Application Step 1 of 7 14% Rochester Volunteer Fire Company 31020 Academy Rd. Burlington, WI 53105 Telephone:(262) 534-3444 Email:firechief@rochestervolunteerfd.com Website:https://rochestervolunteerfd.com Application for Employment The Rochester Volunteer Fire Company is an equal opportunity employer. All hiring, promotion practices and other terms and conditions of employment shall be maintained and conducted in a manner which does not illegally discriminate on the basis of age, race, creed, political, or religious affiliation, color, disability, marital status, gender, sexual orientation, national origin, ancestry, or any of the protected classes covered under federal law (race, color, religion, sex (including pregnancy and sexual harassment) and national origin) or under state law (race, color, religious observation or practice, sex, national origin, ancestry, age, creed, marital status, sexual orientation, sexual harassment, membership in the National Guard, state defense force, or any reserve component of the military force of the United States or this state, use or nonuse of lawful products off the employer’s premises during non-working hours, unfair honesty testing and genetic testing). Please note that some felony convictions may preclude the applicant from being awarded a license by the State of Wisconsin.Answer all questions completely. Incomplete applications may be rejected. If you are physically unable to fill out this application, you may request reasonable accommodations in completing the form.Name* First Middle Last Maiden Nameif applicable.Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Length of time at current address.*in years. Schooling Attended* High School or GED College Business or Trade School Professional School High SchoolName*Address* City State / Province / Region Graduated* Yes No Graduation Date*MM/YYYYCollegeName*Address* City State / Province / Region ZIP / Postal Code Field of Study/Degree*Graduated* Yes No Graduation DateAdd Another* Yes No Additional CollegeName*Address* City State / Province / Region ZIP / Postal Code Field of Study/Degree*Graduated* Yes No Graduation DateBusiness/Trade SchoolName*Address* City State / Province / Region ZIP / Postal Code Field of Study/Degree*Graduated* Yes No Graduation DateAdd Another* Yes No Additional Business/Trade SchoolName*Address* City State / Province / Region ZIP / Postal Code Field of Study/Degree*Graduated* Yes No Graduation DateProfessional SchoolName*Address* City State / Province / Region ZIP / Postal Code Field of Study/Degree*Graduated* Yes No Graduation Date Employment InformationAre you legally eligible for employment in the U.S.?* Yes No Have you previously been employed by RVFC?* Yes No Position(s) applied for:* Firefighter EMR EMT AEMT Paramedic/EMS RN Are you interested in:* Volunteer Part-time Select all that apply.How many hours are you looking to work each week?Please enter a number from 1 to 32.Maximum of 32 hours for part-time.The Rochester Volunteer Fire Company has implemented a ride-a-long program for new/perspective members. The ride-along program will be a length of 30 days for applicants who are already licensed EMT's or Firefighters in the State of Wisconsin, and a minimum of 90 days for non certified applicants. Part-time (up to 32 hours a week) and Volunteer positions are also available. Background Check InformationFull Name*Current Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Social Security Number*Date of Birth* Month Day Year Phone*Email* 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:NOTE: A conviction record or pending arrest record does not constitute an automatic bar to employment and will be considered only if there is substantial relationship to the circumstances or of the particular position or if the employer deems there is a bona fide occupational qualification inherent in the position which requires this information prior to hiring.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 DateI certify to the best of my knowledge and belief, that the answers given by me to all questions on this application and attachments are true, correct, complete and without any significant omissions, and I recognize that this information is subject to verification. I understand any omission or misrepresentation of fact in the application may result in refusal of acceptance of my application for membership and in termination of membership with the Rochester Volunteer Fire Company. I also understand that I will be asked to submit to a physical exam as part of my application process for membership. I understand that the physical examination and testing for drugs will be done by an independent laboratory selected by Foothills Fire & Rescue and that the results of the physical exam will be given to representatives of Rochester Volunteer Fire Company for the purpose of evaluating my eligibility for membership. As an applicant for membership, I hereby authorize Rochester Volunteer Fire Company and its agents to contact any third parties (including current and previous employers, schools, credit bureaus, licensing authorities, motor vehicle departments, governmental agencies, and individuals familiar with my background to obtain information which is deemed necessary or appropriate in connection with my application and qualifications for membership. This information may include, but is not limited to, references, academic background, performance, disciplinary, attendance, personal history, consumer credit, motor vehicle and criminal conviction records. I hereby release Rochester Volunteer Fire Company, its employees and agents and any individual, entity or agency they may contact from any claims arising from making or responding to such requests for information. By Checking this box, I consent to a full background check based in the information in this application.* I agree I disagree Work ExperienceWork 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 informationUpload a resumeAccepted file types: doc, docx, pdf, Max. file size: 1 GB. Upload a resume in Word (.doc) or .PDF format only. Maximum size 33mb. Wisconsin State Certifications:Do you have Wisconsin State Certifications in Fire or EMS?* Yes No Choose all that apply* Wisconsin State Certified EMR Wisconsin State Certified EMT Wisconsin State Certified AEMT Wisconsin State Certified Paramedic Firefighter 1 Firefighter 2 Driver/Operator Pumper Driver/Operator Aerial Fire Inspector Fire Officer 1 Fire Officer 2 Fire Officer 3 Fire Instructor 1 Fire Instructor 2 Fire Instructor 3 Wisconsin EMS License Number* 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 SignedSection Break
