IMPORTANT Instructions for COMPLETING the WASHOECO1J' NTY APPLICATION for EMPLOYMENT

1001 E. NINTH ST. Bldg. D P. O. BOX 11130 TRUCKEE MEADOWS RENO NV 89520 PH: 775-326-6007 FIRE PROTECTION DISTRICT APPLICATION FAX: 775-328-3646 FIRE DEPUTY CHIEF

IMPORTANT APPLICANT INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR EMPLOYMENT

 List all relevant jobs in reverse order, starting with your present or last job. Include part-time, temporary, self- employment, volunteer, and military jobs.  List all important and/or time-consuming duties.  Attach additional employment history forms, if needed.  Resumes may not be substituted for this application or any of its parts. Incomplete applications may be rejected.  Required licenses and certifications must be submitted with application.

Instructions in filling out form:  Use “Tab” to go to next field in the form. Or “Shift”+“Tab” to go back one field in the form.

This application form and its attachments are official property of Truckee Meadows Fire Protection District and cannot be returned, reused or copied after submission. You should retain a copy of this application for future use or reference.

Please have all required information saved and ready to upload before clicking on “Apply.”

EMPLOYMENT QUESTIONNAIRE

The following information will be used for research and statistical purposes only. Federal and State laws make it unlawful to discriminate in employment on the basis of race, color, sex, sexual orientation, gender identify and expression, age, disability or national origin in the activities and/or services which it provides. EOE. Your participation is voluntary and would be greatly appreciated. This information will be kept separate and confidential and will not be used to make any employment decisions.

I first learned of this recruitment through (check one): Choose one ethnic group with which you most closely identify: A. Job Announcement I Walk-in County Human Resources Department White (Not of Hispanic origin: All persons having origins in any of the B. Human Resources Dept. Telephone Job Information line (Job Hotline) original peoples of Europe, North Africa, or the Middle Ease.) C. TMFPD or County Employee / Department (other than Human Resources) Black (Not of Hispanic origin. All persons having origins in any of the D. Employment Security Department Job Service Black racial groups.) E. Ad in Newspaper Hispanic (All persons of Mexican, Puerto Rican. Cuban, Central or South F. Professional Trade Journal/Organization/ Conference American, regardless of race.) G. Community Service Organization Asian Pacific Islander (All persons having origins in any of the original H. Letter or other correspondence from Human Resources Department peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the I. College/ Technical School Pacific Islands. This area includes, for example, China, Japan, Korea, the J. Internet Philippine Islands, and Samoa.) Date of Birth: / / Sex: Male Female American Indian or Alaskan Native (All persons having origins in any of the original peoples of North America.)

THIS AREA FOR OFFICE USE ONLY. EVALUATED BY: ______DATE ______

☐ ACCEPT ☐ REJECT – EXPERIENCE ☐ REJECT – EDUCATION ☐ REJECT – NO REQUIRED LICENSE ☐ REJECT – OTHER (Explain) ______

REEVALUATED BY ______DATE ______☐ APPLICANT WITHDRAWAL DATE ______

☐ ACCEPT ☐ REJECT COMMENTS______

APPLICANT ID: ______

PLEASE LIST JOBS BEGINNING WITH THE MOST RECENT

NAME: LAST FIRST MIDDLE

CURRENT MAILING ADDRESS (House or Apt. #, Street, P O Box, etc.) CITY STATE ZIP

PRIMARY PHONE: BUSINESS/MSG PHONE: EMAIL ADDRESS:

HAVE YOU EVER BEEN EMPLOYED BY TMFPD OR WASHOE COUNTY: Yes No (If your answer is yes, please use either the back of this form, or an additional sheet to list the specific dates, job title, department, and name of your supervisor. Omission of this information may lead to disqualification or dismissal.) IMPORTANT: Are you a Veteran: Yes No Eligible veterans who were honorably discharged from the U.S. Armed Forces shall receive one (1) bonus point upon passing open competitive examinations. In order to be given a bonus point, applicants much show proof of HONORABLE DISCHARGE (DD 214 with Classification of Discharge) prior to establishment of the eligible list. Valid driver’s license number / State / Expiration date: AVAILABLE DATE: AVAILABLE IMMEDIATELY 2 OR MORE WEEKS NOTICE NOT AVAILABLE NOW, BUT WILL BE / / (Available date) CONVICTION: Have you ever been convicted of a felony or misdemeanor other than minor traffic violations? (Include drunk, reckless, hit-run, and military convictions) Yes No Note: a conviction is not necessarily a bar to employment. LACK OF REQUESTED INFORMATION IS BASIS FOR REJECTING AN APPLICATION. PLEASE EXPLAIN CONVICTIONS BELOW. CONVICTION DATES & NATURE (Use additional sheet if necessary):

