present or last position: Full ime: art ime: Full ime: ears Months art ime: ears Months Duties: Reason for leaving: he job before your Current or most recent Company ame: Supervisor: ddress: City: Zip: elephone umber: Date Employed: Date Separated: itle of present or last position: Full ime: art ime: Full ime: ears Months art ime: ears Months Duties: Reason for leaving: wo jobs before your Current or most recent Company ame: Supervisor: ddress: City: Zip: elephone umber: Date Employed: Date Separated: itle of present or last position: Full ime: art ime: Full ime: ears Months art ime: ears Months Duties: Reason for leaving: Have you ever been discharged, (Fired) from employment? Have you ever resigned (Quit) after being informed that your employer intended to discharge you? f you answered yes to the last two questions on the application, please give details:

5 Medical nformation F R E F G H E R U X General job expectations if applying for Firefighter Firefighter s will work with various equipment they wear, generally in the range of 50lbs or greater. he job demands a high mental & physical stress load that may have to be endured for long hours. hey work in extreme temperature ranges from below freezing temperatures to being in a structure fire. Some tools alone weigh as much as 70lbs and will require intricate placement and control. While on wildfires, they may be required to use long endurance and work in smoky conditions. hey are required to take classes for training and refer to certain manuals or paperwork for important information during calls. Body movements of almost every type, under stress, are required. Do you have any physical ailments, disabilities or other physical or mental attributes that may affect your participation in the description above. Ges (f so, give details below including certain accommodations that may be made by the FD) G o General job expectations if applying for uxiliary he auxiliary s purpose is to support the Fire Department during operations by supplying food and other items. he job may consist of carrying boxes of food, 5 gallon drink containers or other items. Do you have any physical ailments, disabilities or other physical or mental attributes that may affect your participation in the description above. Ges (f so, give details below including certain accommodations that may be made by the FD) G o re you currently taking any medications? G o aking it for: aking it for: aking it for: aking it for: aking it for: aking it for: Ges (f so, give details below)

6 General nformation How long have you lived in the Swannanoa Fire District? Do you have reliable transportation that will be immediately available to respond to perform duties? G es Go (f no, give details below) What times or days will you generally be able to perform duties for the Fire Department and what are any time limitations you may have? re you related to any member of the Swannanoa Fire Department? f yes, who: Do you belong to any civic, fraternal or professional organizations? G o Ges (f so, give details below) Have you ever been convicted in any courts, in any state or country (civil or military) of any Misdemeanor, Felony or any offense including traffic violations? f yes, give full details (ote:felony convictions are automatic reason for rejection) : re you a military veteran? Which Branch: Did you receive an honorable discharge? f no, please explain: re you subject to be called to active duty? re you presently in the reserves? Why do you want to be a member of the Swannanoa Fire Department?

7 References ist references other than relatives or members of the Swannanoa Fire Department who can verify your character, work experience and ability. ame: How do they know you? ddress: City: Zip: el. umber: ( ) ame: How do they know you? ddress: City: Zip: el. umber: ( ) ame: How do they know you? ddress: City: Zip: el. umber: ( ) Read the following paragraph carefully before signing this application. hereby declare that all statements on this application are true. false or dishonest answer to any question in this application may be grounds for not being accepted or dismissal after acceptance. ll statements made in this application are subject to investigation, including a check with law enforcement agencies and former employers. ll applicants (Except uxiliary) are subject to a complete physical examination as required by federal law. ll applications will become the property of the Swannanoa Fire Department. Signature of applicant: Date:

Fire Officers use only Application Revision 7/10/2013. Application received by: Date: / / Time: : What are you applying for? Relation?

Fire Officers use only Application Revision 7/10/2013. Application received by: Date: / / Time: : What are you applying for? Relation? Application for the Swannanoa Fire Department The Swannanoa Volunteer Fire Department & Rescue Squad Inc. is an equal opportunity employer and does not discriminate on the basis of sex, race, color, age,