NO APPLICATION WIL BE CONSIDERED UNLESS ALL THE ABOVE ITMES ARE INCLUDED WITH THE APPLICATION (WHERE APPLICABLE)

Transcription

1 MUNCIE FIRE DEPARTMENT APPLICATION FOR EMPLOYMENT ATTACHMENT TO MUNCIE FIRE DEPARTMENT APPLICATION CITY OF MUNCIE, INDIANA EQUAL OPPORTUNITY EMPLOYER Prospective employees will receive consideration Without regard to race, sex, religion National origin, creed, color or disability MUNCIE FIRE DEPARTMENT APPLICATION INFORMATION Please submit the following items with your application by mail to Muncie Fire Merit Commission 300 North High Street, Muncie, Indiana These items must be postmarked by September 16, Copy of valid, non-suspended, non-expired, non-conditional, non-revoked driver s license. 2. High School transcript verified with a raised seal or a G.E.D. results verified with a raised seal. 3. Copy of High School diploma, or verification of G.E.D. 4. Birth certificate authenticated with a raised seal. 5. Copy of DD form-214 if you served time in any branch of military service. NO APPLICATION WIL BE CONSIDERED UNLESS ALL THE ABOVE ITMES ARE INCLUDED WITH THE APPLICATION (WHERE APPLICABLE) PLEASE READ CAREFULLY Minimum requirements to be considered for appointment to the Muncie Fire Department: All applicants: 1 Must b e a min imum o f twenty-one ( 21) years o f a ge a t t ime of application, but not yet thirty-six (36) years of age at time of appointment. 2 Must be a High School Graduate or have a G.E.D. 3 Must be a citizen of the United State of America prior to the date of making application. 4 Must become a resident of Delaware, Madison, Henry, Randolph, Jay, Blackford or Grant County, Indiana, upon appointment. 5 Must have and maintain a valid, non-suspended, non-expired, non-conditional, non-revoked driver s license. 6 Must keep the Merit Commission informed of address and telephone information changes if you want to remain on the list for appointment. 7 Must be able to perform the essential functions of the job of firefighter in a safe manner with or without a reasonable accommodation. 8 Must not ha ve be en f ound g uilty of a f elony i n a ny court w hich ha s n ot be en a nnulled, expunged or sealed by a court. 9 Must maintain in residence telephone service if appointed to the Muncie Fire Department. 10 Must show valid driver s license for identification at the aptitude testing location to participate. 11 Must be c ertified t o ha ve pa ssed t he C andidate P hysical A bility Test ( C.P.A.T.) b y t ime aptitude test is taken. Verification will need to be given at time of testing. (See for more information about C.P.A.T. testing and certification).

2 THIS APPLICATION WILL NOT CONSIDERED UNLESS FULLY COMPLETED MUNCIE FIRE DEPRTMENT CITY OF MUNCIE, INDIANA APPLICATION FOR EMPLOYMENT Equal Opportunity Employer Last Name First Name Middle Name Social Security No. Street Address (Incl. City, State & Zip Code) Telephone (Incl. Area Code) STATEMENT & AUTHORITY TO RELEASE INFORMATION (Read This Statement Carefully Before Completing This Application) I understand that I must satisfy or be able to satisfy all of the minimum requirements set forth on page 1 of this application form for my application to be considered by the Muncie Fire Merit Commission and I hereby certify that I have met or will be able to meet all requirements set forth by the Commission. I understand that i f I am employed, any misrepresentation or omission of any facts on this application i s sufficient cause for dismissal. My continued employment will depend upon the successful performance of work assigned t o m e a nd upo n t he c ontinued s uccessful pe rformance a nd the further need of m y c ontinued employment by the Fire Department of the City of Muncie, Indiana ( Fire Department ). The Fire Department, in c onsidering m y a pplication for e mployment, m ay v erify t he information s et forth o n this a pplication a nd obtain additional information relating t o m y ba ckground. I a uthorize a ll persons, schools, c ompanies, corporations, and State, Local and Federal agencies to supply any information concerning my background. I further agree to submit to alcohol and/or drug screening tests, if requested of me at any time prior to or during my employment. Date you can start work Apart from absence for religious observance, are you available To work at least 40 hours each work week? ( ) Yes ( ) No Will you work overtime if asked? ( ) Yes ( ) No

