Entry Level Firefighter/EMT Testing Dist 3 FF.E… · (7/27/16) Page 3 of 12 Employment History Starting with your present or last employer, list your employment history. Include

Clallam County Fire District 3 323 N. FIFTH AVE.

SEQUIM, WASHINGTON 98382

360-683-4242

FAX: 360-683-6834

BEN ANDREWS

CHIEF

JAMES D. BARNFATHER G. MICHAEL GAWLEY

STEVEN CHINN

COMMISSIONERS

Entry Level Firefighter/EMT Testing

Clallam County Fire District 3 is now accepting applications for the purpose of establishing an eligibility list for the position of Firefighter/EMT.

Filing Deadline – October 17th, 2016 at 16:00 (4 PM) hrs. ESSENTIAL DUTIES: The primary duty of the position is to respond to alarms of fire and medical emergencies. The employee shall provide firefighting skills in accordance with NFPA 1001, Firefighter 1 and 2. The employee shall provide pre-hospital care in accordance with the State of Washington EMT scope of practice and within the guidelines established by the Clallam County Medical Program Director. The employee in this classification shall be expected to work as a team member under the supervision of a Lieutenant or Captain. The employee shall participate in training, fire prevention, physical fitness, and station and apparatus readiness activities.

QUALIFICATIONS:

Be a citizen of the United States of America, or a registered permanent resident alien with authorization to work in the United States

Possess a high school diploma or GED

Be or have reached the age of 21 before hire date

Possess and maintain a valid Washington State Driver’s License, prior to date of hire, and must be insurable

Experience as a career firefighter/EMT and/or volunteer firefighter/EMT

Successful completion of a firefighter training academy equivalent to the Clallam County Fire District 3 Volunteer Recruit Academy. The District will determine whether the applicant’s training meets its requirements

Current Washington State EMT certification or National Registry EMT certification with the ability to obtain a Washington State EMT certification by date of hire

Meet and maintain department medical, physical and grooming standards

Successfully pass a background investigation

Pass a psychological evaluation prior to appointment

Possess and present a valid C.P.A.T. (Candidate Physical Abilities Test) card or letter prior to the written test

DESIRABLE QUALIFICATIONS:

Successful completion of training to the level of NFPA 1001, Firefighter 1 and 2

Successful completion of the Washington State Patrol Fire Academy

Possess Hazardous Materials First Responder training at an Operational level

Successful completion of the Clallam County Fire District 3 Volunteer Recruit Academy

Experience as a volunteer firefighter/EMT

Experience as a career firefighter/EMT WAGES AND BENEFITS: Wages and benefits listed below are for 2016. Firefighter/EMT Step 1 $4,949.96 Step 2 $5,303.53 Step 3 $5,657.10 Step 4 $6,364.23 Step 5 $7,071.37 In addition to the above wages, the Fire District offers a very generous benefit package. PROJECTED TIMELINE (Subject to change):

Application received by October 17th, 1600 (4 PM) hours

Written Test October 31st, 0900 (9 AM) hours, Location TBA

Assessment Lab November 5th, 0700 hours, TOC

Oral Interview November 7th, By Appt., Sta. 34

Eligibility list submitted for Approval by Board November 15th

APPLICATION AND SELECTION PROCEDURES: Applications will be available on a walk-in basis at 323 N. 5th Ave. in Sequim during normal business hours. Applications will also be available by download by visiting the district website at www.clallamfire3.org. All application material shall be submitted to the administrative office of Clallam County Fire District 3 by 16:00 hours (4 PM), Monday, October 17th. The applicant must provide documentation verifying the applicant meets the above listed qualifications. All pertinent certificates and training records must be included. The applicant must provide an abstract of the applicants driving record (available from Washington Department of Licensing at https://fortress.wa.gov/dol/dsdiadr/ ) for at least the last 3 years. Résumés shall be submitted with a completed District application. Applicants will be screened for relevant education, training, experience and licenses as listed in the job announcement. The most qualified applicants will be invited to the written test. Successful candidates from the written test

