List below all present and past employers over the past three years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.
List all emergency services certifications and/or training that you have completed (Even if they are expired.)
List any professional, trade, business or civic activities and offices held. You may exclude membership that would reveal gender, race, religion, sexual orientation, national origin, ancestry, age, disability or any other protected status.
Please read each statement closely and check the check box acknowledging your understanding.
Please indicate the names of the persons who will provide your references. The first reference should be your current or most recent supervisor.
I certify that I have given true, accurate and complete information on this application and any supplements. I authorize educational institutions, associations, registration and licensing boards and others to furnish whatever detail is available concerning my qualifications. I authorize investigations of all statements made in this application and understand false information or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action or dismissal if I am employed, and/or criminal action. I further understand that dismissal upon employment shall be made mandatory if fraudulent disclosures are given to meet position qualifications, notwithstanding any provision of State or Federal law, I expressly waive any right I may have to review material or information received from a previous employer or educational institution under promise of confidentiality.