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Job Opening

District Membership Application

Please complete this form and submit with any required or optional attachments for consideration for employment with the Olathe Fire Protection District, Olathe, CO.

Complete all questions fully and correctly. Choose N/A or enter "Not Applicable" if a question does not apply. If you do not answer all questions, you may delay the review of your application and possibly lose job opportunities.

Be prepared to provide copies of all certifications and driver's license.

Include all experience and training that might qualify you for the position you are applying for.

OFPD is an equal opportunity employer. Applicants for positions are considered without regard to race, color, religioin, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

To request a paper hardcopy or printable version of this job application form, please contact the District office at 970-323-6234 x101.

Your signature is required at the end of this application.

APPLICANT INFORMATION

Name (required)

Address (street number, name and any unit# with city, state and zip code) (required)

Phone Number (required)

Email Address (required)

Have you ever been employed/educated under another name? (required)

Yes

If yes, please state name: (required)

Position Desired (select all that apply) (required)

Date Available (required)

Desired Wage (required)

Are you a citizen of the United States? (required)

Yes

If no above, are you authorized to work in the United States? (required)

Yes

N/A

Are you 18 years of age or older? (required)

Yes

Have you ever been convicted of a crime other than traffic citations? (required)

Yes

If yes above, please explain: (required)

Have you ever had a HIPAA violation? (required)

Yes

If yes above, please explain: (required)

Have you ever been involved in a lawsuit? (required)

Yes

If yes above, please explain: (required)

Are you currently a certified provider? (If yes, select all that apply, detail other certifications held) (required)

If yes above, please upload certifications you hold.

Do you have a valid driver's license? (required)

Yes

Has your driver's license been suspended/revoked in the last three (3) years? (required)

Yes

How many driving violations in the last seven (7) years? Please describe: (required)

Please upload a copy of your driver's license. (required)

Have you ever worked/volunteered for OFPD before? (required)

Yes

If yes above, provide dates (from start to end) and position(s) held:

Do you have any medical conditions that would inhibit the performance of your duties? (required)

Yes

EMPLOYMENT HISTORY

Describe your current and/or most recent position under Current Employer. Work backwards, describing positions you have held. List all full and part time employment information. Your resume may be uploaded in addition to providing the requested information below.

Current Employer

Current Employer Name (required)

Current Employer Address (required)

Current Employer Supervisor and Phone Number (required)

Current Employer Job Title (required)

Responsibilities (required)

Current Employer Starting Wage (required)

Current Employer Ending Wage (required)

Dates of Employment (start end and end date) (required)

May we contact this supervisor for a reference? (required)

Yes

Do they understand the need to be excused from work for an emergency? (required)

Yes

Previous Employment

Previous Employer Name (required)

Previous Employer Address (required)

Previous Employer Supervisor and Phone Number (required)

Previous Employer Job Title (required)

Previous Employer Job Responsibilities (required)

Previous Employer Starting Wage (required)

Previous Employer Ending Wage (required)

Previous Employer Dates of Employment (start and end dates) (required)

May we contact this supervisor for a reference? (required)

Yes

Prevous Employment #2

Previous Employment #2 Name (required)

Previous Employment #2 Address (required)

Previous Employer #2 Supervisor and Phone Number (required)

Previous Employer #2 Job Title (required)

Previous Employer #2 Job Responsibilities (required)

Previous Employer #2 Starting Wage (required)

Previous Employer #2 Ending Wage (required)

Previous Employment #2 Dates of Employment (start and end dates) (required)

May we contact this supervisor for a reference? (required)

Yes

EDUCATION (required)

TRAINING

Please provide any additional training/courses taken related to your desired position. Your resume may be uploaded below to detail additional training not included here.

Course

Name and Address of Training Facility/School

Detail Month/Year training completed and the total classroom hours

Did you receive a certificate/diploma?

Yes

Obtaining Certificate/Diploma

MILITARY and VETERANS INFORMATION

Branch of service

Dates of active service

Describe any job-related training received in the U.S. Military

Veterans Preference (required)

Yes

If preference eligible, please upload copy of DD214 and SF-15

REFERENCES

List three (3) individuals not related to you who have known you for at least one (1) year. They should be able to verify your qualifications and fitness for the job for which you are applying. Do not list supervisors you previously detailed in Employment History.

Reference #1 Name (required)

Reference #1 Relationship (required)

Reference #1 Company, address and phone number (required)

Reference #1 Email address (required)

Reference #2 Name (required)

Reference #2 Relationship (required)

Reference #2 Company, address, and phone number (required)

Reference #2 Email Address (required)

Reference #3 Name (required)

Reference #3 Relationship (required)

Reference #3 Company, address and phone number (required)

Reference #3 Email address (required)

EMERGENCY CONTACT

Name (required)

Relationship (required)

Phone Number (required)

Briefly state your reasons for wanting to become a part of our organization (required)

If there is anything else that you would like to add, or detail any other items there was not sufficient room to address within this application, please detail here

Document upload - upload cover letter, resume and any other relevant documents here

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at-will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee/Member at any time with or without cause. It is further understood that this "at-will" employment relationship may not be charged by any written document of by conduct unless an authorized executive of this organization specifically acknowledges such change in writing. (required)

I agree to permit the Olathe Fire Protection District to conduct an investigation into my background through the police department, CBI, FBI, Department of Revenue, or any other law enforcement organization or background information system. This information will be held in confidence by the Olathe Fire Protection District. I have also read and understand the job description and functional position description. (required)

In the event of employment, I understand that false or misleading information stated within this application or during the interview process, may result in discharge. I also understand that I am required to abide by all rules and regulations of the Olathe Fire Protection District and this application does not grant me any right of continued employment and does not establish or create a contract of employment, either express or implied, between the Olathe Fire Protection District and myself. (required)

By signing below, I hereby attest that the above information is true and accurate, that all information provided within this application has been provided willingly, and I understand that any false or misleading information will subject me to disqualification or dismissal. (required)

Signature

By typing my full name below, I hereby attest to my identity as submitted by uploaded documents and submit this application for employment. (required)

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406 S. 5th St., Olathe CO 81425

Telephone (970) 323-6234

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