Laserfiche WebLink
NORTH OLMSTED CIVIL SERVICE EXAMINATION <br />APPLICATION FOR FIRE FIGHTER <br />PAGE 1 OF 2 <br />AN EQUAL OPPORTUNITY EMPLOYER <br />_ --Ase type or print in ink. Notify us of any change in address. <br />1. If you are presently an employee of this municipality, give your title and department: <br />2. Name: <br />Last <br />3. Address: <br />Number and Street <br />4. Telephone Numbers: <br />First <br />M.I. <br />City/State/Zip Code <br />Home or cell Business <br />5. Date of Birth: / / Social Security Number: - - <br />6. Do you claim Veteran's Preference? If "yes", check one of the following: <br />As an honorably discharged veteran who served in Armed Forces of the United States. <br />Dates of Service: From To <br />As the widow of a disabled veteran. <br />As the widow of a veteran who died in service during war. <br />Have you ever received a discharge other than Honorable from the Armed Forces of the United States? <br />Note: Veterans must submit a copy of an Honorable discharge, (DD -214) showing the dates of service. <br />submit in addition, proof of marriage and disability or death. If this proof is unavailable, explain why. <br />Wives or widows must <br />Do you have paramedic certification? Yes No NOTE: Be Sure to attach a copy of the certificate. <br />S. Have you ever been employed by this municipality within the past year? <br />9. Were you ever convicted of any law violation -- including military offenses -- other than minor traffic offenses? <br />(If yes, give details under 12) <br />10. Do you have any physical defect or disability or any chronic illness or disease which would require special testing facilities? <br />(If yes, give details under 12) <br />11. Do you have a current valid Driver's License? Chauffeur's License? <br />12. Explanations to Questions 9 and 10: <br />READ BOTH PAGES OF THE APPLICATION AND YOUR ANSWERS CAREFULLY BEFORE SIGNING BELOW: <br />I certify that the statements made by me on BOTH PAGES of this application are true, complete and correct to the best of my knowledge <br />and belief and are made in good faith. I understand that if I knowingly make any misstatement of facts I am subject to disqualification or <br />dismissal and to such other penalties as may be prescribed by law, ordinance, or Civil Service Regulations. <br />nature: <br />DATE: <br />THIS PAGE MUST BE RETURNED IN YOUR APPLICATION PACKET <br />10 <br />