RESERVE FIREFIGHTER. Timber Mesa Fire and Medical District Attn: Jo Baird 3561 E Deuce of Clubs Show Low, AZ 85901

Similar documents
PINETOP FIRE DISTRICT EMPLOYMENT APPLICATION

Reserve Firefighter EMT/ Reserve Firefighter Paramedic

Aumsville Rural Fire Protection District 490 Church St, Aumsville, OR Phone: Fax:

FIRE DEPARTMENT POSITION DESCRIPTION. Class Title: Volunteer Fire Chief

TIMBER MESA FIRE AND MEDICAL DISTRICT. Inviting Applications For Deputy Chief of Operations

Central Arizona Fire and Medical Authority (928) E Yavapai Road EMPLOYMENT APPLICATION

DATE: May 21, RE: Job Posting Refuse Driver/Loader

CITY OF RED BLUFF INVITES APPLICATIONS FOR $12.00/HR TO $14.50/HR

COLUMBUS RURAL FIRE DISTRICT #3

Big Sky Fire Department P.O. Box Big Sky, Montana (406)

City of Coquille JOB DESCRIPTION. Position: Firefighter/Paramedic. Salary Range: $40,128 to $51,204. Fire/Ambulance, Regular, Full-Time

Verde Valley Fire District 2700 E Godard Road Cottonwood, AZ Telephone: (928) Fax: (928)

Draft POSITION DESCRIPTION. Class Title: Public Information Officer. Salary: (E8) $49, $61, Approved Date:

OSHTEMO FIRE & RESCUE DEPARTMENT

2.5 inch Supply/Attack Hose Assembly and Deployment 1.75 inch Charged Attack Line Deployment and Fire Stream Manipulation

CITY OF TAFT. Works under the general supervision of the Police Chief or his/her designee.

POLICE OFFICER (PART-TIME AND FULL-TIME) Performs police patrol, investigation, traffic regulation, and related law enforcement activities.

ADMINISTRATIVE ASSISTANT PART - TIME

City of Jacksonville

CITY OF LYNDEN JOB OPPORTUNITY

EMPLOYMENT APPLICATION PROCESS DISPATCHERS

POSITION DESCRIPTION. Class Title: Code Enforcement Specialist Department: Code Enforcement Grade Number: 57 Date: 4/24/13

TITLE: Captain CATEGORY: Professional FLSA STATUS: Exempt GRADE: I (Law Enforcement)

Position Description Firefighter/Paramedic

Woodburn Fire District

Firefighter/CEP Eligibility List

Employment Application

MAMMOTH LAKES POLICE DEPARTMENT

SANITARY DISTRICT OF MICHIGAN CITY, INDIANA APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer

AJO UNIFIED SCHOOL DISTRICT #15 P.O. Box 68, 111 Well Road Ajo, Arizona APPLICATION OF SUPPORT STAFF

JOB OPENING ANNOUNCEMENT

REFINERY TERMINAL FIRE RTFC POSITION DESCRIPTION

Kootenai County Fire & Rescue

City of Lakeland Position Description

Job Title: Parking Lot Attendant

490 Church St, Aumsville, OR Phone: Fax: APPARATUS MAINTENANCE POSTING

7. Conduct professional presentations at local seminars and meetings and perform other duties as assigned.

CENTENNIAL WATER & SANITATION DISTRICT JOB DESCRIPTION

Frenchtown Rural Fire District An Equal Opportunity Employer Position Description

Community Development Division Director Recruitment

APPLICATION FOR EMPLOYMENT

The City of Whitefish, Montana is seeking a Water Plant Operator II for the Public Works Department. This full-time non-exempt position requires:

Grundy County Housing Authority Employment Application

SUPERINTENDENT OF PUBLIC WORKS

EMPLOYMENT OPPORTUNITY

EMPLOYMENT APPLICATION AN EQUAL OPPORTUNITY EMPLOYER

EMPLOYMENT OPPORTUNITY. Animal Shelter Volunteer Job #9750 Closes: Open Until Filled

CITY OF WAUPUN APPLICATION FOR EMPLOYMENT

CALLEGUAS MUNICIPAL WATER DISTRICT JOB DESCRIPTION

State College of Florida, Manatee-Sarasota Job Description

APPLICATION FOR EMPLOYMENT

City of Oak Creek. Location: Police Station. Summary Description

Evansdale Fire Rescue Position Description

KENDALL COUNTY HIGHWAY DEPARTMENT

Public Works Director

This application will be kept on file for one year. It is the applicant s responsibility to ensure that a current application is on file.

