Job application form
West Blount Fire & EMS District
Employment Requirements for Full Time/Part Time/Volunteer:
  • Must be at least 18 years of age
  • Must have a valid driver's license
  • Must have a GED or high school diploma
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Email *
Name *
First and last name
Date of Birth *
MM
/
DD
/
YYYY
Phone number *
Address *
How long at present address?
Are you a US citizen? *
Current Driver's License #
State of License
Expiration Date
 *
Level of E.M.T.
License #
Expiration Date
Which position(s) are you interested in? *
Required
Have you ever been arrested? *
(if yes, explain in detail in the next section)
If you answered yes, please explain in detail.
What date will you be available for work? *
MM
/
DD
/
YYYY
How did you hear about West Blount Fire District? *
Why do you want to be a firefighter?
Emergency Contact Information
(Include Name, Address, Home/Cell Phone)
 *
Military Service Record (if applicable)
(Include your Selective Service Classification, which branch of US Armed Forces, dates of duty, current rank or rank at discharge and a list of duties while in service)
Education
*High School
*College
*Other
(Include names of all that apply as well as location and course of study.  Also list all diplomas and degrees)
Employment Record
List all jobs held, either full time or part time, for the last 5 years.  Give place of employment, work performed, salary, and length of employment.  Start with present or most recent employer.
I hearby affirm that the information provided in this application (and any accompanying resume) is true and complete to the best of my knowledge.  I also agree that falsified information or significant omissions may disqualify me and may be considered significant justification for dismissal if discovered at a later date.

I authorize a thorough investigation and agree to cooperate in such an investigation into my past employment and activities.  I agree to release, from all liabilities or responsibilities, all persons and corporations requesting or supplying such information.  I further authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the job for which I am being considered or any future job in the even that I am hired.

I understand that if employed, my employment is for no definite period of time and that I may terminate my employment relationship with the company at any time, for any reason, and that West Blount Fire District has the same right.  I also understand that no management official other than the Chief of the District has any authority to enter into any agreement contrary to the foregoing or make any assurance or promise of continued employment.

If employment is obtained under this application,  I will comply with all rules and regulations of West Blount Fire District.  I agree to be responsible for the District's property and equipment issued to me by the District until returned to the company.

I hereby agree to submit to any lawful drug, alcohol or integrity testing that may be required as a condition of employment or continued employment and understand that refusal to submit to such testing during the course of my employment may result in disciplinary action, up to and including termination.

I understand that according to federal law all individuals must, as a condition of employment, produce certain documentation to verify their identity as a U.S. citizen or, if aliens, their legal authorization to work in the United State of America.  As a result, I understand that any offer of employment would be contingent upon my ability to produce the required documentation within the time period required by the law.

By signing my name electronically below, I have read and understood all questions and statements.

(Please type your name and date of application completion)
 *
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