http://www.clallamfire3.org/

https://fortress.wa.gov/dol/dsdiadr/

will proceed to the assessment lab. Candidates who successfully complete the assessment lab will be invited to the oral board. An eligibility list will be established and candidates will be notified of their standing. Upon receiving a provisional job offer, candidates will then undergo a NFPA compliant medical evaluation and drug test followed by a psychological evaluation and personal background investigation. WRITTEN TEST REFERENCES: Firefighting Written Test: Jones & Bartlett Fundamentals of Fire Fighter Skills, 3rd Edition EMT Written Test: Emergency Care, 13th Edition (Pearson) PHYSICAL EFFORT: Employees in this position must be able to work in a hazardous environment for long periods of time. Applicant must have the ability to maintain a respiratory physical clearance for self-contained breathing apparatus use. Ability to safely lift, carry, manipulate and operate firefighting equipment such as hose, ladders, monitors, and various power equipment, some weighing as much as 150 lbs. The ability to meet these physical standards shall be determined by regular performance evaluations. EQUAL OPPORTUNITY EMPLOYER: Clallam County Fire District 3 is an equal opportunity employer who promotes employment opportunity without regard to race, color, national origin, ancestry, religious creed, age, marital status, disability, medical condition, pregnancy or pregnancy related condition. REASONABLE ACCOMMODATION: Applicants with legal disability who require special accommodation must advise the District at time of application. The Fire District reserves the right to verify disability. MEDICAL EXAM AND DRUG TESTING: All new employees must successfully complete a thorough medical examination and drug test by a District approved physician and laboratory prior to employment. BACKGROUND CHECK: All candidates must successfully complete a criminal and financial background check prior to an offer of employment. PROBATIONARY PERIOD: New employees are expected to complete a 12 month (minimum) probationary period. If the employee has not already completed an approved firefighter 1 & 2 recruit training program, they will be required to attend and successfully complete an approved training academy as directed by the Fire District.

FINAL FILING DATE All application material must be received

at Clallam County Fire District 3 by

October 17th, 2016 at 16:00 (4 PM) Hours Applications submitted by email or fax will NOT be

accepted.

All application materials must be received at the address below by the deadline.

Questions? Contact: Assistant Chief Tony Hudson

(360) 683-4242 x 111 [email protected]

Clallam County Fire District 3 Attn: FF/EMT Testing

323 N. 5th Ave. Sequim, WA 98382

Form 2410, Employment Application

(7/27/16) Page 1 of 12

Clallam County Fire District 3 Application for Employment 323 N. Fifth Avenue, Sequim, WA 98382

(360) 683-4242 FAX (360) 683-6834

Website: www.clallamfire3.org

Reference Policy 2410, Recruitment of Staff

Please read everything carefully and thoroughly. Provide all information requested, completing

legibly by printing in ink or by typing. You may attach a cover letter and/or resume, but the

application must be completed in full.

Position Sought:

Name: Date Submitted: Last First Middle Initial

Email: Are you over 21 years old: Yes No

Mailing Address: Street/PO Box City State Zip Code

Phone: Home Cell Work

In an effort to evaluate the effectiveness of our recruiting efforts, how did you learn of the position?

Advertisement – Which one:

Department Member – Who:

Other – Please explain:

Records Retention – Applications are retained according to the requirements of the State of

Washington Records Retention Schedule. However, applicants must complete a new application to be

considered for additional and/or future positions.

Proof of Citizenship – As a condition of employment, documentation is required to prove eligibility to

obtain employment along with personal identification as required by the Immigration Reform and

Control Act of 1986.

Equal Opportunity Employer – Clallam County Fire District 3 is an equal opportunity employer and does not discriminate on the basis of race, religion, age, national origin, gender, marital status, sexual orientation, disability, or veteran status or any other protected status.

Drug Free Workplace – Clallam County Fire District 3 is a drug-free and non-tobacco workplace. If selected as a finalist, the successful applicant will be required to take a pre-employment drug test that demonstrates they are able to perform the essential functions of the position for which they are being considered.



Clallam County Fire District 3



(7/27/16) Page 2 of 12

Educational History

School Name Location

(city, state) Major/Course of Study

Graduate

Yes No Year/Degree

(credits completed)

High School

Post High School

Technical/Trade School

College (list all attended)

Other Education/Training

Experience – List any position relevant memberships, certificates, or licenses (include expiration dates).