3 Give employment as completely as possible, starting with your present or last employer. For an unemployment or self-employed periods, show dates and locations. (Insert an additional sheet if necessary). If you have never been employed, list references in place of Company Name, and give their address and phone numbers. Company Name Address & Telephone Month Year Rate of Pay Title of Job Held/ Name of Supervisor Reason for Leaving From To Starting Final From To Starting Final From To Starting Final If currently employed, may we contact your employer for a reference at this time? ( ) Yes ( ) No Are you a United States citizen? ( ) Yes ( ) No Are you 21 years of age or order? ( ) Yes ( ) No

4 EDUCATION Name and Address of schools attended Graduate YES/NO High School Or G.E.D. Course of Study Dates Attended College Other Name & Type Describe any background experience, military service, education or training, which you consider applicable to the position for which you are applying.

5 Give the names and addresses of three (3) people (no relatives) you have worked with and to whom we may refer for a reference if necessary. Name: Telephone Number: Address: Occupation: City: State: Name: Telephone Number: Address: Occupation: City: State: Name: Telephone Number: Address: Occupation: City: State: Are you willing to submit to a Physical examination if required? ( ) No ( ) Yes Name and Address of personal physician: Have you ever been convicted of a crime, including misdemeanors and summary offenses, which have not been annulled, expunged or sealed by a court? ( ) No ( ) Yes If yes, please explain: Do you have a valid driver s license? ( ) No ( ) Yes If yes, please provide your driver s license number and the state you license was issued.

6 I certify that the information contained in this application is correct to the best of my knowledge, and understand that any misrepresentation of any facts, falsification or omissions on this application is grounds for disqualification from further consideration or is sufficient cause for dismissal from employment at the time the Muncie Fire Department discovers the omission or falsification. My continued employment will depend upon the successful performance of work assigned to me and upon the continued successful performance and the further need of my continued employment by the Fire Department of the City of Muncie, Indiana ( Fire Department. ). I understand that this application is good until the next application process begins (which is normally every two years). If I still desire a position with the Muncie Fire Department at that time, it will be my duty to fill out a new application and file it with the City of Muncie. Otherwise, I will not be considered for employment. I further agree to submit to alcohol and/or drug screening tests, if requested of me at any time prior to or during my employment. Date of Application Signature

7 AFFIRMATIVE ACTION SURVEY This data is for periodic government reporting and will be kept in an Affirmative Action file separate from the Application for Employment. This information is kept solely to help us comply with government record keeping, reporting and other legal requirements. Please fill out the Applicant Data Record. We appreciate your cooperation. Government agencies require periodic reports on the sex, ethnicity, disabled and veteran status of applicants. This data is for analysis and affirmative action only. Submission of the information is voluntary. Check one: ( ) Female ( ) Male Check one of the following: Race/Ethnic Group: ( ) White ( ) Black ( ) Hispanic ( ) American Indian/Alaskan Native ( ) Asian/Pacific Islander Check if any of the following are applicable: ( ) Handicapped Individual ( ) Disabled Veteran ( ) Vietnam Era Veteran Position(s) Applied For: Referral Source: ( ) Advertisement ( ) Friend ( ) Relative ( ) Walk-In ( ) Employment Agency ( ) Other

