West Pierce Fire & Rescue

3631 Drexler Drive West

University Place, WA 98466

253.564.1623

www.westpierce.org

EMPLOYMENT APPLICATION

NAME (Last, first, middle initial) Click here to enter text.	APPLICATION FOR Firefighter / Paramedic
MAILING ADDRESS Click here to enter text.	CITY / STATE / ZIP Click here to enter text.
HOME PHONE Click here to enter text.	MESSAGE / CELL PHONE Click here to enter text.
EMAIL ADDRESS Click here to enter text.	DRIVER LICENSE NUMBER (Including state) Click here to enter text.
CONTACT PREFERENCE ☐ HOME PHONE ☐ MESSAGE / CELL ☐ EMAIL	LEGALLY ABLE TO WORK IN THE UNITED STATES? ☐ YES ☐ NO

TYPE OF SCHOOL	NAME, CITY / STATE	MAJOR	GRADUATED (YES / NO)	DEGREE
HIGH SCHOOL / EQUIVALENT	Click here to enter text.	Click here to enter text.	Click here to enter text.	Click here to enter text.
COLLEGE	Click here to enter text.	Click here to enter text.	Click here to enter text.	Click here to enter text.
PARAMEDIC SCHOOL	Click here to enter text.	Click here to enter text.	Click here to enter text.	Click here to enter text.
FIRE ACADEMY	Click here to enter text.	Click here to enter text.	Click here to enter text.	Click here to enter text.

Certifications / Training:

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Veterans Preference: Veterans will be accorded scoring criteria status as provided under RCW 41.04.010. To be eligible, you must be a “veteran” as defined by RCW 41.04.005.	I certify that I am a veteran as defined in RCW 41.04.005	☐ Yes	☐ No

Do you claim veteran’s preference?	☐ Yes	☐ No	*If yes, please attach a copy of your DD 214 form

Dates of service:	From Click here to enter text.	To Click here to enter text.	Branch of Service: Click here to enter text.

West Pierce Fire & Rescue is an equal opportunity employer and does not discriminate on the basis of race, creed, color, religion, sex, age, national origin, presence of a physical, sensory or mental disability, military status or honorably discharged veteran, marital status, sexual orientation, gender identity, or any other protected class defined by federal, state and local laws.

A conviction record will not necessarily disqualify you from employment, unless such record would reasonably affect your fitness for this position. We take into consideration the obligation to protect our citizens, and what a conviction history and/or driving record indicates about a candidate’s judgment, maturity, respect for the law and general character. Crimes against others and property are taken seriously due to the access our personnel have to citizens and their homes. Have you ever been convicted of a felony, released from prison or been convicted of a misdemeanor other than minor traffic offenses?

☐ Yes ☐ No If yes, please explain: Click here to enter text.

To the best of my knowledge, the information herein is true and complete. I understand that falsification of this application will be grounds for elimination from further consideration or, if employed, for dismissal at any time. Further, I understand that at time of hire, I will be required to provide documentation showing authorization to work in the United States.

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APPLICANT SIGNATURE	DATE

WEST PIERCE FIRE & RESCUE IS A TOBACCO FREE WORKPLACE

West Pierce Fire & Rescue

3631 Drexler Drive West

University Place, WA 98466

253.564.1623

www.westpierce.org

VOLUNTARY SELF-IDENTIFICATION FORM

Completion of this form is voluntary and has no effect on the application process nor hiring decisions.

West Pierce Fire & Rescue has expanded recruiting outreach efforts to increase organizational diversity, to better reflect the diverse communities we serve. This information will assist us in evaluating and broadening our recruitment efforts.

GENDER

☐ Male	☐ Female

ETHNIC ORIGIN

☐ American Indian / Native American or Alaskan Native

☐ Asian

☐ Black / African American

☐ Hispanic

☐ Native Hawaiian or other Pacific Islander

☐ White / Caucasian

☐ Multiracial

AGE GROUP

☐ 18 – 25

☐ 26 – 35

☐ 36 – 45

☐ Over 46

Please tell us how you learned of this position:

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In your job search endeavors, are there sources you utilize in which our posting was not included?

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