Specialized Skills – List and briefly describe any position relevant skills, expertise, or work experience.




(7/27/16) Page 3 of 12

Employment History

Starting with your present or last employer, list your employment history. Include self-employment,

summer, and part-time jobs. If more space is required, please continue on a separate sheet. You may

attach a resume, but this portion of the application must be completed in full as well.

Present or Last Employer Type of business Title of Position Held

Street Address Phone No. Brief Description of Job Duties:

City State Zip Code

Supervisor’s Name and Title Phone No.

Base salary Dates Worked

From To

Reason for Leaving or Seeking Employment:

Previous Employer Type of business Title of Position Held


City State Zip Code



From To


Previous Employer Type of business Title of Position Held


City State Zip Code



From To





(7/27/16) Page 4 of 12

Professional References

List five persons below who are not related to you who have knowledge of your qualifications for the

position for which you are applying.

Name Title/Relationship Address

(Street, city, state, zip code) Phone Number

(Include area code) Occupation

May we contact your present employer? Yes

Phone: No

Desired Salary: Date Available:

In evaluating your application we may contact the above listed employers unless you list below

those who you do not want us to contact and state a reason. Please list additional employers on a

separate sheet.

Do not contact this employer: Reason:

Do not contact this employer: Reason:

Miscellaneous

Have you been previously employed by Clallam County Fire District 3? Yes No

If yes, describe when and in what capacity: Do you have relatives employed by Clallam County Fire District 3? Yes No

If yes, please list them:

Have you been convicted of any crimes other than minor traffic violations

during the past seven years? (An affirmative answer will not automatically

disqualify employment considered.) Yes No

If yes, please list on a separate sheet (Include name of the court, city/state, and date of conviction).




(7/27/16) Page 5 of 12

Will visa or immigration status prevent lawful employment? (Proof of

citizenship or immigration status will be required upon employment) Yes No

Are you able to perform the essential functions of the job as stated in the job

description? Yes No

Are you able to work 24 hour shifts, work weekends, holidays, and be

available for mandatory overtime? Yes No

Explain:

Certification and Authorization to Release Information

I hereby certify that the answers and other information I have provided in this application are true and

correct and that I understand any misrepresentation or omission of facts on my part will be justification

to disqualify my application and/or may be used as just cause for termination from Clallam County Fire

District 3’s service, if employed. I understand that my employment may be contingent upon receipt of an

alien registration number, verification of birth, and any other pertinent information bearing upon my

employment and my continued employment depends upon the will of the department or myself.

With my signature below, I authorize Clallam County Fire District 3 to solicit information regarding my

character, general reputation, credit, previous employment, and similar background information; and to

contact any and all references I have listed in my application. I release all parties and persons connected

with any such request for information from all claims, liabilities, and damages that may arise out of the

furnishing of such information. If employed, I release Clallam County Fire District 3 from any liability

for future references it may provide regarding my work history at the department.

Applicant Signature: Date:

If any of your educational or employment records are under other than the above name, please

provide other names.

Equal Opportunity Statement: Equal opportunity is District policy and employment opportunities will

NOT be limited because of race, color, religion, sex, handicap or nationality and will be so applied. The

District affirmatively seeks to employ and advance qualified applicants in protected classes. Hiring,

promotions, lay-offs, discharge, rates of pay, training and other employment activities will be consistent

with this Equal Opportunity Statement. The District abides by the principles of the Age Discrimination

in Employment Act (ADEA) and does not unlawfully discriminate on the basis of age. The District

complies with the Americans with Disabilities Act (ADA) when requested to make an accommodation.

You are to report violations to management or to the Personnel Officer. If an applicant needs assistance

in applying in completing this application please notify the District and assistance will be provided.

Tobacco Use Declaration: I understand the use of any tobacco product is forbidden by the District and

do hereby declare that I will abide by this prohibition during my employment.




