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APPLICATION FORM

Please use this form to make application with the Boiling Springs Fire District.

Date of Application *

Employment Type * Full-Time Paid Un-Paid Volunteer

Based on the described example of duties found on the cover page, do you feel you are capable of performing as an interior firefighter? * Yes No

Are you legally qualified for employment in the United States? * Yes No

Full Name *

Address *

City *

State *

Zip Code *

How long have you lived at the address listed above? *

The address listed above is your: * Primary Residence Seasonal / Part-Time Residence

If Seasonal / Part-Time, how many month of the year do you reside there?

Home Phone Number *

Cell Phone Number *

Email Address *

Social Security Number *

Driver\'s License *

Are you over the age of 18 years old? Yes No

Have you applied for employment here before? Yes No

If so, when?

Our Firefighters work a 48 hour On - 96 hour Off schedule. Are you able to work this schedule? * Yes No

When will you be available to begin work? *

Overtime work may be required. Will you work overtime when needed? Yes No

Special training or skills relevant to the fire service. *

What certifications have you achieved relevant to this type of position? *

How did you learn of Boiling Springs Fire District?

College Education *

Did you graduate? * Yes No Still Enrolled / In Progress

Type of Degree earned and Major *

High School Education *

Did you complete High School? * Yes No

Did you receive a High School Diploma or a GED? * Yes No

Employer #1 *

Employer #1 Address *

Employer #1 Phone Number *

Job Title and Description of Work *

Supervisor\'s Name and Phone Number *

Dates of Employment *

Ending Annual Pay

Reason for Leaving *

May we contact Employer #1 * Yes No

If no, why?

Employer #2 *

Employer #2 Address *

Employer #2 Phone Number *

Job Title and Description of Work *

Supervisor\'s Name and Phone Number *

Dates of Employment *

Ending Annual Pay *

Reason for Leaving *

May we contact Employer #2 * Yes No

If no, why?

Employer #3 *

Employer #3 Address *

Employer #3 Phone Number *

Job Title and Description of Work *

Dates of Employment *

Ending Annual Pay *

Reason for Leaving *

May we contact Employer #3 * Yes No

If no, why?

Employer #4 *

Employer #4 Address *

Employer #4 Phone Number *

Job Title and Description of Work *

Dates of Employment *

Ending Annual Pay

Reason for Leaving *

May we contact Employer #4 * Yes No

If no, why?

Professional Reference *

Reference of a family member not living with you *

Other Reference *

A criminal history background check is required by State Law for persons working in the fire service in South Carolina. Due to the high level of trust and integrity required of its members, certain criminal convictions may disqualify you from participation. Have you been convicted of any such crime? * Yes No Not Sure

Do you hereby declare that the information provided in this application is true and correct to the best of your knowledge? * Yes No

Do you understand that if accepted for employment with the Boiling Springs Fire District that any misrepresentation or omission of fact on this application shall be considered cause for dismissal? * Yes No

Do you authorize the Boiling Springs Fire District to conduct a background investigation on you which may include contacting your references, employers, co-workers, friends, neighbors and acquaintances? * Yes No

Sign this application form by entering the first four digits of your date of birth which will be verified against your photo identification when interviewed. *

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