EMPLOYMENT OPPORTUNITY PARK RANGER (PART-TIME) Hourly Rate: $ $20.69

5. Ensure that all EPCC vehicles have current inspection, insurance, and registration documents.

JOB DESCRIPTION. JOB TITLE: Firefighter FLSA: Non-Exempt DEPARTMENT: Fire GRADE: 228 REPORTS TO: Fire Chief DATE: 10/26/2017

Kittitas County Fire District 7 POSITION DESCRIPTION

D~r;arr rj~!!! --- " Employment information packet for all firefighter applicants.

POSITION DESCRIPTION. TITLE: Assistant Director for Military and Veteran CATEGORY: Professional. FLSA STATUS: Exempt GRADE: E

POSITION DESCRIPTION GENERAL PURPOSE

State College of Florida, Manatee-Sarasota Job Description

State College of Florida, Manatee-Sarasota Job Description. Trades Worker II- Small Engine Mechanic

WSI CASED HOLE SPECIALIST 4668 FM 1607 Snyder, Texas (325) APPLICATION FOR EMPLOYMENT

4. Act as a liaison with faculty, departments, and local agencies to provide

CHEROKEE COUNTY APPLICATION FOR EMPLOYMENT

EMPLOYMENT APPLICATION AN EQUAL OPPORTUNITY EMPLOYER

2. Provide leadership in the development of goals and objectives for instructional long range planning.

PERSONAL DATA EMPLOYMENT DESIRED GENERAL INFORMATION

M E M O R A N D U M JOB APPLICANT FOR WYTHEVILLE FIRE DEPARTMENT

M E M O R A N D U M JOB APPLICANT FOR WYTHEVILLE FIRE DEPARTMENT HUMAN RESOURCES DEPARTMENT

2016 FIREFIGHTER SELECTION ENNIS FIRE DEPARTMENT

4. Direct engineering consultants in the development of plans and specifications. 10%

APPLICATION FOR EMPLOYMENT

Employment Application This is a Drug-Free Workplace Offering Equal Employment Opportunities

City of Millbrook Utility Department Wastewater Operator Grade III

NORTH TAHOE PUBLIC UTILITY DISTRICT JOB DESCRIPTION OPERATIONS MAINTENANCE WORKER I/II

State College of Florida Job Description

JOB DESCRIPTION. JOB TITLE: Firefighter/Paramedic FLSA: Non-Exempt DEPARTMENT: Fire GRADE: 233 REPORTS TO: Fire Chief DATE: 6/7/2017

EMPLOYMENT OPPORTUNITY. RECREATION COORDINATOR (Adult Kickball) Hourly Rate: $10.51 Closes: Open Until Filled

Application for Employment Suwannee County Board of County Commissioners An Equal Opportunity Employer

APPLICANT INFORMATION - READ VERY CAREFULLY

POSITION DESCRIPTION. TITLE: Associate Vice President, Instruction and Student CATEGORY: Administrative. FLSA STATUS: Exempt GRADE: F

EMPLOYMENT APPLICATION

State College of Florida Job Description

APPLICATION FOR EMPLOYMENT

POSITION DESCRIPTION

APPLICATION FOR EMPLOYMENT

PERSONAL DATA Last Name: First: Middle: Today s Date: City: State: ZIP: Primary Telephone: Secondary Telephone: Address:

