Employment Application Please upload a copy of your Resume, Cover Letter, and BCI Criminal History Report and submit the information below. Cover Letter (.pdf, .docx or .doc) (required) Resumé (.pdf, .docx or .doc) (required) BCI Criminal History Report It is the applicant's responsibility to provide to the NTFD a BCI Criminal History Report dated within the last 90 days prior to the review of the application. Please note: A concealed weapons permit does not meet this requirement. This background check is obtained through the Department of Public Safety, Bureau of Criminal Identification (BCI) at https://bci.utah.gov/criminal-records/obtain-a-copy-of-your-own-criminal-history-record/. Please submit a copy of your Criminal History report with your application. Any application submitted without a BCI Criminal History Report will NOT be considered. (required) Applicant Information Position Applied For (required) Position Type (required) Full-Time Part-Time First Name (required) Last Name (required) Street Address City State Zip Code Phone Number (required) Email address (required) Date Available to Start (required) Are you at least 21 years of age or older? (Firefighter applicants only) Yes No Do you have a valid Driver's License Yes No Have you ever worked for this fire district? Including volunteer? (required) Yes No If yes, when and what position. Have you ever been convicted of a felony? Yes No Have you ever been convicted of arson or been suspected in an arson investigation? (required) Yes No If yes to either, please explain. Important URS Retiree Information Enrollment in the URS does not prevent employment. North Tooele Fire District is a participating employer inthe Utah Retirement System (URS). If you have retired under URS within the last 12 months, employment with NTFD after July 1, 2010 could result inthe cancellation of your retirement benefits. You are encuraged to contact the URS before accepting any offer of employment or contract work from URS to determine if and how your retirement benefits could be impacted. Are you currently enrolled in the Utah Retirement System? Yes No Education High School (City/State) Did you graduate? (required) Yes No If No, did you receive your GED equivalent? Yes No College (City/State) Did you graduate? Yes No Degree Employment History Please list your last 3 employments starting with your most recent. #1 - Company Name Phone Address Job Title Supervisor Name Responsibilities Dates Worked Reason for Leaving May we contact this employer for a reference? Yes No #2 - Company Name Phone Address Job Title Supervisor Name Responsibilities Dates Worked Reason for Leaving May we contact this employer for a reference? Yes No #3 - Company Name Phone Address Job Title Supervisor Name Responsibilities Dates Worked Reason for Leaving May we contact this employer for a reference? Yes No Other Training, Qualifications or Military Service List other special training or qualifications relevant to the position for which you are applying, which are not covered elsewhere in your application. (Certifications, licenses, skills, technical skills or other specialized training, including business, trade, correspondence school or military service). References (Please list 3 Professional References) #1 - Full Name Relationship Company Phone Email Address Full Address #2 - Full Name Relationship Company Phone Email Address Full Address #3 - Full Name Relationship Company Phone Email Address Full Address Disclaimer and Signature I certify that my answers are true and complete to the best of my knowledge. By making this application, I hereby authorize any previous employers to give and release to the North Tooele Fire District any and all information of whatever kind in either written or verbal form which relates to my ability to perform the duties of the position for which I am applying. Any or all previous employers may be contacted. I release North Tooele Fire District of any liability for the use of information in considering and reviewing my application for the available position. If this application leads to employment, I understand that false or misleading information in my application or interview or omission of material may result in my disqualification or dismissal. I also understand that if offered employment, I may be required to disclose certain medical information. (required) Yes No By inputting your name below, you are verifying that the statements and information provided are true and correct, and you are attesting to the validity of all contents within this electronic submission. By clicking on the submit button, you are deemed to have electronically signed this statement. (required) There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
