APPLICATION FOR EMPLOYMENT

Personal Information

Employment History

Education

Driving History

Legal

Firefighting and EMS Related Experience

References

APPLICANT’S STATEMENT AND AUTHORIZATION TO CONDUCT AND OBTAIN EMPLOYER’S CRIMINAL BACKGROUND HISTORY AND DRIVING RECORD

**PLEASE READ CAREFULLY**

I certify that all of the information and answers provided by me in this application is/are true and complete to the best of my knowledge. I understand that the information contained herein may be used to determine my eligibility and suitability as a volunteer or employee with the Bennett Fire Protection District, and that if I provided false or misleading information or if I concealed information or caused or authorized anyone else to provide false or misleading information or to conceal information in connection with my application, that it will be grounds for denial of my Application or termination my membership or employment as the case may be. I give my permission for the Fire Chief or his designee to investigate and verify all of the information given by me in this Application. I release any person from any liability in connection therewith. I authorize the District to receive a copy of my driver’s license a copy of which is attached and to obtain a copy of my driver’s record. I consent to a criminal background check and will provide my social security number for that purpose but for no other purpose. I understand that neither this Application nor any offer of membership or employment from the District constitutes an employment contract unless a specific document to that effect is executed by the District’s Board of Directors as authorized at an official Board meeting. I also understand that I am required to and will abide by all of the District’s rules, Standard Operating Procedures, policies and orders of the District and its officers.

FAIR CREDIT REPORTING ACT – DISCLOSURE AND CONSENT

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In connection with an Application for employment or membership as a volunteer, the Bennett Fire Protection District will obtain a copy of the applicant’s driving record and conduct a criminal background check. These records and criminal documents may be obtained from outside third parties who conduct applicant background checks. These records and documents may be considered investigative consumer reports under the Fair Credit Reporting Act (“FCRA”), and will be used solely for employment/membership purposes. I authorize and consent to the District requesting and receiving a copy of my driver’s license and my driver’s record. I authorize the District to perform and consent to a criminal background check and will provide my social security number for that purpose but for no other purpose. I understand that these records and documents may be obtained by and from outside third parties who conduct applicant background checks. I release the District from any liability in connection therewith. If the District decides not to hire or select an applicant based in whole or in part on information in the consumer report, the District will inform the applicant that it plans on taking adverse action, will give a copy of the consumer report to the applicant and advise the applicant of his/her rights under the FCRA to dispute inaccurate or incomplete information contained the report.