Summit Fire District. Highlands Fire District

EMPLOYMENT APPLICATION

ALL APPLICATIONS ALONG WITH REQUIRED DOCUMENTS MUST BE TURNED IN AT TIME OF APPLICATION

CITY OF SAUK RAPIDS Application for Employment

Revised: August 29, 2018 Last Reviewed: Union: AFSCME Status: Full-time

Y of WEST SAN GABRIEL VALLEY APPLICATION for EMPLOYMENT (AN EQUAL OPPORTUNITY EMPLOYER)

POSITION DESCRIPTION. TITLE: Assistant Director, Veterans Resource Center CATEGORY: Professional FLSA STATUS: Exempt GRADE: D

Transcription:

RESERVE FIREFIGHTER A UNIQUE OPPORTUNITY! Timber Mesa Fire and Medical District (TMFMD) and Pinetop Fire District (PFD) invite applications for the shared position of Reserve Firefighter EMT or Paramedic (CEP). This is a great opportunity to become a valuable member of a dynamic team serving the communities of Pinetop, Lakeside, Show Low and Linden. Located in the beautiful White Mountains in eastern Arizona, both TMFMD and PFD are dedicated to consistently providing superior emergency fire/medical, safety and education services for our customers spanning a 200+ square mile area. AN OVERVIEW OF THE JOB The Reserve Firefighter EMT/CEP performs a variety of duties which have been identified in the complete job description provided below. The salary range for the position is $10.00 during the training phase. After the training phase, the salary range for a Qualified Reserve Firefighter (EMT) is $13.38; Qualified Reserve Firefighter (CEP) is $15.28). Continued employment as a Qualified Reserve is dependent upon successful completion of the reserve training program. This is a part-time position with limited benefits that include educational assistance, uniform allowance, and employee assistance. THE IDEAL CANDIDATE The ideal candidate for the position of Reserve Firefighter EMT/CEP will have a working knowledge as a Firefighter EMT/CEP that is familiar with fire district and/or fire department operations. The candidate must have the ability to work independently, or in a company, communicate effectively and work collaboratively with other District personnel and members of the public. THE APPLICATION PROCEDURE Interested applicants must submit a cover letter, resume, completed application (available on Timber Mesa Fire and Medical District website) and proof of completed qualifications with supporting educational transcripts to: Timber Mesa Fire and Medical District Attn: Jo Baird 3561 E Deuce of Clubs Show Low, AZ 85901 Closing date/time for submission of the required application documents is July 7, 2017 @ 5:00 p.m. Applications received after the deadline shall not be considered. Those applicants whose qualifications are deemed best suited for the position will be contacted for an oral interview and basic skills assessment. Applicants will be subject to a pre-employment drug screening and a background check. Questions in regards to the Reserve Firefighter program should be directed to: Brian Plumley

Division Chief 928-537-5100 bplumley@timbermesafire.org TIMBER MESA FIRE MEDICAL DISTRICT JOB DESCRIPTION RESERVE FIREFIGHTER EMT or PARAMEDIC GENERAL SUMMARY: Engages in all forms of community risk reduction which includes responding to alarms and protects life and property by performing firefighting, medical services, hazard control and other duties as assigned. Maintains fire and medical equipment, apparatus, and facilities. SUPERVISION RECEIVED: Works under the supervision of a Fire Captain, or his/her assigned representative in the absence of the Fire Captain but will be evaluated and managed by the Division Chief of Training. ESSENTIAL DUTIES AND RESPONSIBILITIES: Responds to emergency calls and public service calls as dispatched within the TMFMD and on mutual aid assignments. Provides basic life support and first aid treatment in accordance with Arizona laws, Arizona Department of Health Services rules and regulations, regional protocols, and base hospital directions. Drives or attends to patients within departmental ambulance or rescue transport vehicles. Performs firefighting activities including driving fire apparatus, operating pumps and related equipment, laying hose, and performing fire combat, containment, extinguishments and overhaul. Performs salvage operations including throwing salvage covers, sweeping water, and removing debris. Completes necessary paperwork and documentation as required on calls for service. Writes reports accurately and in a timely manner, documenting incident data, patient assessment and patient treatment. Receives fire and/or emergency medical calls and alarms. Operates radio and other communication equipment. Participates in inspections of buildings, hydrants and other structures in pre-plans. Performs general maintenance work in the upkeep of fire and emergency medical equipment, apparatus, and facilities. Presents programs to public on safety, emergency medicine, and fire prevention and suppression topics. Participates in fire drills, and attends classes in firefighting, emergency medical service, and other related areas. Maintains required certifications in fire and emergency medicine. Maintains positive working relationships. MINIMUM QUALIFICATIONS: 18 years of age or older High school diploma or G.E.D. equivalent Valid Arizona Driver s License Arizona Firefighter I and II certification or equivalent Arizona Emergency Medical Technician or Paramedic or ability to attain (NREMT) Ability to acquire and maintain Wildland Red Card as a Firefighter II or higher Hazardous Materials First Responder Awareness and Operations certification

