Miami Valley Fire District
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Application Form – Part-Time
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Position Being Applied For
Job Title
(Required)
What position are you applying for?
Part-time Firefighter/EMS
Referred By:
(Required)
School
Social Media
Internet Search
District Employee
Do you know anyone currently employed at MVFD?
(Required)
Yes
No
Name of MVFD employee that you know.
(Required)
First
Last
Personal Information
Name (Legal):
(Required)
First
Middle
Last
Address
(Required)
Street Address
City
State
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
(Required)
Email Address
(Required)
Name of Emergency Contact
(Required)
Relationship of Emergency Contact
(Required)
Emergency Contact Phone
(Required)
Have you been employed with us before?
(Required)
Yes
No
Date of Previous Employment
MM slash DD slash YYYY
Position Previously Held
Are you legally eligible for employment in the United States?
(Required)
Proof of U.S. citizenship or immigration status will be required upon employment.
Yes
No
Date Available for Work
MM slash DD slash YYYY
Education and Training
High School Graduate?
(Required)
Yes
No
Name and Location (City and State) of High School
(Required)
GED Certificate Number
GED Issued By
Are you currently attending school?
(Required)
Yes
No
Grade Level?
Post-High School Education
(Required)
Including Technical School, Business School, Professional School, College and University.
School Name and Location
Major areas of Study
Type of Degree or Certification
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Remove
Specific Course Work Areas
(Required)
Please list below the specific course work areas at the high school level or beyond relevant to the position for which you are applying. Also indicate the number of courses you have successfully completed in each area. NOTE: A transcript may not be substituted for this section, although you may be required to submit one.
Course Work Area
Number of Courses
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Remove
Training & Other Qualifications, Including Volunteer Activities
Do not include coursework already described above.
Subject or Title of Training
Organization
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Remove
Special Equipment
List special equipment or machines you can operate:
Computer Skills
List computer software in which you have skills, including word processing, spreadsheet, database, and presentation programs. Please indicate the name of the specific software:
Additional Relevant Skills
List any additional relevant skills you have:
License, Registration, & Certificates
(Required)
Be sure to include any type of driver's license
License/Certification Issued by
License/Certification Number
Expires
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Remove
Previous Employment & References
List your entire work history including military service assignments. Start with your present or most recent job and attach extra copies of this page if additional space is needed. NOTE: In order to be considered for employment, you must fill in the information below accurately and completely. You may submit a resume IN ADDITION to completing this section.
Have you ever been discharged or asked to resign from any job?
(Required)
If yes, make sure job is listed below and specified.
Yes
No
Your Previous Employers
(Required)
Please list your previous employers, the dates you worked and the position you held
Employer
Dates
Position
Full-time or Part-time
Reason for Leaving
Supervisor
Employer Phone
Employer Email
Wage Amount
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Remove
Professional References
(Required)
Please provide contact information for two professional references. If prior supervisory experience, include one reference of someone you supervised.
Name
Title
Organization
Phone
Email
Add
Remove
Current Certifications
In order to be considered “complete,” applications must include the following at the time of submission:
Evidence of active Firefighter II and EMT or Paramedic certifications.
A copy of your Authentication Letter showing Successful Completion of either the
Firefighter Mile
or
CPAT Test
.
Provide your State Certification Number here:
(Required)
https://services.dps.ohio.gov/EMSProviders/Verification
Upload Your Current Certifications
Upload clear copies of your current certifications in .pdf, .doc or .docx format
Drop files here or
Select files
Accepted file types: pdf, doc, docx, Max. file size: 25 MB.
Release and Authorization
Terms and Conditions
(Required)
I certify that the information I provided in this application is true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application or resume shall be considered sufficient cause for dismissal. The Miami Valley Fire District is hereby authorized to make any investigation of the information provided in this application and/or resume.
I hereby authorize any reference, school, former employer, or other person to disclose to the Miami Valley Fire District upon request any and all records, documents, or other information, and I release them from liability for disclosing such information to the Miami Valley Fire District.
I hereby authorize the Miami Valley Fire District, to obtain an abstract of my driver license and/or commercial driver license as well as criminal history so that my qualifications for employment may be reviewed. In the event I am hired, I also authorize the Miami Valley Fire District to continue to obtain this information during my employment.
I hereby authorize the Miami Valley Fire District to investigate my personal history and financial and credit record, as necessary, through any investigative or credit agency of its choice. Financial and credit check will be conducted in accordance with the Fair Credit Reporting Act. I further understand that the Miami Valley Fire District intends to use this information for employment purposes only.
I understand that a physical examination, including a drug screening, may be required before and/or during my employment to assure my physical ability to perform the essential functions and responsibilities of the position. Specific positions may also require the submission of fingerprint impressions to be submitted to the Ohio Bureau of Criminal Investigation and Identification and/or the Federal Bureau of Investigation prior to a hiring decision.
I agree to conform to all existing and future policies and procedures of the Miami Valley Fire District. I understand that if employed, I may be required to work additional or less hours as the needs of the organization require, and that my employment is subject to complying with rules, regulations, and conditions as established by management.
I understand that I must provide appropriate documentation of my eligibility to work in the United States as required by the Immigration Reform and Control Act.
I understand that this employment application is not a contract of employment and that any individual who is hired may voluntarily leave employment.
I agree that any claim or lawsuit relating to my service with the Miami Valley Fire District must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary. If hired, this application will become a part of the official employment record.
I hereby acknowledge that I have read and understand the terms of this application and that the information which I have furnished is true to the best of my knowledge.
I agree to the terms and conditions.
Signature
(Required)
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