Oconto County, Wisconsin

PENSAUKEE FIRE DEPARTMENT

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Oconto County, Wisconsin

PENSAUKEE FIRE DEPARTMENT

Main
About
Events
Resources
Join
Contact

Please complete the form below.

Pensaukee Fire Department Job Application

"*" indicates required fields

Today's Date*

MM slash DD slash YYYY

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Cell Phone*

Email*

Sex*

Male

Female

Date of Birth*

MM slash DD slash YYYY

Do you have a valid Drivers License?

Yes

No

If yes, please list your Drivers License Number

Do you have any disabilities that might inhibit your ability to be a firefighter or EMR?

Yes

No

Not Sure

If yes, please explain.

Do you live in the Town of Pensaukee?

Yes

No

If not, which one?

Have you ever been a member of another fire department?*

Yes

No

If yes, please give the name of the fire department.*

Name of the Fire Chief*

First Last

Phone Number of Fire Chief*

Email of Fire Chief

Have you ever had any misdemeanor or felony charges?*

Yes

No

If yes, please explain?

Please list any alias or nicknames you have used.

Have you lived in any other states?

Yes

No

If yes, please list.

Have you ever been fired or have been asked to resign from a job?

Yes

No

If yes, please explain.

Please provide 3 PERSONAL references that we can contact.

First Person Name*

This needs to be a PERSONAL reference that is NOT a relative or former employer.

First Last

First Person Phone*

First Person Address

Street Address Address Line 2 City State ZIP Code

Second Person Name*

This needs to be a PERSONAL reference that is NOT a relative or former employer.

First Last

Second Person Phone*

Second Person Address

Street Address Address Line 2 City State ZIP Code

Third Person Name*

This needs to be a PERSONAL reference that is NOT a relative or former employer.

First Last

Third Person Phone*

Third Person Address

Street Address Address Line 2 City State ZIP Code

Please provide 2 PROFESSIONAL references that we can contact.

Name of First Professional Reference*

This could be a co-worker, a fellow member of an organization/association you are an active member of, a professor/teacher at a school you attended, etc.

First Last

Phone of First Professional Reference*

Address of First Professional Reference

Street Address Address Line 2 City State ZIP Code

Name of Second Professional Reference*

This could be a co-worker, a fellow member of an organization/association you are an active member of, a professor/teacher at a school you attended, etc.

First Last

Phone of Second Professional Reference*

Address of Second Professional Reference

Street Address Address Line 2 City State ZIP Code

Please provide us with your current employment information.

Are you currently employed/working?*

Yes

No

Name of the company you are currently employed at.*

Contact Phone of Your Supervisor/Boss*

Company/Work Address

Street Address Address Line 2 City State ZIP Code

Date Hired*

MM slash DD slash YYYY

Your Job Title*

Do you have any additional information you would like to add?

All the information above is correct and true to the best of my knowledge.*

Yes

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