Bonita Springs Fire Control & Rescue District

Employment Application

BONITA SPRINGS Fire Control and Rescue District

EMPLOYMENT APPLICATION

27701 Bonita Grande Drive, Bonita Springs, FL 34135 - employment@bonitafire.org

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability, marital status, or other protected classifications.

BACKGROUND INFORMATION: All questions must be answered carefully and completely.

First name:

Last name:

Address:

City, State: ,

Postal code: -

Phone:

Are you legally authorized to work in the U.S. on an unrestricted basis? (Proof of identity and eligibility will be required upon employment):

Do you hold a valid Florida Driver's License:

Driver's License Number:

Are you at least 18 years old (If no, you may be required to provide authorization):

Position desired:

Have you worked for the Bonita Springs Fire District before:

Date available:

Can you work overtime, if nedded:

Are there any hours, shifts, or days you cannot or will not work:

Have you been told of the essential functions of the job or have you been shown a copy of the job description:

Can you perform these essential functions with or without reasonable accommodation:

Have you been convicted of a felony or a misdemeanor within the last seven years? (A conviction may not result in the denial of employment):

If yes, please explain:

EDUCATION: All areas must be answered carefully and completely.

EDUCATION	NAME/LOCATION OF SCHOOL	YEAR GRADUATED	MAJOR
High School
College
College
College

CERTIFICATIONS: What license or certification do you hold which would qualify you for this position with the District? Email all certificates and additional information to employment@bonitafire.org.

LICENSE OR CERTIFICATION	NUMBER	EFFECTIVE DATE	EXPIRATION DATE	LICENSING AGENCY

What further training, skills, or qualifications would qualify you for this position:

MILITARY HISTORY: All areas must be answered carefully and completely. Email your DD214 and any additional documentation to employment@bonitafire.org.

Military branch of service:

Rank at discharge:

Date of service from: to:

Military list of duties:

Are you claiming Veterans Preference: If yes, complete the section below.

I am a veteran with a service-connected disability who is eligible for or receiving compensation, disability retirement, or pension under public laws administered by the US Veterans Administration and the Department of Defense.

I am the spouse of a veteran who cannot qualify for employment because of a total and permanent disability, or the spouse of a veteran missing in action, captured, or forcibly detained by a foreign power.

I am a veteran of any war who has served on active duty for 180 consecutive days or more since January 31, 1955 and who was honorably discharged from the Armed Forces of the United States of America if any part of such active duty was performed during a wartime era, excluding active duty for training.

I am the un-remarried widow or widower of a veteran who dies of a service-connected disability.

I am the mother, father, legal guardian, or unremarried widow or widower of a service member who died as a result of military service under combat-related conditions as verified by the United States Department of Defense.

I am a Veteran as defined in Section 1.01 (14), Florida Statutes: The term ‘Veteran’ means a person who served in the active military, naval, or air service and who was discharged under honorable conditions.

I am a current member of any reserve component of the United States Armed Forces or The Florida National Guard.

NOTE: Under Florida Law, preference in appointment shall be given by the first to those persons included in 1 and 2 above, and second to those persons included in 3 and 4 above. If an applicant claiming Veterans Preference for a vacant position is not selected, he/she may file a complaint with the Department of Veterans' Affairs, PO Box 1437, St. Petersburg, FL 33731. A complaint must be filed within 21 days of the applicant receiving notice of the hiring decision made by the employing agency or within 3 months of the date the application is filed with the employer if no notice is given.

WORK EXPERIENCE: List below all present and past employment, for at least the past 10 years, beginning with your most recent employer. Include temporary and part-time jobs. If unemployed, or in school, include those dates. All time must be accounted for. Must have complete addresses:

May we contact your present employer:

Most recent employer:

Address:

Telephone:

Date started:

Date left:

Salary upon starting:

Salary upon leaving:

Starting title:

Leaving title:

Name/title of supervisor:

Description of duties:

Reason for leaving:

Previous Employer:

Address:

Telephone:

Date started:

Date left:

Salary upon starting:

Salary upon leaving:

Starting title:

Leaving title:

Name/title of supervisor:

Description of duties:

Reason for leaving:

Previous Employer:

Address:

Telephone:

Date started:

Date left:

Salary upon starting:

Salary upon leaving:

Starting title:

Leaving title:

Name/title of supervisor:

Description of duties:

Reason for leaving:

REFERENCES: Three references are required, excluding former employers or relatives. Fill out completely.

Name and occupation:

E-Mail address:

Telephone:

Name and occupation:

E-Mail address:

Telephone:

Name and occupation:

E-Mail address:

Telephone:

By clicking this submit application button, you hereby certify that the facts set forth in this Application for Employment are true and cpmplete to the best of your knowledge. You understand that if you are employed, false statements, omissions, or misrepresentations may result in your dismissal. Furthermore, you hereby authorize the District to conduct an investigation of any of the facts set forth in this application.

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