Application for Firefighter Paramedic - 2024 Personal InformationDate* MM slash DD slash YYYY Name* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell Phone*Email* How did you Learn of the Opening?*Have you Ever Applied for Employment with CFPD?*YesNoIf Yes, List the Month and Year.Are You Legally Eligible for Employment in the United States?*YesNoHave You Ever Been Convicted of a Felony or Misdemeanor? If Yes, Please List Conviction, Date of Conviction and Sentence.*EducationDo you have a High School Diploma or Equivalent (GED)?*YesNoDo you have valid Missouri Paramedic license or current licensure with the National Registry of Emergency Medical Technicians as a Paramedic?*YesNoHave you completed and are current on Advanced Cardiac Life Support (ACLS) & CPR Healthcare Provider Certifications?*YesNoHave you completed and obtained Firefighter I and II certifications that are accepted by the Missouri Division of Fire Safety?*YesNoName Colleges, Trade Schools, or other Education. Include number of years attended, if you obtained your degree or certificate and the name of the degree or certificate.*Military - Describe any military service, including branch, dates active, duties/special training, rank at date of discharge.Employment HistoryPlease give accurate, complete full-time and part-time employment record. Start with most recent. Company Name and Address*Phone*Job Title and Describe Duties and Responsibilities*Reason for Leaving*May We Contact?*YesNoCompany Name and AddressPhoneJob Title and Describe Duties and ResponsibilitiesReason for LeavingMay We Contact?YesNoCompany Name and AddressPhoneJob Title and Describe Duties and ResponsibilitiesReason for LeavingMay We Contact?YesNoCompany Name and AddressPhone NumberJob Title and Describe Duties and ResponsibilitiesReason for LeavingMay We Contact?YesNoAdd Any Additional Work HistoryList 3 References with Name, Title, Phone Number, and Years Acquainted.*Resume Upload Drop files here or Select files Max. file size: 100 MB. You may upload your resume or send it via email to Kelly Dunkle at Kdunkle@cottlevillefpd.orgCertifications/License (Firefighter I and II, Paramedics License, ACLS and CPR)Upload Drop files here or Select files Max. file size: 100 MB. You may upload your Certifications/Licenses or send via email to Kelly Dunkle at Kdunkle@cottlevillefpd.orgCandidate's Physical Ability Test (CPAT) Upload Drop files here or Select files Max. file size: 100 MB. You may upload your CPAT or send via email to Kelly Dunkle at KDunkle@cottlevillefpd.orgSignature: The information provided in this application for employment is true, correct and complete. If employed, any misstatements or omissions of fact on this application may result in my dismissal. I understand that acceptance of an offer does not create a contractual obligation upon the employer to continue to employ me in the future. If you decide to engage an investigative consumer reporting agency to report on my credit and personal history, I authorize you to do so. If a report is obtained you must provide, at my request, the name and address of the agency so I may obtain from them the nature and substance of the information contained in the report.*Untitled