Speak, read, and write the English language Meet TMFMD physical standards Meet insurability requirements of the District s insurance carrier Meet TMFMD residency requirements as set forth in policy KNOWLEDGE, SKILLS, AND ABILITIES: Working knowledge of fire suppression and prevention principles fire behavior and characteristics emergency medical and rescue techniques and their applications District geography, streets, and water supply locations Ability to apply standard firefighting and emergency medical techniques follow verbal and written instructions function effectively in emergency situations handle the arduous physical requirements of the job under stressful and adverse conditions take effective decisive actions under stressful and adverse conditions effectively communicate in both written and verbal format establish and maintain effective working relationships with fellow employees and members of the public PHYSICAL DEMANDS: The physical demands described are representative of those that must be met by all personnel to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with qualifying disabilities to perform the essential functions. The position requires the individual to meet NFPA and OSHA standards for the wearing of selfcontained breathing apparatus. While performing the duties of this job, personnel are frequently required to stand, sit, walk, talk, hear, use hands to finger, handle or operate objects, tools or controls, and reach with hands and arms. Personnel are frequently required to climb or balance, stoop, kneel, crouch, crawl, and smell. Personnel must be able to frequently lift and/or move up to 50 pounds and occasionally lift and/or move up to 150 pounds. Specific vision abilities required by this job include close, distance, color, and peripheral vision, depth perception, and the ability to adjust focus. WORK ENVIRONMENT: The work environment characteristics described here are representative of those personnel encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office, vehicle or outdoor setting in all weather conditions, including temperature extremes at all times of day and night. Work is often performed in emergency and stressful situations. Personnel are exposed to sirens and hazards associated with fighting fires and rendering emergency medical assistance, including infectious substances, smoke noxious odors, fumes, chemicals, liquid chemicals, solvents and oils. Personnel occasionally work near moving mechanical parts and in high, precarious places and are occasionally exposed to wet and/or humid conditions, fumes or airborne particles, toxic or caustic chemicals, radiation, risk of electrical shock and vibration. The noise level in the work environment is usually moderate, except during certain firefighting or EMS activities when noise levels may be loud. The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. The job description does not constitute an employment agreement between the District and employee and is subject to change by the District as the needs of the District and requirements of the job change.

JOB DESCRIPTION POSITION TITLE: TYPE: REPORTS TO: FLSA STATUS: CLASSIFICATION: WORK SCHEDULE: Firefighter / EMT Appointment Fire Captain Non-exempt Sworn Safety Sensitive Position Full-Time (Typically a 56-hour shift schedule, but subject to administrative assignment on a 40-hour work week) or Reserve (no guaranteed hours; provides backfill as needed) GENERAL SUMMARY: Responds to alarms and protects life and property by performing firefighting, emergency medicine, hazard control and other duties as assigned. Maintains fire and emergency medical equipment, apparatus, and facilities. Upholds District mission and values. SUPERVISION RECEIVED: Works under the supervision of a Fire Captain, or his/her assigned representative in the absence of the Fire Captain. ESSENTIAL DUTIES AND RESPONSIBILITIES: Responds to emergency calls and public service calls as dispatched within District coverage areas and on mutual aid assignments. Provides basic life support and first aid treatment in accordance with Arizona laws, Arizona Department of Health Services rules and regulations, regional protocols, and base hospital directions. Drives or attends to patients within departmental ambulance or rescue transport vehicles as required. Performs firefighting activities including driving fire apparatus, operating pumps and related equipment, laying hose, and performing fire combat, containment, extinguishments and overhaul. Performs salvage operations including throwing salvage covers, sweeping water, and removing debris. Operates and cares for self-contained breathing apparatus. Completes necessary paperwork and documentation as required on calls for service. Writes reports accurately and in a timely manner, documenting incident data, patient assessment and patient treatment. Receives fire and/or emergency medical calls and alarms. Operates radio and other communication equipment in accordance with District policies and procedures. Participates in inspections of buildings, hydrants and other structures in pre-plans.