(7/27/16) Page 6 of 12

Drug Policy: The nature of fire service requires that all District personnel refrain from the use of

drugs/alcohol in the workplace or prior to reporting to duty. Any employee observed to be in

possession, under the influence or using drugs (other than medications prescribed by a medical provider

for the employee’s medical condition), or alcohol will be required to be removed from the workplace

and required to submit to a urinalysis or blood draw. If an employee is found to have violated the

District’s drug free policy they may be terminated and subject to criminal action.

Signature and Acknowledgment

This is a legal document, read it carefully before signing.

I, the below-signed, make this application as an inducement to the District to evaluate my application

and to employ me. I have read this completed application, including the Equal Opportunity Statement

and I certify that entries made by me are without omission and are a fully, truthful account of my present

and past activities. I authorize and give the right to the District to make a thorough, vigorous

investigation of all entries made on this form by me and other materials I have provided. Any false or

misleading statement or entry on this form and other material I have provided will result in my

immediate termination, if I am employed.


Driving Record

You will need to submit a copy of your driving record along with a copy of your current driver’s

license when submitting this employment application.

How to request a copy of your driving record

1. Complete a Driving Record Request and mail it with the fee to:

Driver Records

Department of Licensing

PO Box 9048

Olympia, WA 98507-9048

Or,

2. Bring your completed Driving Record Request, the fee, and photo ID to a driver licensing

office. The local office is located at 228 West 1st Street, Port Angeles, WA 98362, 360-457-

8887.

Fees – All driving records are $13 each. You may pay the fee by check or money order if

submitting your request by mail, or by cash, check, or money order if requesting a copy of your own

record in person.

https://fortress.wa.gov/dol/dolprod/dsdoffices/

https://fortress.wa.gov/dol/dolprod/dsdoffices/


323 N. Fifth Ave., Sequim, WA 98382 360-683-4242 Fax: 360-683-6834


(7/27/16) Page 7 of 12

Authorization to Release Information

Reference Policy 2410, Recruitment of Staff

To Whom It May Concern:

I hereby authorize any Clallam County Fire District 3 officer or

other authorized representative bearing this release, or a copy of it, to review information pertaining to

my employment, military service, credit history, or education, including, but not limited to, academic

achievement, attendance, athletic, personal history, disciplinary, medical, and credit records.

I hereby release you and your organization (including its officers and employees or related personnel,

both individually and collectively) from any and all liability or damage of whatever kind, which may, at

any time, result to me, my heirs, family or associates because of compliance with this authorization and

request to release information, or any attempt to comply with it.

I hereby direct you to release this information upon request of the bearer. This release is executed with

full knowledge and understanding that the information is for the official use of Clallam County Fire

District 3.

Consent is further granted to Clallam County Fire District 3 to furnish such information as described

above, to third parties in the course of fulfilling its official responsibilities.

A photocopy of this release form will be valid as an original thereof, even though the said photocopy

does not contain an original writing of my signature. The original of this form is maintained at Clallam

County Fire District 3 headquarters, in Sequim, Washington.


Background Screeners of America · 18344 Oxnard St. Suite 101

Tarzana, CA 91356 · 866-570-4949 · FAX 866-570-5656 · [email protected]


(7/27/16) Page 8 of 12

Disclosure and Authorization for Consumer Reports

(Data based Records) 15 U.S.C. §1681b and 1681k

(Revised 5/17/16)

Disclosure: In connection with my application for employment (including contract or volunteer

services) or application for tenancy with Clallam County Fire District 3, I understand consumer reports

will be requested by you (“Company”). These reports may include, as allowed by law, the following

types of information, as applicable: names and dates of previous employers, reason for termination of

employment, work experience, reasons for termination of tenancy, former landlords, education,

accidents, licensure, credit, etc. I further understand that such reports may contain public record

information such as, but not limited to: my driving record, judgments, bankruptcy proceedings,

evictions, criminal records, etc., from federal, state, and other agencies that maintain such records.

In addition, investigative consumer reports (gathered from personal interviews, as applicable, with

former employers or landlords, past or current neighbors and associates of mine, etc.) to gather

information regarding my work or tenant performance, character, general reputation and personal

characteristics, and mode of living (lifestyle) may be obtained.

