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2. We are an equal opportunity employer and will not discriminate against any applicant on the basis of any characteristic that is protected by state or federal law. Michigan law requires that a person with a disability requiring accommodation to perform the essential duties of the job must notify the employer in writing within 182 days of the date that the need is known or should have been known. Federal law has no such requirement.

4. Please confirm that all of these are true:

   1. I confirm that all of these apply to me.

   • You are at least 18 years of age
   • You have proof of High School graduation or GED certificate
   • You are able to physically perform the duties of a firefighter
   • You have a valid driver's license
   • You live within a reasonable distance from the fire station to respond to calls
6. Date You Can Start
   Date You Can Start
7. First Name
8. Middle Initial
9. Last Name
11. Email Address
13. Present Address
15. City
16. State
17. Zip Code
19. Permanent Address
20. Permanent Address Is the Same as Present Address

    1. Yes
22. City
23. State
24. Zip Code
26. Home Phone Number
27. Work Phone Number
29. Are you 18 years or older?

    1. Yes
    2. No
30. Are there any hours of the week you cannot work?

    1. Yes
    2. No
31. If so, when?
33. Salary Desired
34. Type of Employment

    1. Full Time
    2. Part Time
35. Are you employed now?

    1. Yes
    2. No
36. May we contact your present employer?

    1. Yes
    2. No
38. Have you ever applied to the city before?

    1. Yes
    2. No
39. If Yes, where?
40. Under what name?
41. When?
43. Have you ever been employed with us before?

    1. Yes
    2. No
44. If Yes, Where?
45. Under what name?
46. When?
48. Do any of your friends or relatives, other than your spouse, work here?

    1. Yes
    2. No
52. Education
54. Elementary School
55. Name and Address of School
57. Number of Years Attended
58. Did You Graduate?

    1. Yes
    2. No
59. Subject/Major
61. High School
62. Name and Address of School
64. Number of Years Attended
65. Did You Graduate?

    1. Yes
    2. No
66. Subject/Major
68. College
69. Name and Address of School
71. Number of Years Attended
72. Did You Graduate?

    1. Yes
    2. No
73. Subject/Major
75. Specialized Training
76. Name and Address of School
78. Number of Years Attended
79. Did You Graduate?

    1. Yes
    2. No
80. Subject/Major
82. Do You Have U.S. Military Experience?

    1. Yes
    2. No
83. Date Entered
85. Branch
86. Rank
88. Date Discharge
89. Honorably?

    1. Yes
    2. No
93. Are you lawfully entitled to be employed in the United States?

    1. Yes
    2. No
95. Have you ever been convicted of a crime except a minor traffic violation?

    1. Yes
    2. No

    (The response to this question will be considered in the context of its job-relatedness only.)

96. If so, please state citation, date and place where offense occurred.
98. Please provide any additional information such as special skills, training management experience, equipment operation or qualifications you feel will be helpful to us in considering your application.
102. References

     Please provide information about 3 individuals not related to you, whom you have known for at least 1 year.

104. Name
105. Relationship
106. Years Acquainted
108. Address and Phone Number
110. Name
111. Relationship
112. Years Acquainted
114. Address and Phone Number
116. Name
117. Relationship
118. Years Acquainted
120. Address and Phone Number
124. Emergency Contact
126. Name
127. Phone Number
129. Address
131. City
132. State
133. Zip Code
137. Current and Most Recent Former Employers
139. Employer 1
140. From

     (mm/yyyy)

141. To

     (mm/yyyy)

143. Name, Address, Phone Number
145. Salary (Starting/Ending)
147. Last Position Held and Responsibilities
149. Reason for Leaving
151. May We Contact This Employer?

     1. Yes
     2. No
153. Employer 2
154. From

     (mm/yyyy)

155. To

     (mm/yyyy)

157. Name, Address, Phone Number
159. Salary (Starting/Ending)
161. Last Position Held and Responsibilities
163. Reason for Leaving
165. May We Contact This Employer?

     1. Yes
     2. No
167. Employer 3
168. From

     (mm/yyyy)

169. To

     (mm/yyyy)

171. Name, Address, Phone Number
173. Salary (Starting/Ending)
175. Last Position Held and Responsibilities
177. Reason for Leaving
179. May We Contact This Employer?

     1. Yes
     2. No
181. Employer 4
182. From

     (mm/yyyy)

183. To

     (mm/yyyy)

185. Name, Address, Phone Number
187. Salary (Starting/Ending)
189. Last Position Held and Responsibilities
191. Reason for Leaving
193. May We Contact This Employer?

     1. Yes
     2. No
197. Authorization for Inquiry
199. Please read the following carefully:

     1. I Agree

     I understand that the City of Fenton may obtain a consumer report containing information regarding my credit history, as well as my work, education, military service, and police records as they may be relevant to determine my suitability for employment, promotion or any employment-related purposes. I further understand that I will be subject to a pre-employment drug/alcohol screening. I know that any or all the results of these reports, inquiries, and investigations may be used in making employment decisions concerning me. I hereby authorize the city of Fenton to obtain such reports, inquiries, and investigations. A photocopy of this signed authorization will carry the same effect as the original.

201. Complete Application
203. Please Read the following statement carefully before clicking "I Agree" to indicate your understanding:

     1. I Agree

     I understand that, prior to being offered employment, I may be requested to take an employment examination. In the event that I have a disability that will affect my ability to take the test, I will so inform the city prior to the administration of the test so that a reasonable accommodation can be made. The city reserves the right to require medical documentation regarding the need for accommodation.

     I further understand that I will be required to take a drug/alcohol test prior to being employed and that cooperating in the administration of this test and passing it are conditions for employment.

     I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements or omitted information on this application may result in termination.

     I authorize investigation of all statements contained in this application for any employment-related purpose. I release the listed references and all employers, except those specifically excepted, to provide you with any and all applicable information they may have. I hereby release these references and former employers from all liability for any information they may give to you.

     I understand and acknowledge that any employment relationship with the city is of an "at-will" nature, which means that either the city or I may terminate the employment relationship at any time, with or without cause and with or without notice. I further understand that the "at-will" nature of employment relationship with the city may not be changed by any written document or conduct unless the change is specifically acknowledged in writing by the City Manager.

     I agree that any action or suit against the city arising out of my employment or termination of employment, including, but not limited to, claims arising under state or federal civil rights statutes, must be brought within 182 days of the event giving rise to the claims or be forever barred. I waive any limitations period to the contrary.

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

     This field is not part of the form submission.

207. Submit

* indicates a required field