Deputy Fire Chief / Fire Marshal

Position of Interest

Position Applying For (required)

Date of Application (required)

Date available to start (required)

Resume (required)

Personal Information

Name (required)

Phone Number (required)

Email Address (required)

Full Street Address (required)

Drivers License Number (required)

State Issued (required)

Expiration Date (required)

Have you ever been convicted of a felony?

Yes

If yes, please explain

Have you ever previously been employed by North Davis Fire District? (required)

Yes

If yes, when?

Do you have any relatives employed with the North Davis Fire District? (required)

Yes

If yes, please list their names.

Do you possess a work permit? (required)

Yes

Some jobs have age requirements. Are you 18 years or older? (required)

Yes

Are you currently employed? (required)

Yes

If so, may we contact your current employer? (required)

Yes

Special Skills or Certifications

Have you graduated from an accredited college with an associates degree in Fire Science or BS in Business Administration? (required)

Yes

If yes, please upload degree

Do you have five years progressively responsible for a fire inspection and public fire education program? (required)

Yes

Which Department(s)?

Do you have residency within ten miles of the NDFD boundary? (required)

Yes

Do you have four years of firefighting experience? (required)

Yes

Which Department(s)?

Do you have five years supervisory experience at a Captain of Battalion Chief Level? (required)

Yes

Please upload your drivers license (required)

Do you have your Utah State Fire Officer 1 certification? (required)

Yes

Please upload certification

Do you have your Incident Command and Control Certification? (required)

Yes

Please upload certification

Do you have your Utah State Fire Inspector 1? (required)

Yes

Please upload certification

Do you have your Utah State certified FF/1 1? (required)

Yes

Please upload certification

Do you have your Level II Utah HazMat? (required)

Yes

Please upload certification

Are you a certified Fire Investigator?

Yes

Please upload certification

Are you a National or Utah State certified Paramedic or AEMT? (required)

Yes

Please upload certification

Please upload any additional certifications (may need to combine files if not enough room)

Education

Which high school did you attend? (required)

School's full address (required)

Did you attend college? If so, which one? (required)

College Address

Do you have a degree? If so, in what? (required)

Other education

Employment History

Company 1 (required)

Position (required)

Company's Address (required)

Employment Dates (required)

Supervisor's Name and Phone Number (required)

Reason for Leaving (required)

Responsibilities (required)

May we contact your previous supervisor/employer for reference? (required)

Yes

Company 2 (required)

Position (required)

Company's Address (required)

Employment Dates (required)

Supervisor's Name and Phone Number (required)

Reason for Leaving (required)

Responsibilities (required)

May we contact your previous supervisor/employer for reference? (required)

Yes

Company 3 (required)

Position (required)

Company's Address (required)

Employment Dates (required)

Supervisor's Name and Phone Number (required)

Reason for Leaving (required)

Responsibilities (required)

May we contact your previous supervisor/employer for reference? (required)

Yes

References

Full Name (required)

Relationship (required)

Employer (required)

Phone Number (required)

May we contact this reference? (required)

Yes

Full Name (required)

Relationship (required)

Employer (required)

Phone Number (required)

May we contact this reference? (required)

Yes

Full Name (required)

Relationship (required)

Employer (required)

Phone Number (required)

May we contact this reference? (required)

Yes

Disclaimer and Signature

I certify that the information contained in this application is correct to the best of my knowledge, and I understand that falsification of this information or information given in an interview is grounds for refusal to hire or if hired, dismissal. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. I authorize you to request and receive such information. I understand that this application will remain active only for the time period in which the position I applied for remains open. I authorize investigation of all statements contained in this application and an investigation of my background, including any and all criminal history records and driver’s license history. I understand that the findings of the investigation may or may not may or may not bar me from employment with the North Davis Fire District. (Please type your name) (required)

Date Signed (required)

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