Mission Statement. Job Requirements:

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2 Amherst Fire Department Office of the Chief 414 Church Street Amherst, Ohio (440) Station (440) Fax Web Site: Mission Statement To save lives, reduce injuries and economic loss, to preserve the safety and well being of all Amherst Citizens and adjoining areas with cost effective service oriented methods. Job Requirements: You must be 21 years of age You must pass a physical examination, driver s license check and criminal background check. You must complete a 56-hour training course during the first year probationary period. You must be willing to sacrifice a lot of your time learning all aspects of the fire service. You must be available to respond to emergency calls when not working at you regular job. You will be required to attend regular training classes during the month, also any additional trainings that are required. Please take into consideration that this job can be extremely dangerous. The job can be very time consuming, particularly during the first year of employment. We are a very committed and proud organization. The citizens we protect count on us giving 100% to their safety and protection. This job requires a huge commitment on your part, if you are willing to do so then complete this application.

3 EMPLOYMENT APPLICATION City of Amherst Fire Department 414 Church Street Amherst, OH (440) IMPORTANT INSTRUCTIONS It is extremely important that you answer all questions completely and accurately. You may attach a resume or other documentation. The information in this application will be used to determine the applicant s qualifications prior to further consideration. Date of Application: TYPE OR PRINT IN INK address: First Name Middle Name Last Name Address Apt/Lot # City State Zip Social Security # Driver s License # Expiration Date: Home Phone # Business Phone # Business Fax # Cellular Phone # ( ) ( ) ( ) ( ) If necessary, the best time to call you at home is : am pm May we contact you at work? yes no Are you now employed by the City of Amherst or County of Lorain? yes no If yes, Class No. & Title: Department: Years Employed: Have you been convicted by any court, including military court, of any offense? yes no If Yes, please explain each offense, the violation, court, place of conviction, penalty (fine, sentence and date of court probation, if applicable), and name under which convicted of other than that listed above, and any record which has been sealed or expunged by the court. Conviction is not necessarily a bar to employment. Each case is given individual consideration based on job-relatedness of the offense.

4 In case of an emergency: List name and phone numbers of three (spouse, relative, or friend) to be contacted: Name Home Number / Work Number Relationship Name Home Number / Work Number Relationship Name Home Number / Work Number Relationship Personal References: List name and phone number of three personal references not related to you: Name Home Number Years Known Name Home Number Years Known Name Home Number Years Known Motor Vehicle Driving Record Check yes or no to the following questions. The City of Amherst Fire Department will check driving records for all applicants. All members driving records are checked periodically. (See charts below for conviction explanations). Have you had more than one at-fault traffic accident in the past three years? yes no Have you had more than two minor driving convictions in the past three years? yes no Have you ever had a major driving conviction in the past seven years? yes no MAJOR CONVICTIONS Driving while intoxicated or under the influence of alcohol or drugs. Failure to stop and report an accident. Homicide, manslaughter or assault arising out of the operation of a motor vehicle. Driving while license is suspended or revoked. Reckless driving, negligent driving, careless driving. Possession of opened container of alcoholic beverages. Speed contest, drag racing, or attempting to elude an office of the law. Making a false accident report. Driving while impaired. MINOR CONVICTIONS Any moving traffic citation received which is not listed as MAJOR CONVICTION. Do not check YES in the minor conviction column for the following items: Motor vehicle equipment, load or size requirements. Improper display or failure to display license plates. Failure to sign or display registration card. Failure to have in possession a valid driver s license. AT FAULT ACCIDENT Defined as: Any accident where the driver is designated as having caused the accident,

5 or negligently contributed to its occurrence. Educational Background School Name Number of Years Completed Degree Earned Additional Training List any additional training relating to the position you are applying for. For example (EMT certification, Fire certification, etc.) Please attach copies of certificates. Type of Training Name of Training Institution Certification Earned Date of Training Public Safety History List the name of any public safety department or group you have been employed by or volunteered for. Name of Organization Dates Supervisors Name Organization Phone Number Military Service Record Branch Dates of Duty From to Discharged Honorable (copy of discharge certificate) Other List duties and/or special training Employment History Provide the following information for your past and present employers, starting with most recent. Employer Address To / From Job Title Verification: Inquiry may be made of your employers or schools attended. May we contact your present employer? Yes No If No state reason:

6 Certification of Applicant: (READ CAREFULLY) I hereby certify that all statements made in this application are true and complete to the best of my knowledge. I understand that any false, incomplete, or incorrect statement may result in my disqualification or dismissal from employment with the City of Amherst Fire Department. I give the Amherst Fire Department the right to contact and obtain information from all references, employers, and/or educational institutes, and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the Amherst Fire Department and its representatives for seeking, gathering and using such information, and all other persons, corporations, or organizations for furnishing such information. The Amherst Fire Department does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law. Signature of Applicant Date NOTICE: Completed application subject to public disclosure per Ohio House Bill 9 (September 2007) without additional notice to you. For Office Use Only Interview Date: / / Interview Time: : am / pm Members Present: Probation Begins: / / Probation Ends: / /