Form Center

Step One

Last Name*
First Name, Middle Initial *
Maiden Name or Other Names Used
Street Address*
Mailing Address
City*
State*
Zip*
Telephone Number*
Alternate Telephone
Email Address
Please select the type of position you are seeking:*
1. Police
2. Dispatch
3. Fire
4. General
Position Desired:*
How did you learn about this position?
Are you P.O.S.T. Certified?
1. yes
2. no
If yes, provide State and certification number.
Have you ever pleaded guilty or nolo contendere to any felony charge?
1. yes
2. no
If yes, please explain.
Please check any of the following qualifications that you may possess.
1. Firefighter I
2. Firefighter II
3. Rookie School
4. Trench Rescue
5. Fire Apparatus Operator
1. First Responder
2. EMT
3. EMT-IV
4. EMT-P
1. Pumps I
2. Pumps II
3. Pumps III
4. Swift Water
1. Haz-mat Tech
2. Haz-mat Specialist
3. Extrication
4. EVOC
Please list any other fire related qualifications.
Why do you want to be a Spring Hill Firefighter?
Have you ever been in an emergency situation? Please describe the situation, and your response.
What are your core values? Explain what each means to you.
In what situation would you be tempted to lie?
Please select the certifications you currently hold:
1. NCIC
1. EMD
1. CPR
Are you applying for: *
Select all that apply.
1. Full-time
2. Part-Time
3. Seasonal
If Part-time, days, hours available:
Are you able to perform the essential functions of the job for which you've applied?*
You may later be asked to demonstrate such ability prior to an offer for employment.
1. yes
2. no
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Criminal Background

Do you have a legal right to work in the U.S.?*
1. yes
2. no
Are you over the age of 18?*
1. yes
2. no
Please provide your driver's license number and state of issue (if required by job):
Have you ever been employed by the City of Spring Hill?*
1. yes
2. no
If yes, please indicate position, department and dates:
Have you ever been convicted of a felony? *
1. yes
2. no
If yes, please explain.
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Education and Training

Work Experience

List below all present and past employment information. Please include any substantive volunteer work. Begin your list with your most recent position, and end the list with your first, if appropriate.
Name of Employer*
Title/Position held:
Hire Date
Hire Date
Separation Date
Separation Date
Supervisor Name:
Street Address
Telephone Number
City
State/Zipcode
Duties/Responsibilities*
Starting pay
Ending Pay
Reason for Leaving
Please provide an explanation for any periods of unemployment lasting 3 months or more.
Any additional positions?
1. yes
2. no
Name of Employer
Title/Position held:
Hire Date
Hire Date
Separation Date
Separation Date
Supervisor Name:
Street Address
Telephone Number
City
State/Zipcode
Duties/Responsibilities
Starting pay
Ending Pay
Reason for Leaving
Any more additional positions?
1. yes
2. no
Name of Employer
Title/Position held:
Hire Date
Hire Date
Separation Date
Separation Date
Supervisor Name:
Street Address
Telephone Number
City
State/Zipcode
Duties/Responsibilities
Starting pay
Ending Pay
Reason for Leaving
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Emergency Communications / Dispatch

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References

Please list three or more persons, other than relatives or former employers, who have knowledge of your character and/or abilities.
Include their name, mailing address, years known and phone number.
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Notices/Certification

Notice to Applicants
The City of Spring Hill is an equal opportunity employer and does not discriminate on the basis of gender, race, color, religion, creed, national origin, disability or veteran status in employment opportunities and benefits. the employment application is but one part of the hiring process, which may include an interview, employment examination or testing, as well as a demonstration of an ability to perform the essential functions of the job for which an applicant applies. Pre-employment testing and screening may include physical agility testing, polygraph examinations, as well as drug and alcohol screenings. All applicants should be prepared to supply proper proof of education and certifications upon offer of a position.
Release of Information/Certification
I hereby affirm that the information provided on this application and any accompanying materials is true and complete to the best of my knowledge. I understand that falsified information or significant omissions may disqualify me and my application from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I give the City of Spring Hill the right to investigate all references and secure additional information about me. I consent to the release of information to the City of Spring Hill and its authorized agents about my ability and fitness for employment by employers, schools, law enforcement agencies and other individuals and organizations. I hereby release from liability the City of Spring Hill and its representatives for seeking such information, and all other persons, corporations or organizations for furnishing such information.
Electronic Signature (type name below)
Attach Resume
Please submit your resume in PDF format.

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1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Steps

Step One

Criminal Background

Education and Training

Work Experience

Emergency Communications / Dispatch

References

Notices/Certification

Contact

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