Birthday*

Have you ever been convicted of a felony or misdemeanor?*

Do you have a high school diploma or equivalency diploma (GED)?*

Did you attend any educational institution post high school?*

Are you a veteran of the US Military?*

OK to Contact*

OK to Contact*

Were you terminated?*

Do you have an previous fire department or emergency service experience?*

Do you have, or have you ever had, any of the following conditions: heart conditions, diabetes, high blood pressure, epilepsy or seizures in general, back injury, a job related injury, permanent disability?*

Do you agree to have a physical exam performed by a licensed physician at no cost to you?*

Are you currently receiving workers compensation due to a workplace injury?*

How would you describe your current health?*

I consent to a preliminary background, criminal history, and drivers history check*