Application for Employment

Great Falls Emergency Services

   

     

 

Will you accept part-time (less than 40 hours/week) or on-call work?   

Do you have a valid Montana Driver License?   

If hired can you show proof of authorization to work in the U.S.?  (Verification will be required.)   

Have you been employed here before?      –

Please list the times in a typical week when you would not be available to work.

Education

(All education listed will be confirmed with the school(s).)

High School/GED

  Graduate?   

College/University

  Graduate?   

Business/Vocational

  Graduate?   

Graduate/other

  Graduate?   

Training

Describe any other training (workshops/seminars) you have completed that will qualify you:

List any professional certifications or licenses you have earned:

Employment Experience

Start with your present or last job and go back five (5) years, listing former employers.  You may include military service assignments and volunteer activities.

1.

   

 

 

 

Work Performed:

2.

   

 

 

 

Work Performed:

3.

   

 

 

 

Work Performed:

4.

   

 

 

 

Work Performed:

Professional References

Most recent supervisors or instructors are required.  Do not list friends or relatives.

1.

 

2.

 

3.

 

Ability

Can you perform all the essential functions of the position for which you are applying with or without a reasonable
accommodation?
    – Please explain:

Supplemental Background Information

1. Have you ever been convicted for neglect or abuse, sexual abuse, or other acts of violence?   

2. Are you currently being investigated for neglect or abuse of any kind?   

3. Have you ever been terminated from any job for any reason other than a layoff?   

Please provide dates and explanations if you answered "Yes" to any of the last three questions.

Background Information Release

Have you ever been convicted of any criminal offense, either misdemeanor or felony?      –

Do you have any tickets on your driving record?      –

The following information is needed for the background check and the motor vehicle check.

 

 

Agreement

Comments

Please list any additional comments or special qualifications you would like to be considered: