Volunteer Application

2. How did you learn of this position?

   1. Advertisement
   2. Walk-In
   3. Friend
   4. Relative
   5. Other
4. If other, please explain
6. Applicant Information
8. Last Name*
9. First Name*
10. Middle Initial
12. Nickname
14. Physical/Mailing Address
15. Apartment/Unit Number
17. City
18. State
19. Zip Code
21. Home Phone*
22. Cell Phone
24. Email Address
25. Are you 18 years or older?*

    1. Yes
    2. No
27. Have you been employed by us before?*

    1. Yes
    2. No
29. If yes, give dates.
31. Do you have relatives employed by the Department?

    Having a relative employed by the Department will not bar you from being selected

    1. Yes
    2. No
33. Relation
35. Have you been convicted of a felony in the last 7 years?*

    A conviction will not necessarily disqualify an applicant. 

    1. Yes
    2. No
37. If yes, please explain.
41. References
43. Full Name
45. Relationship
46. Phone Number
48. Address
50. Email Address
52. Full Name
54. Relationship
55. Phone Number
57. Address
59. Email Address
61. Full Name
63. Relationship
64. Phone Number
66. Address
68. Email Address

72. In consideration of the City of Buckley Fire Department permitting me to apply for this position, and further processing my application, I hereby authorize the department to perform a background investigation on me. I hereby release, hold harmless and indemnify, from any and all liability for damages, all persons who may provide such information to the department. I further waive any rights I may have to discover or demand the results of said background investigation and any materials obtained during or related to apply to my heirs, assigns and any other persons claiming through me. 

    To the best of my knowledge, the information herein is true and complete. I understand that falsification of this application will be grounds for elimination from further consideration or, if employed, for dismissal at any time. 

    Further, I understand that at time of hire, I will be required to provide documentation showing authorization to work in the United States. I am also aware that if hired by the department, my employment is at will, the employment relationship may be terminated at any time as either I or the Fire Chief may deem appropriate. 

74. I agree to the above agreement. *

    1. Yes
76. Signature*

    Type full name to indicate your signature. 

77. Date*
81. Employment Experience

    Resumes may be attached but will not be accepted as a substitute for completing this section. Start with your present or last job. Include any job-related military service assignments and volunteer activities for at least the past ten years. Please include periods of self-employment and U.S military service. 

83. Employers Name
84. Dates Employed
    Dates Employed Start Date

    —

    Dates Employed End Date
86. Address
88. Supervisor
89. Phone Number
91. Hours Worked Per Week
92. Number of Employees Supervised by You
94. May we contact this employer?

    1. Yes
    2. No
96. Reason for Leaving
98. Primary Duties
102. Employers Name
103. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
105. Address
107. Supervisor
108. Phone Number
110. Hours Worked Per Week
111. Number of Employees Supervised by You
113. May we contact this employer?

     1. Yes
     2. No
115. Reason for Leaving
117. Primary Duties
121. Employers Name
122. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
124. Address
126. Supervisor
127. Phone Number
129. Hours Worked Per Week
130. Number of Employees Supervised by You
132. May we contact this employer?

     1. Yes
     2. No
134. Reason for Leaving
136. Primary Duties
140. Employers Name
141. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
143. Address
145. Supervisor
146. Phone Number
148. Hours Worked Per Week
149. Number of Employees Supervised by You
151. May we contact this employer?

     1. Yes
     2. No
153. Reason for Leaving
155. Primary Duties
157. Describe any specialized training, apprenticeship, skills and extracurricular activities.
159. Upload a Resume (Optional)

     Above fields must still be filled out. 

163. Education
165. Name of School
167. Dates Attended
     Dates Attended Start Date

     —

     Dates Attended End Date
169. Did you graduate?

     1. Yes
     2. No
171. Degree or Certification
173. Name of School
175. Dates Attended
     Dates Attended Start Date

     —

     Dates Attended End Date
177. Did you graduate?

     1. Yes
     2. No
179. Degree or Certification
181. Name of School
183. Dates Attended
     Dates Attended Start Date

     —

     Dates Attended End Date
185. Did you graduate?

     1. Yes
     2. No
187. Degree or Certification
191. Additional Information
193. Describe any job-related training received in the United States Military.
195. List professional, trade, business or activities and offices held.

     You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status)

197. Summarize special job-related skills and qualifications acquired from employment or experience.
199. State any additional information you feel may be helpful to us in considering your application.
201. Do you possess a drivers license?

     1. Yes
     2. No
203. Indicate any foreign languages you can speak, read, or write.
207. Driving Record
209. Last Name
210. First Name
211. Middle Initial
213. List any notices of infraction or traffic citations that you have received in the past years. Include State, Month/Year, and Type of Infraction.

     Infractions or citations will not necessarily remove you from consideration, but the City of Buckley Fire Department will consider your driving record and insurability when making employment decisions. 

215. The information provided above is true to the best of my knowledge. I understand that providing false information is cause for elimination in the selection process or dismissal from employment. 

217. Signature*
218. Date*
220. Department Driving Standards

     Applicants for positions in which the occupant is expected to operate a motor vehicle must be at least 18 years old and will be required to present a valid Washington State driver's license with any necessary endorsements. Driving records of applicants may be checked. Applicants may be disqualified under the following circumstances:

     Violations: More than two  moving violations within the preceding three years; or reckless driving violations within the preceding five years; or driving while intoxicated. 

     Accidents: More than one motor vehicle accident within the preceding three years for which the applicants received a traffic or criminal citation and was convicted, forfeited bail, or entered a plea of "guilty" or "nolo contendre."

224. Affirmative Action Data

     It is the policy of the City of Buckley Fire Department to provide equal opportunity in all terms, conditions, and privileges of employment for all qualified job applicants and employees without regard to race, color, national origin, sex, age, marital status, sexual orientation or the presence of any sensory, mental or physical disability. To help us comply with government record keeping, reporting, and other legal requirements, please complete the affirmative action data below. Providing this information is voluntary and will be kept in a confidential file separate from the application form and will not be used to evaluate your qualifications for employment. 

226. Ethnic Category

     1. White (not of Hispanic origin) - those having origins in any of the original peoples of Europe, North Africa or the Middle East
     2. Black (not of Hispanic origin) - those having origins in any of the Black racial groups of Africa
     3. Hispanic - those of Cuban, Mexican, Puerto Rican, Central or South American or other Spanish culture or origin regardless of race
     4. Asian or Pacific Islanders - those having origins in any of the original peoples of the Far East, Southeast Asia, Indian Subcontinent or the Pacific Islands
     5. American Indian or Alaskan Native - those having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition
228. Other
230. Gender

     1. Male
     2. Female
232. Are you a U.S. citizen?

     1. Yes
     2. No
234. If no, indicate citizenry.
236. Are there any limitations that will restrict your ability to perform the essential functions of this position?

     1. Yes
     2. No
238. If yes, please explain.
240. What reasonable accommodations, if any, would be necessary for you to perform the essential functions of this position?
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246. 1. Receive an email copy of this form.
247. Email address

     This field is not part of the form submission.

248. Submit

* indicates a required field