Performs general maintenance work in the upkeep of fire and emergency medical equipment, apparatus, and facilities. Presents programs to the public on safety, emergency medicine, and fire prevention and suppression topics. Participates in fire drills, and attends classes in firefighting, emergency medical service, and other related areas. Maintains required certifications in fire and emergency medicine. Maintains positive working relationships with coworkers, supervisors, members of the public and neighboring agencies. Performs all other duties as assigned. MINIMUM QUALIFICATIONS: 18 years of age or older High school diploma or G.E.D. equivalent Valid Arizona Driver s License Arizona Firefighter I and II certification or NFPA 1001 equivalent Arizona or National Registry Emergency Medical Technician or Paramedic Wildland Red Card certification as a Firefighter II or higher Hazardous Materials First Responder certification Speak, read, and write the English language Meet PFD physical standards Meet insurability requirements of the District s insurance carrier Meet PFD residency requirements as set forth in policy KNOWLEDGE, SKILLS, AND ABILITIES: Working knowledge of fire suppression and prevention principles fire behavior and characteristics emergency medical and rescue techniques and their applications District geography, streets, and water supply locations Ability to apply standard firefighting and emergency medical techniques follow verbal and written instructions function effectively in emergency situations handle the arduous physical requirements of the job under stressful and adverse conditions take effective decisive actions under stressful and adverse conditions effectively communicate in both written and verbal format establish and maintain effective working relationships with fellow employees and members of the public PHYSICAL DEMANDS: The physical demands described are representative of those that must be met by all personnel to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with qualifying disabilities to perform the essential functions. The position requires the individual to meet NFPA and OSHA standards for the wearing of selfcontained breathing apparatus. While performing the duties of this job, personnel are frequently required to stand, sit, walk, talk, hear, use hands to finger, handle or operate objects, tools or controls, and reach with hands and arms. Personnel are frequently required to climb or balance, stoop, kneel, crouch, crawl, and smell. Personnel must be able to frequently lift and/or move up to 50 pounds and occasionally lift and/or move up to 150 pounds. Specific vision abilities required by this job include close, distance, color, and peripheral vision, depth perception, and the ability to adjust focus. WORK ENVIRONMENT:

The work environment characteristics described here are representative of those personnel encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office, vehicle or outdoor setting in all weather conditions, including temperature extremes at all times of day and night. Work is often performed in emergency and stressful situations. Personnel are exposed to sirens and hazards associated with fighting fires and rendering emergency medical assistance, including infectious substances, smoke noxious odors, fumes, chemicals, liquid chemicals, solvents and oils. Personnel occasionally work near moving mechanical parts and in high, precarious places and are occasionally exposed to wet and/or humid conditions, fumes or airborne particles, toxic or caustic chemicals, radiation, risk of electrical shock and vibration. The noise level in the work environment is usually moderate, except during certain firefighting or EMS activities when noise levels may be loud. The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. The job description does not constitute an employment agreement between the District and employee and is subject to change by the District as the needs of the District and requirements of the job change. TIMBER MESA FIRE & MEDICAL AND PINETOP FIRE DISTRICTS EMPLOYMENT APPLICATION Timber Mesa Fire and Medical Pinetop Fire District 3561 E Deuce of Clubs, Show Low, AZ 85901 1845 S. Pine Lake Rd, Pinetop, AZ 85935 Phone: (928) 537-5100 Fax: (928) 537-0029 Phone: (928) 367-2199 Fax: (928) 367-2220 APPLICATION INSTRUCTIONS: Read the job description before completing the application. Answer all questions completely, including any supplemental questionnaire forms. Type or print all answers. Sign this application and all other forms. Resumes may not be substituted in lieu of the requested information. Any omission, misstatement, or falsification may be cause for rejection of this application or discharge from the District. Applications must be received by the posted deadline, whether submitted in person or by mail or fax. Timber Mesa Fire and Medical/Pinetop Fire Districts are not responsible for applications that are not received by the posted deadline, are incomplete or are illegible. GENERAL INFORMATION

