Application

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Blount County Fire Protection District
Employment Application

* Indicates required field

Date *

Social Security # *

Name *

First

Last

Email: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Cell Phone Number *

Home Phone Number *

Work Phone Number *

Person to contact in case of emergency

Name of Emergency Contact # 1 *

First

Last

Phone Number - Emergency Contact # 1 *

Name of Emergency Contact # 2 *

First

Last

Phone Number - Emergency Contact # 2 *

Position Applying For *

Career Part Time Support

Check One *

Under 18 years of age Over 18 years of age Over 21 years of age

Your Occupation *

Current Employer *

Employer Address *

Line 1

Line 2

City

State

Zip Code

Country

Supervisor's Name *

First

Last

Employer's Phone Number *

Do you have a valid Tennessee driver's license *

Yes No

License # *

License Type *

Have you ever been convicted of a DUI? *

Yes No

Have you ever been convicted of any crime? *

Yes No

If yes, what reason? *

Health

Do you have any physical problems which preclude you from performing certain kinds of work? *

Yes No

If yes, explain *

Have you had any trouble with:

Heart *

Yes No

Back *

Yes No

Hernia *

Yes No

If yes to any of the above, explain *

Are you currently under a doctor's care? *

Yes No

If yes, please explain *

Additional information concerning current health status *

Education

High School Graduate *

Yes No

Technical School *

Degree *

Other *

Training (Firefighting, Emergency Service Skills)

Have you ever been a member of a fire department? *

Yes No

If yes, name of the Department *

Address of Department *

Line 1

Line 2

City

State

Zip Code

Country

Department Phone Number *

Chief's Name *

Chief's Phone Number *

Position Held *

Length of Service *

General

Your available time to serve as a Firefighter *

Other interest or hobbies that will limit your time to serve as a Firefighter *

Your reason for wanting to become a Firefighter *

Personal References

Name of Reference # 1 *

First

Last

Phone Number - Reference # 1 *

Address of Reference # 1 *

Line 1

Line 2

City

State

Zip Code

Country

Email - Reference # 1 *

Name of Reference # 2 *

First

Last

Phone Number - Reference # 2 *

Address of Reference # 2 *

Line 1

Line 2

City

State

Zip Code

Country

Email - Reference # 2 *

The facts set forth above in my application are true and complete to the best of my knowledge and I understand that any false statements on this application shall be considered sufficient cause for denial or dismissal.

Signature (Full Name + Last 4 of SSN) *

Date of Signature *

Attach Resume *

Max file size: 20MB

Submit Application

Subscription / Payments
Donations
Address Signs
Smoke Alarms
Stations
Burn Permits
PR'S & Fire Education
Coats for Our Community
Employment
Blog & News
Employee Page
Kids
History
Facebook
Contact
About

Blount County Fire Protection District​Employment Application

Blount County Fire Protection District
Employment Application