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Explorer Application

Explorer applications must be properly completed in order for further consideration. Information not included on the application will not be considered.

For Security Reasons you are allowed only 30 minutes to complete this form.

Position Applied for: Fire Explorer

Last Name

First Name

M.I.

Home Phone

Cell Phone

Address (include apt no.)

City

State

Zip Code

E-mail Address

Date of Birth

Education and Training

School Level

Name

Address

Did you Graduate?

Check for Yes

Middle School

Did you graduate Middle School? Check for Yes

High School

Did you graduate High School? Check for Yes

College/University

Did you graduate College? Check for Yes

Licenses or Certificates:

Other: Special training or skills related to position:

Personal Information

Check for Yes

Are you under 18 years of age?

Have you been convicted of a misdemeanor or felony within the last 5 years?

Experience

Dates of Employment

From

Name of Employer

Address

City

State

Hours Per Week

Title of Your Position

Supervisor's Name

Phone No.

Reason For Leaving:

Type Work Performed of (Be Specific):

Dates of Employment

From

Name of Employer

Address

City

State

Hours Per Week

Title of Your Position

Supervisor's Name

Phone No.

Reason For Leaving:

Type Work Performed of (Be Specific):

References

Give the names and addresses of three people, not relatives, with whom you have known at least one year. You may use past employers.

Name

Address

Phone No.

Other

Use this space for additional information about your qualifications:

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the department from all liability for any damage that may result from utilization of such information."

Your IP: 54.82.93.116