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Berthoud Fire Protection District

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Job Application

Postion applying for *

Career
Reserve
Wildland seasonal

Name *

First

Last

Address *

SSN *

Phone number *

Email address *

US Citizen *

yes
no

Are you bilingual? What language(s)? *

Date avaliable to start *

D you have a valid drivers license *

yes
no

Drivers License Number, State and Expiration *

Have you ever applied to BFPD before? *

yes
no

If yes to the above, when? *

Have you ever worked for BFPD before? *

College/University (name, location, dates attended, degree attained) *

High School (name, location, dates attended, degree attained) *

Graduate or Other education *

Certifications (List certfication, number, year and state of issue) *

Do you have experience as a firefighter? *

yes
no

If yes, location and dates:

Have you completed a firefighter recruit academy? *

yes
no

If yes, location, dates, and number of hours of training

Are you now, or have you ever served in the military? *

If yes, what Branch?

Current status? Active, reserve, inactive reserve?

Dates of service and/or discharge?

Have you ever been convicted of, or pleaded guilty to, or pleaded no contest to any offense against the law or forfeited collateral/bond, or are you now under charges for any offense against the law? You may omit: (1) Traffic violations for which you paid a fine of $100 or less, and (2) an offense committed before your 18 th birthday which was finally adjudicated in a juvenile court under a Youth Offender Law. Include convictions while in military service, if applicable. *

Previous Employment (Company, location, dates, job title, supervisor's contact, reason for leaving) *

Previous Employment (Company, location, dates, job title, supervisor's contact, reason for leaving) (copy) *

Previous Employment (Company, location, dates, job title, supervisor's contact, reason for leaving) (copy) (copy) *

Please read the following statement carefully. Sign only after the entire application has been considered. I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that an omission or falsification of information in this application or other documents submitted is support of this application may result in rejection of this application, removal from an eligibility list, or dismissal from employment. I agree that all statements made in this application (except contacts with my present employer, unless otherwise authorized) may be investigated prior to and/or during my employment (Name & date) *