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Rochester Volunteer Fire Company

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Application

Step 1 of 5

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Rochester Volunteer Fire Company

Application for Employment
Name*
First Middle Last
Maiden Name

if applicable.
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Length of time*

at current address.
Social Security Number*
Phone*
Date of Birth*
Month
Day
Year
Email*
Position Applied for (Volunteer and/or Part-time)*
How many hours are you looking to work each week? (If applying for part-time)
Please enter a number less than or equal to 100.
Days Available*
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Sunday
Start Time*

: Hours

Minutes

Start Time
End Time*

:

End Time
Monday
Start Time*

:

Start Time
End Time*

:

End Time
Tuesday
Start Time*

:

Start Time
End Time*

:

End Time
Wednesday
Start Time*

:

Start Time
End Time*

:

End Time
Thursday
Start Time*

:

Start Time
End Time*

:

End Time
Friday
Start Time*

:

Start Time
End Time*

:

End Time
Saturday
Start Time*

:

Start Time
End Time*

:

End Time

Background
Have you ever been convicted of a crime?*
- No
- Yes
If yes, explain below number of conviction(s), nature of offense(s), leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:
Do you have a drivers license?*
- No
- Yes
Drivers License Number*
State Issued*

State your drivers license is issued in (two letter abbreviation).
Expiration Date*

Drivers License Expiration Date

Work Experience
Work Experience: Please list your work experience for the past five years beginning with your most recent job held. You can upload a resume if necessary.
Business/Employer Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Business Phone*
Supervisor Name*
Employment Dates*

If still employed at this business, please state "present" as the ending date.
Pay / Salary*
Reason for Leaving*
Job Duties*
May we contact this employer
- No
- Yes
Enter Another Job*
- No
- Yes
Business/Employer Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Business Phone*
Supervisor Name*
Employment Dates*
Pay / Salary*
Reason for Leaving*
Job Duties*
May we contact this employer
- No
- Yes
Enter Another Job*
- No
- Yes
Business/Employer Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Business Phone*
Supervisor Name*
Employment Dates*
Pay / Salary*
Reason for Leaving*
Job Duties*
May we contact this employer
- No
- Yes
Do you have additional Job information to enter?*
- No
- Yes
Additional Job information
Upload a resume
Accepted file types: doc, docx, pdf, Max. file size: 100 MB.
Upload a resume in Word (.doc) or .PDF format only. Maximum size 33mb.

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

I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or persons from all liability in responding to inquiries in connection with my application.

In the event I am employed. I understand that false or misleading information given in my application or interview(s) may result in discharge.
Signature*

By typing my name in the line above, I understand that it constitutes my signature and I am agreeing to the statement above.
Date Signed
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