Authorization: I hereby authorize procurement of consumer report(s) and investigative consumer

report(s) by Company. If hired (or contracted), this authorization shall remain on file and shall serve as

ongoing authorization for Company to procure such reports at any time during my employment,

contract, or volunteer period. I authorize without reservation, any person, business or agency contacted

by the consumer reporting agency to furnish the abovementioned information.

This authorization is conditioned upon the following representations of my rights:

I understand that I have the right to make a request to the consumer reporting agency: Background

Screeners of America (“Agency”), 18344 Oxnard Street, Ste. 101, Tarzana, CA 91356, telephone

number 866-570-4949, upon proper identification, to obtain copies of any report furnished to Company

by the Agency and to request the nature and substance of all information in its files on me at the time of

my request. The request includes the sources of information and the Agency, on Company’s behalf, to

provide a complete and accurate disclosure of the nature and scope of the investigation covered by any

investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me

which the Agency has previously furnished within the two year period for employment requests, and one

year for other purposes preceding my request (California three years). I hereby consent to Company

obtaining the above information from the Agency. I understand that I can dispute, at any time, any

information that is inaccurate in any type of report with the Agency. I may view the Agency’s privacy

policy at their website: www.wescreenusa.com

Washington Applicants: I understand that if the report is provided to an employer in the State of

Washington, that I can contact the following office for more information regarding my rights under

Washington state law in regard to these reports: State of Washington Attorney General, Consumer

Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, (206) 464-7744.

I have read and understand this page: Applicant Initials

mailto:[email protected]

http://www.wescreenusa.com/



(7/27/16) Page 9 of 12

Please complete all of the fields below:

I understand that I have rights under the Fair Credit Reporting Act and I acknowledge receipt

of the Summary of Rights.

Last Name: First: Middle: (____ I do not have one)

Social Security Number: Date of Birth:

Email (This is a required field):

Current Address: Previous Address:

Street: Street:

Apt. or Unit #: Apt. or Unit #:

City: State: Zip: City: State: Zip:

Drivers License #: State Issuing:

Former Name/Alias:


Background Screeners of America · 18344 Oxnard St. Suite 101

Tarzana, CA 91356 · 866-570-4949 · FAX 866-570-5656 · [email protected]


(7/27/16) Page 10 of 12

A Summary of Your Rights Under the Fair Credit Reporting Act

(Revised 5/17/16)

Applicant Copy

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of

information in the files of consumer reporting agencies. There are many types of consumer reporting

agencies, including credit bureaus and specialty agencies (such as agencies that sell information about

check writing histories, medical records, and rental history records). Here is a summary of your major

rights under the FCRA.

For more information, including information about additional rights, write to: Consumer

Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552, or go to

www.consumerfinance.gov/learnmore.

You must be told if information in your file has been used against you. Anyone who uses a

credit report or another type of consumer report to deny your application for credit, insurance, or

employment – or to take another adverse action against you – must tell you, and must give you the

name, address, and phone number of the agency that provided the information.

You have the right to know what is in your file. You may request and obtain all the information

about you in the files of a consumer reporting agency (your “file disclosure”). You will be required

to provide proper identification, which may include your Social Security number. In many cases, the

disclosure will be free. You are entitled to a free file disclosure if:

a person has taken adverse action against you because of information in your credit report;

you are the victim of identity theft and place a fraud alert in your file;

your file contains inaccurate information as a result of fraud;

you are on public assistance;

you are unemployed but expect to apply for employment within 60 days.

In addition, all consumers are entitled to one free disclosure every 12 months upon request from each

nationwide credit bureau and from nationwide specialty consumer reporting agencies. See

www.consumerfinance.gov/learnmore for additional information.

You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-

worthiness based on information from credit bureaus. You may request a credit score from consumer

reporting agencies that create scores or distribute scores used in residential real property loans, but

you will have to pay for it. In some mortgage transactions, you will receive credit score information

for free from the mortgage lender.

You have the right to dispute incomplete or inaccurate information. If you identify information

in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the

agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore

for an explanation of dispute procedures.

