Online Application

Personal Information

* First Name:

Middle Name:

* Last Name:

* Gender:

* DOB:

(mm/dd/yy)

* Social Security Number:

* License#:

* License State:

* Address:

* City:

* State:

* Zip:

* Home Phone:

* Cell Phone:

* Email Address:

Demographic Information

Hair Color:

Eye Color:

Height:

Weight:

Glasses/Contacts:

Citizen:

Highest Education: (years)

* Birthplace City,State:

* Position Applied For:

Active Firefighting

Active NON-Firefighting

Employment Information

Occupation:

* Employer:

* Employer Address:

* Employer's Phone:

* Human Resources Contact Name:

* Human Resources Contact Phone:

* Years at Current Job:

Education Information

* High School Name:

Graduation Year:

High School Address:

College Name:

Years Completed:

College Address:

Related Experience

Emergency Services Org:

Chief Officer of Org:

Phone Number:

Years of Service:

Relevant Training Experience:

Incidents involving disciplinary action?:

Emergency Services Org:

Chief Officer of Org:

Phone Number:

Years of Service:

Relevant Training Experience:

Incidents involving disciplinary action?:

Personal References

* Name:

* Phone Number:

* Relationship:

* Years Known:

* Name:

* Phone Number:

* Relationship:

* Years Known:

* Name:

* Phone Number:

* Relationship:

* Years Known:

Fire Company Member Contacts

Name:

Relationship:

Years Known:

Name:

Relationship:

Years Known:

Release Waivers

I acknowledge and understand that the Cheltenham Fire Company investigators will be conducting a thorough investigation into my background and acknowledge that the following are subject to contact: Local Police, School security, previous employers, current employers, references other than those provided, Police departments in any school towns attended, friends, family members, any other parties deemed necessary by committee members.

I have read the above release and agree to its terms

ACTIVE FIREFIGHTING APPLICANTS: I confirm that by applying I am physically able to perform the essential duties of a Firefighter with or without reasonable accommodation. I understand that the Cheltenham Fire Company does not discriminate based on age, race, sex, gender, sexual orientation or physical disability.

I have read the above release and agree to its terms

*All information provided above is true to the best of my knowledge.
*Falsification of information will result in immediate rejection of application.