SPOFR Chief Application

South Pend Oreille Fire and Rescue
325272 Hwy 2 Newport, WA 99156

509-447-5305 Telephone & Fax
Fire Chief Position Application
Date: ____________________
PERSONAL
Name: __________________________________________________________
Address: ________________________________________________________
Telephone: ______________________________________________________
Home Work Cell
Email address: ________________ Social Security Number: _______________
Drivers License Number: ____________________________
Restrictions or endorsements _____________________________

Traffic Citations in last 3 years _____________________________
Felony Convictions in Last 7 years __________________________
Note: Such convictions may be relevant if job related, but does not bar you from
becoming a member of our organization.
EDUCATION
High school Graduate: yes ___ no ___ GED ___ currently in school ___
College (mark highest year completed): 1___ 2___ 3___ 4___ higher___
Page 1 of 4
Areas of study: ___________________________________________________
___________________________________________________
___________________________________________________
PRESENT EMPLOYMENT
Employer: _______________________________ Phone number: ___________
Occupation: ________________________ Years There: ______ Shift: ________
EMPLOYMENT HISTORY
1. Dates: From ___________ To ____________
Employer: ________________________________ Phone number: __________
Occupation: _____________________________________________________
2. Dates: From ___________ To ____________
Employer: _____________________________ Phone number: ____________
Occupation: _____________________________________________________
3. Dates: From ___________ To ____________

Employer: _____________________________ Phone number: ____________
Occupation: _____________________________________________________
TRAINING / EXPERIENCE (attach relevant certifications)

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Page 2 of 4
EMS TRAINING / EXPERIENCE
Present Qualifications
 BLS Provider
 EMT – State:__________
 Paramedic
 Other ____________________________________________
Expires: ________________
REFERENCES
1. Name: ________________________________________________________
Address: ______________________________ Phone Number: __________
2. Name: ________________________________________________________
3. Name: ________________________________________________________
CERTIFICATION
I hereby certify that the answers given in this application are true and correct to
the best of my knowledge.
Applicant Signature: _________________________________ Date: _________
South Pend Oreille Fire and Rescue is an Equal Opportunity

Organization.
Page 3 of 4
South Pend Oreille Fire and Rescue
Authorization for Release of Information
I hereby authorize South Pend Oreille Fire and Rescue to conduct a complete
background investigation for the purpose of verifying the information contained in
my application and my fitness for the position that I have applied for or which I
may be engaged. I further acknowledge and agree that the district may:
✓ Contact my present or former employers
✓ Confirm the status of my driver’s license and driving record
✓ Inquire into any criminal convictions on my record
✓ Contact any personal references provided
✓ Verify my educational background and training.
I specifically authorize any person, firm or corporation contacted by South Pend

Oreille Fire and Rescue to release any of the above records to the District and
waive any privilege of confidentiality I may have with respect to said records.
Dated this ________ day of _________________, 20___

Place of Birth: __________________________________
Date of Birth: ___________________________________
Social Security Number: ______-_____-_______
Full Name Printed ______________________________
Signature: _____________________________________
List all the States you have lived in since turning 18.
___________________________________________________________
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SPOFR Chief Application

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South Pend Oreille Fire and Rescue

325272 Hwy 2 Newport, WA 99156

Fire Chief Position Application

Drivers License Number: ____________________________

Restrictions or endorsements _____________________________

3. Dates: From _ To __

TRAINING / EXPERIENCE (attach relevant certifications)

Applicant Signature: _________________________ Date: _

South Pend Oreille Fire and Rescue is an Equal Opportunity

I specifically authorize any person, firm or corporation contacted by South Pend

Dated this day of _______, 20_

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