Company Officer Application

Please select what position you are applying for (required)

Company Officer- Evans Valley Fire District #6

Company Officer - Applegate Fire District

Available Start Date (required)

Last Name (required)

First Name , Middle Initial (required)

Address (required)

Phone Number (required)

Email (required)

Driver's License Number (required)

State Issued (required)

Are you at least 18 years of age? (required)

Yes

Are you a citizen of the United States? (required)

Yes

If no, are you authorized to work in the United States (required)

Yes

Are you a current member of the Fire District? (required)

Yes EVFD #6

Yes AFD

If yes, please specify title

Have you been employed or volunteered with the Fire District? (required)

Yes- EVFD #6

Yes- AFD

If yes, please specify title and dates of employment

Provide names of any District members you are related to or with whom you live

Do you have a high school diploma ? (required)

Yes

If not a high school graduate, do you have a certificate of equivalency (GED)?

Yes

Date of GED

List all education beyond high school- Name and location ,Course of study ,Dates attended ,Credits completed , Degree earned (required)

List any special active certifications, technical skills, volunteer activities, military training or experience, or other training/activities related to the position you are seeking. For military veterans, please include information on any transferable skills obtained through military education or experience that relate directly or indirectly to the position for which you are applying. (required)

DPSST Number Issued, Expiration, Issue State (required)

CPR / AED: Number , Expiration, Issue State (required)

Emergency Medical Service (EMR, EMT, AEMT, EMT-I, Paramedic) : Number , Expiration, Issue State (required)

Do you speak a language other than English fluently?

Yes

If yes, which language(s)?

List all work experience, including military and volunteer, beginning with your current or most recent position. Briefly describe each position separately, emphasizing your specific tasks and supervisory, technical, or other responsibilities. Give special attention to experience relating to the position for which you are applying for. Account for any periods of unemployment or self-employment. If the space provided is not adequate, please attach additional sheets. (required)

Supervisor's Name and phone number (required)

Job Title of your current/last job? (required)

Begin Date - End Date (required)

Briefly describe your job duties (required)

Reason For Leaving (required)

May we contact for a reference? (required)

Yes

Reference #1 Please give the name and phone number of a professional or personal reference (required)

Reference #2 Please give the name and phone number of a professional or personal reference (required)

Reference #3 Please give the name and phone number of a professional or personal reference (required)

If your certifications are not from Oregon; What state issued your certifications?

Electronic Signing: By typing my full legal name below, I am certifying that all statements made in this application are true, and I agree and understand that any statement that is false, fraudulent, or misleading in this application or attached material, during the interview or screeninig process, or discovered during any employment-related process (post hire) may result in the revoking of a job offer or termination of employment.

The date you're submitting this application

I certify that all statements contained herein are true and complete. I understand that I must provide proof I am authorized to work in the United States, in accordance with federal law, if I am hired. I authorize the employing agency to verify the employment and education information provided in this employment application. I authorize my driving record to be checked if the position for which I am applying requires driving. I understand and agree to be subjected to a pre-employment drug screening and criminal history background check, if applicable. I am able to perform the essential duties of this position as advertised, with or without reasonable accommodations.

Yes

If No, Please explain:

Please Upload a copy of your Resume (required)

Please Upload a copy of your Cover Letter (required)

Please Upload a copy of your High School diploma or GED (required)

Please Upload a copy of your current Driver's License (required)

Please Upload a copy of your current Oregon EMT certification or higher (required)

Please Upload a copy of your NFPA Firefighter I certification with a Fire Pump ( Pumper Operator or equivalent) (required)

Please Upload a copy of your National Incident Management System certificate for IS-100

Please Upload a copy of your National Incident Management System certificate for IS-200

Please Upload a copy of your National Incident Management System certificate IS-700

Please Upload a copy of your NWCG Wildland FFT2 certification

Please Upload a copy of your NFPA Firefighter 2 certification

Please Upload a copy of your NFPA AEFP certification

Please Upload a copy of the Veterens' Preference Form (ORS 408.230)

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Before You Begin