Position Applying For: Name (Last, First, MI): Social Security Number : Mailing Address: City: State: Zip Code: E-mail Address: Telephone: Message Phone: Do you have a legal right to work in the U.S.? Yes No All new hires will be required to submit verification of the legal right to work in the United States within three (3) business days beginning with their first day of work. In accordance with the Immigration Reform and Control Act of 1986, we are legally prohibited from employing anyone who cannot provide such verification. EDUCATION, TRAINING, AND SKILLS Proof of Education, Professional Registration(s), License(s), and Certification(s) may be required prior to hire. Do you have a High School Diploma or a G.E.D.? Yes No If no, please indicate highest grade completed: Education Information: Name of High School / College / University: Major: Type of Degree: Degree Completed: Yes No Yes No Yes No Yes No Yes No Credit Hours: Professional Registrations, Licenses, and/or Certifications that relate to this position: (i.e., Firefighter I/II, EMT, Paramedic, etc.) use back of sheet if necessary) Type of Professional Registration, License, and/or Certification: License Number (if applicable): Date Received: Expiration Date (if applicable): List any specialized training:

List equipment and/or computer software applications you are proficient in operating: Driver s License Information: (This section will only be considered if applicable to the position for which you apply) Do you have a valid Driver s Driver s License Number: State: Classification: License? Yes No Are you a Veteran? Yes No Branch of Service: Date of Discharge: (Please attach DD214) Begin with your present or most recent employer. List all jobs, paid or volunteer, over the last ten years. Provide detail for multiple jobs with single employer. Include any experience prior to ten years ago that relates to the position. Your qualifications will be evaluated on the information provided on this application form and, if applicable, any supplemental questionnaire forms. PLEASE NOTE: RESUMES MAY NOT BE SUBSTITUTED FOR THE REQUESTED INFORMATION. Position Title: Employment Dates (mo/yr) From: To: Employer: Phone # Address: City: State: Zip: Direct Supervisor: Annual Salary: Hours Per Week: Number of Employees Supervised: Primary Job Duties: May we contact your present or most current employer? Yes No Total Time Worked: Years: Months: Reason for wanting to leave: IF NECESSARY, YOU MAY MAKE ADDITIONAL COPIES OF THIS SHEET. Position Title: Employment Dates (mo/yr) From: To: Employer: Phone # Address: City: State: Zip: Direct Supervisor: Annual Salary: Hours Per Week: Number of Employees Supervised: Primary Job Duties: Total Time Worked: Years: Months: Reason for leaving: Position Title: Employment Dates (mo/yr) From: To: Employer: Phone # Address: City: State: Zip:

Direct Supervisor: Annual Salary: Hours Per Week: Number of Employees Supervised: Primary Job Duties: Total Time Worked: Years: Months: Reason for leaving: Position Title: Employment Dates (mo/yr) From: To: Employer: Phone # Address: City: State: Zip: Direct Supervisor: Annual Salary: Hours Per Week: Number of Employees Supervised: Primary Job Duties: Total Time Worked: Years: Months: Reason for leaving: Position Title: Employment Dates (mo/yr) From: To: Employer: Phone # Address: City: State: Zip: Direct Supervisor: Annual Salary: Hours Per Week: Number of Employees Supervised: Primary Job Duties: Total Time Worked: Years: Months: Reason for leaving: Professional References ame Address Telephone Years known To assist with verifying previous work experience and/or education, please list other names you have gone by: Have you ever been terminated, discharged, or resigned in lieu of termination due to misconduct or unsatisfactory performance or service? Yes No If yes, please name the employer, explain the circumstances, and date (mo/yr).

