Firefighter Application Download PDF Application Name First Middle Last Date of Application MM slash DD slash YYYY AddressNote: If you use a PO Box, please also list physical address to show Tooele City residency. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Home or Primary Telephone NumberCell PhoneWork or Day-time NumberSTATEMENT OF INTERESTPlease explain why you want to become a member of the Tooele City Volunteer Fire DepartmentAVAILABILITYWill your employer allow you to attend fires while on the job? Yes No Not Sure (If yes, a letter of authorization from your employer will be required for all potential candidates.)Present Employer & Address Present Position/Title Work HoursSupervisor Supervisor’s Phone NumberAre You Available to Respond to Day Time Fires? Yes No Some Daytime fires Explanation(Explain any limitations)Are You Available to Respond to Evening or Night Time Fires? Yes No Some Nighttime fires Explanation(Explain any limitations)BACKGROUNDCriminal Information (Criminal convictions will not necessarily disqualify an individual from consideration. Please be aware that each selected applicant must successfully pass a comprehensive public safety background investigation which will include completing a comprehensive background questionnaire.) In the last 10 years, have you been convicted of any crime, other than minor traffic offenses? Note: Alcohol related offenses are not considered minor traffic offenses and must be disclosed. If yes, give dates, charges, and penalty for each offense. Attach a separate sheet if necessary. Yes No Additional InformationDriver’s License (Driving record will not necessarily disqualify an individual from consideration; however, Tooele City standards for driver insurability may limit your ability to drive.) Do you have a valid Utah Driver’s License? Yes No Additional InformationHave you ever had your driver’s license revoked or suspended? If yes, please explain why. Yes No Additional InformationHave you had any traffic-related violations or at-fault accidents within the past 5 years? If yes, please explain. Yes No Additional InformationFuture ReportingIf in the future you are arrested for, involved in proceedings related to, or convicted of any criminal offense will you report it immediately (generally within 24 hours of offense) to the officers of this department? Yes No Additional InformationQUALIFICATIONSDo you have any military service? If yes, list branch, date of entry, years of service, and type of discharge. Yes No Additional InformationDo you have any prior experience as a firefighter, either paid or volunteer? If yes, list department, dates, and reason for leaving. Yes No Additional InformationEducation/CertificationsDo you have a high school diploma or equivalent? Yes No List any trade school, college education, certifications or specialized training. Attach a separate sheet if necessary. Additional InformationList any other interests, qualifications, training, experience, skills, or attributes you feel may contribute to your success as a fire fighter.List any other volunteer or civic organizations you belong to that would relate to your ability to perform the duties of a volunteer firefighter.To help us determine your commitment to volunteer services, please provide an estimate of the number of hours you have donated to any civic, charitable, or non-profit cause during the past two years. CERTIFICATION OF APPLICANT & AUTHORIZATION TO VERIFY INFORMATION I certify that the information contained in this application and in any other documents supplied by me in connection with this application is correct and complete to the best of my knowledge and belief. I have not withheld anything that would, if disclosed, affect the application unfavorably. I understand that misrepresentation, falsification, or omission of information may be sufficient cause for the rejection of this application and/or dismissal from the volunteer position. I give Tooele City Corporation, the Tooele City Fire Department, or any of agents thereof, the right to verify any and all information on this application for accuracy. I grant permission to Tooele City Corporation to conduct a background investigation as deemed necessary for the volunteer services I will be performing. I further release all references, previous employers, and schools from damages resulting from furnishing such information. I understand and agree that Tooele City Corporation and the Tooele City Fire Department reserves the right to modify by-laws, guidelines, policies, procedures, or any other operational guidelines as necessary and at their sole discretion. There is no contract between us.Applicant’s SignatureDate Signed MM slash DD slash YYYY REFERENCES In order for your application to be considered, provide two references that are First Class Firefighters from this or any other fire department.Name Fire Department Phone Number(s)Name Fire Department Phone Number(s)DEPARTMENT SPONSOR In order for your application to be considered, you must have one current Tooele City Volunteer Firefighter review your application and sign as a sponsor. Our sponsors do more than just sign your application. If selected, your sponsor will help ensure your success as you train for a demanding yet rewarding volunteer commitment! A current volunteer roster is available on the website. If you are new to our community or don’t know a qualifying volunteer, we still want to hear from you. Please contact our department to find out how you can get involved.Name of Tooele City Fire Department Sponsor SignatureDate MM slash DD slash YYYY FOR DEPARTMENT USE ONLY – Considered On: CAPTCHAfour +10 = ? NameThis field is for validation purposes and should be left unchanged.