Application

Your Personal Information

Name(Required)

First Middle Last

Aliases

List any other names you have used or been known by (include maiden name).

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone Number

Business Phone Number

Cellular Phone Number(Required)

Email Address(Required)

Enter Email Confirm Email

Driver's License #(Required)

Driver's Class(Required)

Are you legally able to work in the United States?(Required)

No

Yes

Do you currently possess a State of Illinois EMS license?(Required)

No

Yes

License Type(Required)

License Number:(Required)

Expiration Date:(Required)

Employment History

List all jobs you have held for the last ten years. Include periods of unemployment. Put your present or most recent job first. Include military service in proper time sequence along with temporary or part-time jobs.

Your Previous Employers(Required)

Please list your previous employers, the dates you worked and the position you held. Put your present or most recent job first. Use the + icon on the right hand side to add additional rows.

Employer

Job Description

Supervisor's Name

Supervisor's Email

Do you object to us contacting them?

Reason for leaving?

Salary

Paid Per

Start Date

End Date

Have you ever been suspended or terminated, other than from an economic layoff, from any prior employment?(Required)

No

Yes

Please Explain(Required)

Have you ever resigned from any employment position because of misconduct or unsatisfactory performance or while under investigation?(Required)

No

Yes

Please Explain(Required)

Are you currently on any fire department eligibility list(s)?(Required)

No

Yes

Eligibility Lists(Required)

Use the + icon on the right hand side to add additional rows.

Position Applied For

Status on List

List Expiration Date

References

Please list three adults not related to you and not former employers, who have known you for more than three years. All persons to whom you refer will be asked to apprise your character, ability, experience, personality, and other qualities.

‎(Required)

Use the + icon on the right hand side to add additional rows.

Name

Email Address

Cell Phone Number

Business Phone Number

Occupation

Relationship

Emergency Contacts

Please list two emergency contacts.

‎(Required)

Use the + icon on the right hand side to add additional rows.

Name

Address

Phone Number

Relationship

Acknowledgements

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. This organization is committed to the policy of equal employment opportunity in recruitment, hiring, career advancement, and all other personnel practices. Your job-related experience and other qualifications will be considered without discrimination on the grounds of race, color, religion, sex, national origin, age, or physical or mental handicap. All information provided in this application will be treated confidentially and will be used only to help assure the best use of your abilities if you are employed with us.

Identification(Required)

Prior to employment, all applicants must produce a valid driver's license or state identification card, a social security card, and one document listed below:

A birth certificate issued by the State Department, Form FS-545

A birth certificate issued abroad by the State Department, Form DS-1350

An original or certified copy of a birth certificate issued by a state, county or municipal authority, bearing a seal

Native American tribal documents

A United States citizen identification card, INS Form I-197, or

An identification card for use of a resident citizen in the United State INS Form I-179

Upload Driver's License or State Identification Card(Required)

Front & Back.

Drop files here or