8 MUNCIE FIRE DEPARTMENT INFORMED CONSENT STATEMENT I,, consent to participate in the ladder climb testing phase of the Muncie Fire Department Applicant Process. I understand that the testing will involve the following: LADDER CLIMB The candidate, wearing a safety belt with a safety line and breathing apparatus (no face piece), is required to climb an aerial ladder extended 70 feet from the platform to the top at an angle of 70 degrees. The candidate must touch the top rung of the ladder and proceed down to the platform without undo hesitation. The candidate must complete this in no more than 3 minutes. I understand the engaging in the above-mentioned tasks may result in injury or dizziness, fainting, muscle cramping, chest pains, occasional disorder or heart beats, stroke and, very rarely, a heart attack. I understand that it is my responsibility during the test to tell the testing monitors of any occurrence of pain, fatigue, tingling, numbness or dizziness. I understand that I may discontinue the testing at anytime of my own will. I HAVE READ THE ABOVE INFORMATION AND I HAVE FULL UNDERSTANDING OF THE RISKS OF THE TESTING, WHICH ARE OUTLINED ABOVE. I REALIZE THAT THIS LIST IS NOT INCLUSIVE OF ALL POSSIBLE RISKS INVOLVED IN PARTICIPATING IN THE LADDER CLIMB TESTING. ANY QUESTIONS THAT I HAD HAVE BEEN ANSWERED TO MY SATISFACTION. I ACKNOWLEDGE RECEIPT OF A HEALTH RISK INFORMATION SHEET, WHICH IDENTIFIES HEALTH CONDITIONS WHICH MIGHT INCREASE MY RISK OF INJURY OR ILLNESS DURING THE LADDER CLIMB TESTING. I UNDERSTAND THAT TO CONTINUE TO PARTICIPATE IN THE LADDER CLIMB TESTING DESPITE WARNINGS PRESENTED ON THE HEALTH RIS INFORMATION SHEET IS AT MY OWN RISK. I ACKNOWLEDGE THAT MY BLOOD PRESSURE HAS BEEN ASSESSED. I UNDERSTAND THAT TO ENGAGE IN THE LADDER CLIMB TESTING WITH A BLOOD PRESSURE READING GREATER THAT 150/90 PUTS ME AT A GREATER RISK OR INJURY OR ILLNESS. PARTICIPANT SIGNATURE DATE

9 HEALTH RISK INFORMATION SHEET The following questions are designed to assess your ability to safely perform the ladder climb testing. These questions identify health risks which might increase your chance injury or illness (e.g., sprained or broken bones, bruises or contusions, nausea, dizziness, fainting, muscle cramping, chest pains, occasional disorder of heart beats, stroke, and very rarely, a heart attack) during the physical agility testing. Please consider your response to each of these questions in evaluating your own health risk before participating in any agility testing. Please note that it is not necessary for you to return this information sheet to the monitoring staff. This questionnaire is provided only for your personal knowledge and safety. 1.) Has your doctor ever said you have heart trouble? 2.) Do you frequently suffer from pains in your chest? 3.) Do you often feel faint or have spells of severe dizziness? 4.) Has a doctor ever told you that you have bone or joint problems, such as arthritis, that has been aggravated by exercise, or might be made worse with exercise? 5.) Is there a good physical reason not mentioned here why you should not follow an activity program, even if you wanted to? 6.) Have you ever had any physical problems arising from vigorous exercise?

10 MUNCIE FIRE DEPARTMENT INFROMED CONSENT STATEMENT BLOOD PRESSURE WAIVER I,, understand that prior to engaging in the ladder climb examination my resting blood pressure was assessed as being. I understand that this blood pressure reading is (circle one) greater than / less than 150/90. I understand that to engage in the ladder climb task with a blood pressure reading greater thank 150/90 puts me at a higher risk for injury or illness (e.g. sprained or broken bones, bruises or contusions, nausea, dizziness, fainting, muscle cramping, chest pains, occasional disorders or heart beats, stroke and, very rarely, a heart attack). I HAVE READ THE ABOVE INFORMATION AND I HAVE FULL UNDERTANDING THAT IF MY BLOOD PRESSURE WAS ASSESSED AS BEING GREATER THAN 150/90 THAT I AM AT GREATER RISK FOR INJURY OR ILLNESS DUE TO AN ELEVATED BLOOD PRESSURE READING. I UNDERSTAND THAT TO CONTINUE TO PARTICIPATE IN THE LADDER CLIMB TESTING WITH A BLOOD PRESSURE READING GREATER THAN 150/90 IS AT MY OWN RISK OF INJURY OR ILLNESS. PARTICIPANT SIGNATURE DATE

11 Dear Applicant: Thank you for applying for a position as a firefighter with the Muncie Fire Department. This letter contains important information about the written aptitude test, ladder climb, and You should read this letter carefully to be sure that you understand the procedures that will be used during the administration of these tests. The department has received more applicants than there are available positions. As a result, the department has established a competitive application process. This application process is designed to ensure that the selection of new recruits will be accomplished in a fair and objective fashion. The written aptitude test will be administered on Saturday, October 29, 2011 at Ivy Tech (4301 S. Cowan Road, Muncie). Park in the rear of the North building and enter the door with the canopy. The test will be administered in Rooms 532 and 534. Instructions for the study period will begin promptly at 9:00 a.m. Applicants who arrive after 9:00 a.m. may be excluded from the test session. Testing will conclude by approximately 1:30pm. The schedule for the written aptitude test is as follows: 15 minutes Instructions for Study Period 2 hours Study Period 30 minutes Break 15 minutes Instructions for Exam 1 ½ hours Examination A description of the written aptitude test procedures is presented on the following pages. Please examine these procedures to ensure that you fully understand them. Each applicant has the responsibility of informing the department of any difficulties or problems created by these procedures. Applicants who wish to report any concerns about these procedures should contact the department no later than one week prior to the examination date.