HIGH SCHOOL: DID YOU GRADUATE: Yes No IF NOT, HAVE YOU PASSED A G.E.D. TEST? Yes No CREDITS DATES ATTENDED MAJOR UNITS IN MAJOR NAME AND LOCATION OF COMPLETED DEGREES OR COLLEGES OR TRADE CERTIFICATES SCHOOLS ATTENDED. SEM. QTR. RECEIVED FROM:

TO: 1. EMPLOYER NAME: EMPLOYER LOCATION:

Length of Experience: Your Title: Immediate Supervisor: From: / To: / Employer/Supervisor Phone Number:

Mo./Yr. Mo./Yr. Duties:

Total: / . Yrs. Mos.

Full-time Part-time Software/Equipment used: (40 hrs/week) Hrs./Wk. Number and Title of people you supervised: Reason for leaving: Monthly Salary:

2. EMPLOYER NAME: EMPLOYER LOCATION:

Full-time Part-time Software/Equipment used: (40 hrs./week) Hrs./Wk. Number and Title of people you supervised: Reason for leaving: Monthly Salary:

Mo. /Yr. Mo. /Yr. Duties:

1. I declare that any statement in this application or information provided is true and complete. I understand that if I provide false information it shall be sufficient cause for disqualification or dismissal. 2. I attest that I have the legal right to reside and work in this country. (Proof required upon employment.) 3. In connection with this application, I authorize TMFPD and any agent acting on its behalf to conduct an inquiry into my potential or continued employment with TMFPD and authorize the release of any such information, including but not limited to prior employers and any criminal conviction on my record. Moreover, I hereby release TMFPD and any agent acting on its behalf from any liability by reason of requesting such information from any person and its subsequent release as provided herein.

I HAVE READ AND ACCEPT THE ABOVE CONDITIONS.

I REQUEST THAT YOU DO NOT CONTACT MY PRESENT EMPLOYER WITHOUT MY PRIOR CONSENT.

HAVE YOU IN THE PAST, OR DO YOU PRESENTLY WORK FOR TMFPD or WASHOE COUNTY IN ANY CAPACITY, INCLUDING TEMPORARY JOBS? Yes No

IF YES, CURRENT EMPLOYEE NUMBER: PLEASE GIVE THE SPECIFIC DATES AND LIST YOUR JOB TITLE, DEPARTMENT IN WHICH YOU WORKED, AND YOUR SUPERVISOR. OMISSION OF THIS INFORMATION CAN LEAD TO DISQUALIFICATION OR DISMISSAL.

Signature( DO NOT PRINT) Date

List any other names that you have used.

Should more space be needed to list your employment history, ADDITIONAL employment history forms are available for your use. PLEASE REMEMBER TO KEEP A COPY OF YOUR APPLICATION WHEN COMPLETED. You may be asked to bring a copy of your current application to job interviews, and you may need it for future reference when applying for other positions.

PLEASE ATTACH COPIES OF APPROPRIATE CERTIFICATIONS, LICENSES, AND/OR TRANSCRIPTS IF REQUESTED IN THE JOB ANNOUNCEMENT. ADDITIONAL EMPLOYMENT INFORMATION SHEET

NAME: SSN DATE

TITLE OF POSITION FOR WHICH YOU ARE APPLYING:

Total: / . Yrs. Mos. Full-time Part-time Software/Equipment used: (40 hrs/week) Hrs./Wk. Number and Title of people you supervised: Monthly Salary: Reason for leaving:

Total: / . Yrs. Mos. Full-time Part-time (40 hrs/week) Hrs./Wk. Software/Equipment used: Number and Title of people you supervised: Monthly Salary: Reason for leaving: