Darien Fire Rescue

Site Updated

January 1, 2010

City of Darien, Georgia

CITY OF DARIEN FIRE DEPARTMENT

Employment Application

“An Equal Opportunity Employer”

(PLEASE PRINT)

Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, marital or

veteran status, or disability

Date of Birth:_____________________ Date of Application:____________________

Position(s) Applied For:_________________________________________________________________________

Referral Source:____ Advertisement:____ Friend:____ Relative:____ Employment Agency:____ Other:______

************************************************************************************************

Name:_______________________________________________________________________________________

Last First Middle

Address:_____________________________________________________________________________________

Number Street City State Zip Code

Telephone #:(________)________________________________ Social Security #:________-_______-________

Area Code

Are you over the age of 18? ________ Yes ________ No

Have you filed an application before? ________ Yes ________ No Date:___________

Have you ever been employed here before? ________ Yes ________ No Date:___________

Are you a citizen of the United States or are you

Legally authorized to work in the United States? ________ Yes ________ No

Are any of your relatives employed by the City? ________ Yes ________ No

If yes, list name(s):____________________________________________________________________________

Have you been convicted of a felony? ________ Yes ________ No

If yes, explain:_______________________________________________________________________________

___________________________________________________________________________________________

Answer these questions only if the job for which you are applying requires a drivers license.

Do you have a valid driver’s license? ________ Yes ________ No

If yes, give driver’s license number, state & expiration:_______________________________________________

EMPLOYMENT EXPERIENCE

Full and accurate phone numbers are required

List each job held. Start with your present or last job. Include military service assignments and volunteer activities.

(Exclude groups which indicate race, color, religion, sex, national origin or disability.)

Employer                                     Telephone

Dates

Work Performed

    From

To

Address

Job Title

Salary

   Starting

Final

Supervisor

Reason for Leaving

Employer                                     Telephone

Dates

Work Performed

From

To

Address

Job Title

Salary

Starting

Final

Supervisor

Reason for Leaving

Employer                                     Telephone

Dates

Work Performed

    From

To

Address

Job Title

Salary

   Starting

Final

Supervisor

Reason for Leaving

Employer                                     Telephone

Dates

Work Performed

From

To

Address

Job Title

Salary

Starting

Final

Supervisor

Reason for Leaving

If you need additional space, please continue on a separate sheet of paper.

Please list any skills and qualifications required from employment or other experience:______________________

____________________________________________________________________________________________

REFERENCES: Give the names of three persons not related to you, whom you have known at least one year.

COMPLETE AND ACCURATE DAY TIME PHONE NUMBERS ARE REQUIRED.

Name

Address

Telephone #

Years Acquainted

1

2

3

EDUCATION

High School

College/ University

Graduate/ Trade Professional

School Name

Years Completed:

    9      10      11      12

      1        2        3        4

       1         2        3        4

Diploma / Degree

Describe Course of Study:

Describe Specialized

Training, Apprenticeship,

Skills and Extra-Curricular

Activities:

Honors Received:

AGREEMENT

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application, including a driver’s license and any

Criminal background checks, as may be necessary in arriving at an employment decision.

________________________________________________________________________________________________

Signature of Applicant Date