Consumer reporting agencies may not report outdated negative information. In most cases, a

consumer reporting agency may not report negative information that is more than seven years old, or

bankruptcies that are more than 10 years old.

mailto:[email protected]

http://www.consumerfinance.gov/learnmore/





(7/27/16) Page 11 of 12

Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable

information. Inaccurate, incomplete or unverifiable information must be removed or corrected,

usually within 30 days. However, a consumer reporting agency may continue to report information it

has verified as accurate.

Access to your file is limited. A consumer reporting agency may provide information about you

only to people with a valid need – usually to consider an application with a creditor, insurer,

employer, landlord, or other business. The FCRA specifies those with a valid need for access.

You must give your consent for reports to be provided to employers. A consumer reporting

agency may not give out information about you to your employer, or a potential employer, without

your written consent given to the employer. Written consent generally is not required in the trucking

industry. For more information, go to www.consumerfinance.gov/learnmore.

You may limit “prescreened” offers of credit and insurance you get based on information in

your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-

free phone number you can call if you choose to remove your name and address from the lists these

offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-8688.

You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user

of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA,

you may be able to sue in state or federal court.

Identity theft victims and active duty military personnel have additional rights. For more

information, visit www.consumerfinance.gov/learnmore.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some

cases, you may have more rights under state law. For more information, contact your state or

local consumer protection agency or your state Attorney General. For information about your

federal rights, contact:

Type of Business: Contact: 1. a. Banks, savings associations, and credit unions

with total assets of over $10 billion and their

affiliates.

b. Such affiliates that are not banks, savings

associations, or credit unions also should list, in

addition to the Bureau:

a. Bureau of Consumer Financial Protection

1700 G Street NW

Washington, DC 20006

b. Federal Trade Commission: Consumer Response Center -

FCRA


(877) 382-4357

2. To the extent not included in item 1 above:

a. National banks, federal savings associations, and

federal branches and federal agencies of foreign

banks

b. State member banks, branches and agencies of

foreign banks (other than federal branches,

federal agencies, and insured state branches of

foreign banks), commercial lending companies

owned or controlled by foreign banks, and

organizations operating under section 25 or 25A

of the Federal Reserve Act

c. Nonmember Insured Banks, Insured State

Branches of Foreign Banks, and insured state

savings associations

d. Federal Credit Unions

a. Office of the Comptroller of the Currency Customer

Assistance Group

1301 McKinney Street, Suite 3450

Houston, TX 77010-9050

b. Federal Reserve Consumer Help Center

P.O. Box 1200

Minneapolis, MN 55480

c. FDIC Consumer Response Center

1100 Walnut Street, Box #11

Kansas City, MO 64106

d. National Credit Union Administration Office of Consumer

Protection (OCP) Division of Consumer Compliance and

Outreach (DCCO)

1775 Duke Street

Alexandria, VA 22314


http://www.consumerfinance.gov/learnmore



(7/27/16) Page 12 of 12

Type of Business: Contact: 3. Air carriers Asst. General Counsel for Aviation Enforcement & Proceedings

Department of Transportation

400 Seventh Street SW


4. Creditors Subject to Surface Transportation Board Office of Proceedings, Surface Transportation Board

Department of Transportation

1925 K Street NW


5. Creditors Subject to Packers and Stockyards Act Associate Deputy Administrator for Capital Access

United States Small Business Administration

406 Third Street, SW, 8th Floor


6. Small Business Investment Companies Associate Deputy Administrator for Capital Access

United States Small Business Administration

406 Third Street, SW, 8th Floor


7. Brokers and Dealers Securities and Exchange Commission

100 F St NE Washington,

DC 20549

8. Federal Land Banks, Federal Land Bank Associations,

Federal Intermediate Credit Banks, and Production

Credit Associations

Farm Credit Administration

1501 Farm Credit Drive

McLean, VA 22102-5090

9. Retailers, Finance Companies, and All Other

Creditors Not Listed Above

FTC Regional Office for region in which the creditor operates or

Federal Trade Commission: Consumer Response Center – FCRA


(877) 382-4357

Applicant Copy

Documents

Entry Level Firefighter/EMT Testing Dist 3 FF.E… · (7/27/16) Page 3 of 12 Employment History Starting with your present or last employer, list your employment history. Include