12 TESTING PROCEDURES A study session will begin immediately after the completion of the registration period. The instructions for the study session will be read aloud by a test monitor. During the study session, each applicant will be given two (2) hours to study a variety of printed materials. These materials will include printed text, line drawings, written instructions, and pictures. These study materials are the basis for the aptitude test that will be administered during the test session. Applicants are allowed to make written notes about the study materials. However, these notes must be written on paper that will be provided by the test monitor. Also, each applicant must turn in his/her notes to the test monitor at the conclusion of the study session. During the study session, you may take as many breaks as you would like. Please note, however, that these breaks will shorten the amount of time that you will have for studying. You may leave early from the study session. However, once you decide to leave from the study session you, must turn in your materials and you will not be allowed back until the registration period for the test. Applicants will be given a half hour break for lunch/snack. Lunch will not be provided. Instead, you should bring a snack. Applicants are responsible to return to the test site in time for the test instructions. The test session will begin with the re-registration of each applicant. Instructions for the test will be read aloud by the test monitor. The test will require that applicants read printed materials and record their answers on an optically scanned computer sheet. Applicants will be required to use a pencil to record their answers. You will have one and one half (1 1/2) hours to complete the written examination. All questions in the examination will be drawn directly from materials provided during the morning study session. You must learn the study materials presented during the morning to do well on the examination. Note this important instruction: You will not be allowed to take the exam if you did not attend and register for the morning study session. Do not bring notebooks or other study materials with you to the testing site. All necessary materials, including notepaper, will be provided to you.

13 Listed below are some tips that might help to make your test date more comfortable and successful: 1) Answer every question on the test, even if you have to guess - there is no penalty for guessing. 2) Take your time - there should be plenty of time in both the study session and the test period. 3) Bring a snack - food will not be provided. If you leave the test site during the scheduled break, you must return in time for the test instructions. 4) Arrange for transportation. 5) Listen carefully to the monitor's instructions. 6) Make certain that your answers are entered into the correct spaces on the answer sheet. 7) If you have trouble with a particular question, skip it and return to it later. 8) Be certain that you really understand the material in the Study Guide. 9) Get a good night's rest before the test. 10) Try to relax as much as possible during the test. Testing will take all day so be sure to wear comfortable clothing. Also, you should bring along picture identification such as a driver's license. Smoking will not be allowed in the study/examination room(s). However, applicants may take as many breaks as they wish during the study session...

14 The written examination for the application process consists of a study session, held on the day of the examination, and the examination itself.. a.) The study session, which will be held from 8:30am until 12:00pm on Saturday, October 29, 2011, is mandatory for all who wish to apply to be a firefighter. Applicants who are signed up to take the written aptitude test must attend the study session on Saturday, October 29, 2011 in order to remain eligible for the selection process. Ladder climb Information is also attached regarding the upcoming Applicant Ladder Climb. The Ladder Climb will be the first phase in the selection process. Applicants who intend to take the written aptitude test must first successfully complete the Ladder Climb. The Ladder Climb will be held on Saturday, October 8, 2011 from 9:00am to 12:00pm and 4:00pm to 6:00pm and Saturday, October 15, 2011 from 9:00am to 12:00pm and 4:00pm to 6:00pm. In case of adverse weather conditions, an alternative date Sunday, October 9, 2011 and Sunday, October 16, 2011 has been scheduled as rain dates for the ladder climb testing. Applicants will meet at Station # 2, 820 E. Memorial ave, Muncie for the ladder climb testing. If you need additional information, or wish to report a difficulty associated with the testing procedures, contact Deputy Chief Delk at (765) Sincerely, Muncie Fire Merit Commission