Fire Captain Application

Position Applying For (required)

Date of Application (required)

Personal Information

Name (required)

Phone Number (required)

Email Address (required)

Full Street Address (required)

Driver's License Number (required)

State Issued (required)

Copy of Driving Record (required)

Copy of Drivers License (required)

Expiration Date (required)

Special Skills / Education

Resume (required)

Do you have a high school diploma, or equivalent? (required)

Do you have a degree? (required)

Do you have five years of full-time career firefighting operation experience as a firefighter and/or apparatus driver/operator. Or, have an Associate Fire Science Degree and four years of full-time firefighting experience.Part-time employment as a firefighter/AEMT / Paramedic will convert two years of part-time service to one year of full-time service. (required)

What is Your EMS Certification Level (required)

Copy of EMS Certification (required)

What is your Fire Certification Level (required)

Copy of Fire Certification (required)

Do you have the Utah/NFPA Hazardous Materials First Responder - Operations certification? (required)

Copy of Hazardous Material Certification (required)

Do you have the Utah/National Fire Protection Association (NFPA) Fire Officer 1 certification? If not, Fire Officer 1 must be obtained within 1-year if promoted to captain. (required)

Copy of Officer 1 certification (required)

Do you have UFRA Instructor 1 certification?

Copy of Instructor 1 certification (required)

List other pertinent certifications. Must be able to provide to human resource upon request.

Reference Letter 1 (required)

Reference Letter 2 (required)

Reference Letter 3 (required)

Disclaimer and Signature

I certify that the information contained in this application is correct to the best of my knowledge, and I understand that falsification of this information or information given in an interview is grounds for refusal to hire or if hired, dismissal. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. I authorize you to request and receive such information. I understand that this application will remain active only for the time period in which the position I applied for remains open. I authorize investigation of all statements contained in this application and an investigation of my background, including any and all criminal history records and driver’s license history. I understand that the findings of the investigation may or may not may or may not bar me from employment with the North Davis Fire District. (Please type your name) (required) (required)

Date (required)

NOTE: North Davis Fire District is an equal opportunity employer. Contact the NDFD Fire Chief if you have any questions regarding equal employment. The North Davis Fire District considers all applicants for positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status. North Davis Fire District will provide reasonable accommodations for any applicant during the application, examination, or interview process. If you have need of special accommodations, please call 801-525-2850 and speak to with the Human Resource Director

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