Please Print and Return the following application if you are interested in joing Westside Fire and Rescue Department.

APPLICATION
WESTSIDE VOL. FIRE AND RESCUE DEPARTMENT INC.

(PLEASE PRINT) DATE:__________________

Name in full:
Last________________________First________________Middle__________________

Present Address__________________________________________________________

City________________________State____________________Zip_________________

Present Mailing Address__________________________________________________

City________________________State____________________Zip_________________

Telephone(____)_________________Social Security Number____________________

Date of Birth__________________Sex:_________Place of Birth__________________

N.C. Drivers License #___________________________Class_____________________

Name of friends or relatives in our employment_______________________________

Are you an American citizen?_______________

Were you ever in Military Service?_______________What branch?______________

Have you ever been convicted in court of any offense other than minor traffic violations?_______If yes, give details_______________________________________

RECORD OF EXPERIENCE
Prior Fire Dept. experience

Name of Fire Dept.____________________________Chief_______________________

Address________________________________________________________________

City____________________________State_________________Zip________________

Phone # (____)_________________

List any special skills you posses and machines you can use_____________________________________________________________________________________________________________________________________________________________________________________________________________________
EDUCATION


SCHOOL (Circle highest grade completed) Years of college completed
1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8


Name Address Date attended Did you Degrees Major course
From to graduate received of study

Elementary_________________________________ Y / N xxxxxx xxxxxxxx

Middle School________________________________ Y / N xxxxxx xxxxxxxx

High School__________________________________ Y / N xxxxxx xxxxxxxx

College________________________________________________________________

University or Professional__________________________________________________

Other Schools or courses___________________________________________________


CHARACTER REFERENCES

Do not list more acquaintances, previous employers or relatives. Refer to persons who know you well, either personally or in business.

Name Address Phone Occupation

1._____________________________________________________________________

2._____________________________________________________________________

3._____________________________________________________________________

4._____________________________________________________________________

5._____________________________________________________________________








PREVIOUS EMPLOYMENT

Start with your present position and work back.
Please complete all information.


Name of Company___________________________Title of Position________________

Address of Company_______________________________________________________

Type of business_______________Description of work___________________________

Dates of Employment: From________________To_________________

Number of people supervised by you_______Employer’s phone #___________________

Name and Title of immediate supervisor_______________________________________

Remarks:________________________________________________________________________________________________________________________________________



Name of Company___________________________Title of Position________________

Address of Company_______________________________________________________

Type of business_______________Description of work___________________________

Dates of Employment: From________________To_________________

Number of people supervised by you_______Employer’s phone #___________________

Name and Title of immediate supervisor_______________________________________

Remarks:________________________________________________________________
________________________________________________________________________




Name of Company___________________________Title of Position________________

Address of Company_______________________________________________________

Type of business_______________Description of work___________________________

Dates of Employment: From________________To_________________

Number of people supervised by you_______Employer’s phone #___________________

Name and Title of immediate supervisor_______________________________________

Remarks:________________________________________________________________
________________________________________________________________________


Summarize briefly below other experiences or qualifications
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________