Have you ever been convicted of, admitted committing, are awaiting trial, or been placed on probation for any crime (excluding only minor traffic violations not involving any allegation of drug or alcohol impairment)? You must answer YES even if the matter was later dismissed, deferred, vacated, expunged or had any other legal action taken that may have removed the matter from court records. If you answer YES, you must provide dates of the proceedings, the court where the proceedings occurred, a statement of the accusation against you and the final disposition of the case(s). Note: Prior criminal history shall not automatically disqualify an individual for employment. Yes No Explanation: EMPLOYMENT POLICY It is the policy of Timber Mesa Fire and Medical District and Pinetop Fire District to grant equal employment opportunity to all persons in all terms, conditions, and privileges of employment without regard to race, creed, color, sex, religion, national origin, age, marital status, physical/mental disability, sexual orientation or veteran status. TIMBER MESA FIRE AND MEDICAL AND PINETOP FIRE DISTRICTS ARE EQUAL OPPORTUNITY EMPLOYERS PLEASE READ THE FOLLOWING STATEMENTS AND CAREFULLY REVIEW YOUR ENTIRE APPLICATION MATERIAL BEFORE SIGNING BELOW. By signing this application, I certify that all statements made on this form are true and complete to the best of my knowledge. I understand that, any omission, misstatement, or falsification may be cause for rejection of this application and/or discharge from employment. I understand that all documents requested and/or submitted, such as, but not limited to a cover letter, resume, certifications, and reference letters, are a part of the total application packet. Failure to submit all required documents shall cause my application to be eliminated from consideration. I also authorize Timber Mesa Fire and Medical District/Pinetop Fire District to make all necessary and appropriate investigations allowable by law to verify the information concerning my employment.

I understand that any offer of employment will be conditional upon the results of a criminal background investigation, social security verification, and a driver s license check (if applicable to the position). I understand that any offer of employment will be conditional upon the successful completion of a drug screening test. I understand that my employment is at will, that the terms and benefits provided to me do not constitute any contractual relationship between myself and the District, is for no definite period of time and is terminable by myself or the District with or without notice or cause. No oral statements or representations made either before or during employment can change or modify this non-contractual and at-will relationship. I understand that in consideration for my employment, I agree to comply with all federal, state and local laws, as well as District policies, procedures, rules/regulations and guidelines, which may be changed from time to time. If employed, I authorize the District to deduct from my earnings amounts sufficient for my payments to cover any financial liability which I may incur during my employment. This may include, but not be limited to, damage to or loss of District property, group insurance premiums, tuition reimbursement, and lost tools/equipment/supplies. I understand that this application will remain active only for the job opening for which I have applied and will become inactive upon completion of the associated hiring process. I understand that it is my responsibility to keep the District advised of any changes of address and/or phone number. I have read the above, understand its content and meaning, and agree to all of its provisions. Applicant's Name: Applicant's Signature: Date: Applicant Information Release Waiver I voluntarily and knowingly authorize, for employment purposes only, any present or past employer or supervisor, university or institution of learning, administrator, law enforcement agency, state agency, federal agency, credit bureau, private business, military branch or the National Personnel Records Center, the Bureau of Criminal Apprehension, personal reference, and/or other persons or organizations, to give record of information they may have concerning my criminal history, motor vehicle history, earnings history and employment records, general reputation, character, and any other information requested to Timber Mesa Fire and Medical District/Pinetop Fire District and/or its agents or representatives. I understand that, if hired, my consent will apply throughout my employment with the District. Applicant Name:

Applicant Signature: Date: Witness Name: Witness Signature: Date: