Whitewater Fire Department


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WFD Application

Whitewater Fire Dept Inc. Application for Employment

Required   Indicates Required Field
Position For Which You Are Applying: Required
Today's Date: Required 07/29/2021 1127
Date Available To Start: Required
First Name: Required
Last Name: Required
Middle Name: Required
Street Address: Required
City: Required
State: Required
Are You At Least 18 Years of Age? : Required Yes
Home Telephone:
Cell Phone Number:
Work Telephone Number:
May We Call You At Work?: Yes
Are you legally eligible to work in the United States?: Required Yes
Do you have any relatives working for the WFD?: Yes
If answered YES to above, relationship/s to you:
Have you ever been convicted of a misdemeanor or felony?: Required Yes
Do you have any pending criminal charges against you?: Required Yes
If convicted of a crime or have pending charges, please explain below. :
(1) Nature of crime. (2) Date of conviction. (3) State in which convicted. Youranswer will not necessarily bar you from employment with the WFD. Circumstances of conviction will be taken into consideration.
Work Experience #1
Employing Firm:
Your Title:
Supervisor's Title:
Phone Number:
# Positions Supervised:
Date Started:
Date Left Employment:
Last Salary:
Hours Worked Per Week:
Reason for Leaving or Seeking Other Employment:
May we contact this employer?: Yes
Work Experience #2
Employing Firm Job 2:
Address Job 2:
Your Title Job 2:
Supervisor Job 2:
Supervisor's Title Job 2:
Phone Number Job 2:
# Positions Supervised Job 2:
Date Started Job 2:
Date Left Employment Job 2:
Last Salary Job 2:
Responsibilities Job 2:
Hours Worked Per Week Job 2:
Reason for Leaving or Seeking Other Employment - Job 2:
May we contact this employer? Job 2: Yes
Work Experience #3
Employing Firm Job 3:
Address Job 3:
Your Title Job 3:
Supervisor Job 3:
Supervisor's Title Job 3:
Phone Number Job 3:
# Positions Supervised Job 3:
Date Started Job 3:
Date Left Employment Job 3:
If still employed, fill in current date.
Last Salary Job 3:
Responsibilities Job 3:
Hours Worked Per Week Job 3:
Reason for Leaving or Seeking Other Employment - Job 3:
May we contact this employer? Job 3: Yes
Work Availability
Please describe availability.
Please describe availability.
Please describe availability.
Please describe availability.
Please describe availability.
Please describe availability.
Please describe availability.
Education 1
Did you graduate High School or obtain a GED?: Yes
Name and Location of High School:
Number Of Years Of High School Completed:
Degree or Diploma Received?:
Name of Trade or Undergraduate School Attended:
Number Of Years Of Trade or Undergraduate School Completed?:
Please List Undergraduate or Trade School Majors/Minors:
Name of Graduate School Attended:
Number Of Years Graduate School Completed?:
Please List Graduate Degrees Obtatined:
Certifications / Classes Attended:
Please list relevant certifications or classes attended related to the position you are applying for.
Please List Current Licensure Held and Expiration Dates. :
EX: EMT-B / Expiring March 2023
Please list allt he languages you are proficient in, and indicate whether you are proficient in speaking that language, writing that language, and / or reading that language.:
Please list the computer programs and operating systems you are proficient in and, indicate the number of years you have with each.:
Driver's License Number:
A valid driver's license is required for employment with the WFD.
Please List any driving infractions within the last 5 years and any serious infractions for the last 25 years. :
Serious infractions or alcohol related should be included up to the last 25 years.
Full Name:
Date of Signing:
Please Add Your Initials:
By adding your initials, the WFD has the right to verify the information provided in this application. I may be discharged if there are any misrepresentations on this application, or my resume, or made by me in an interview that may be discovered now or any time in the future. I acknowledge that the information I have supplied is correct to the best of my knowledge and understand that any deliberate falsifications, misrepresentations, or omissions of fact may be grounds for rejection of my application or dismissal from subsequent employment
Attach Resume If Applicable:
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Upon completion of the interview process, potential candidates must submit to a background check.  Submission of application is not a guarantee of interview or employment.

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Whitewater Fire Department
312 W. Whitewater St.
Whitewater WI 53190
Emergency Dial 911
Non-Emergency: 262-473-0510
E-mail: info@whitewaterfire.org
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