Do you have a High School diploma or equivalent? (This is required)
Yes
No
What is your highest level of education?
None
High School Diploma or equivalent
Less than 60 hours of college credit
Associate's Degree
Greater than 60 hours of college credit
Bachelor's Degree
If you have a degree, please provide the degree type and describe it or put "none" if you do not.
Are you an IFSAC certified Firefighter I, or have you completed Firefighter I course meeting NFPA 1001 standard from an accredited educational facility?
Yes, I have completed Firefighter I and Hazardous Materials Operations courses meeting NFPA 1001 standard from an accredited educational facility.
No, I am not an IFSAC certified Firefighter I, or have not completed Firefighter I courses meeting NFPA 1001 standard from an accredited educational facility.
Do you hold a certificate for Hazardous Materials Operations or have you completed Hazardous Materials Operations courses meeting NFPA 1001 standard from an accredited educational facility?
Yes, I hold a certificate for Hazardous Materials Operations.
No I do not hold a certificate for Hazardous Materials Operations or have not completed Hazardous Materials Operations courses meeting NFPA 1001 standard from an accredited educational facility.
Do you have Firefighter II certification from any IFSAC approved organization?
Yes
No
Are you certified as an EMT (minimum) or AEMT through the State of Kansas Board of EMS (BEMS)? (This is required)
Yes
No
Are you certified as a Paramedic through the State of Kansas Board of EMS (BEMS)?
Yes
No
Do you currently have a valid Kansas driver's license and a good driving record?
Yes
No
If you answered "no" to the above question, please explain. If "yes", put "not applicable"
Are you currently a volunteer or paid part-time member of Derby Fire & Rescue Department?
Yes
No
Please describe your previous fire service experience. (Provide position title and name of employer).
Do you fluently speak any language in addition to English? If so, which language(s)? (Use n/a if you only speak English).
Are you related to anyone that currently works for the City of Derby? If yes, please list their name.
Have you ever been convicted of a felony?
Yes
No
If you have been convicted of a felony, please explain. If you have not, put "N/A"
Please describe any crimes you've been convicted of, other than minor traffic citations. Provide the dates of convictions, as well.
Have you ever been terminated from a job or received disciplinary action?
Yes
No
If you answer yes to the question above, please describe. If no, put "N/A".
Are you currently drawing money from a KPERS retirement benefit?
Yes
No
How did you find out about this position?
"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 on this application shall be grounds for dismissal, and I agree to hold my employer harmless in the event of my dismissal based thereon.
I authorize investigation of all statements contained herein and to do background checks to give you and all information concerning my previous employment and any pertinent information they may have, confidential or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.
I realize that under certain legal provisions, pre-employment drug testing could be a condition of my employment. I also acknowledge that the employer may require drug testing at a subsequent time providing that proper advance notice of testing is provided.
I also recognize that I could be offered employment subject to appropriate medical examination and that such a report could nullify my ultimate employment by this employer. I agree to submit to physical examination if required.
I understand and agree that, if hired, my employment is for no definite period and may, regardless of the method of payment of my wages and salary, be terminated at any time without prior notice. If employment is obtained under this application, I will comply with all the rules and policies of my employer."
AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER
This employer does not discriminate in hiring or employment on the basis of age, race, color, sex, religion, national origin, disability, military or veteran status
I understand and accept the