Employment Application

PO BOX 695, 251 Broadway

Lyons, CO 80540

Ph: 303-823-6611, Fax: 303-823-5568

The Lyons Fire Protection District (LFPD) is an equal opportunity agency. It is the policy of the fire district not to discriminate in accordance with the requirements of applicable state and federal laws, on the basis of race, creed, color, religion, national origin, sex, veteran status, ancestry, or marital status.

Date: *

Please mark the box beside the position(s) you are applying for: *

Full-time
Part-time
Volunteer
Auxiliary

Name *

First

Last

Email *

Home Phone: *

Cell Phone: *

Work Phone: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you at least 18 years of age? *

Position Applying For *

Please list any Police, Fire and/or Medical agencies that you are currently with, or have been a member of, the dates of employment, reason for leaving and contact information for the agency:

Please list in chronological order starting with the most recent:

RELATED TRAINING / EDUCATION/ CERTIFICATIONS: UPLOAD ANY CERTIFICATES OR DEGREES YOU HAVE OBTAINED:

Click or drag files to this area to upload. You can upload up to 20 files.

DRIVER'S LICENSE AND DRIVING HISTORY: *

Click or drag files to this area to upload. You can upload up to 20 files.

Cover Letter, Resume, & References

Click or drag files to this area to upload. You can upload up to 10 files.

PLEASE LIST the PAST FIVE YEARS OF WORK EXPERIENCE:

Company Name:

Start Date:

End Date:

Supervisor's Name:

Supervisor's Phone Number:

Supervisor's Email: *

Reason for Leaving:

If you need to add additional employer information please do so on a separate page and upload here:

Click or drag a file to this area to upload.

Have you ever been terminated, or asked to resign in lieu of termination, from a job (listed or not listed above)? *

Terminated
Resigned in Lieu of Termination
Not applicable

Please explain circumstances below:

What skills do you have that may benefit our agency?

Please list below:

GENERAL: If you answer yes to any of the below questions, please provide an explanation on a separate sheet of paper and upload to your application. For a conviction, include the violation type, date, and jurisdiction.

Have you ever been convicted of any moving violation, misdemeanor, or felony? (Conviction of a moving violation, misdemeanor or felony will not automatically disqualify you from being considered for a position.) *

Have you ever been found in any proceeding to have violated any state or federal law or rule regarding the practice of a health care profession? *

Have you read the job description for a firefighter? *

Can you perform the duties of the position with or without reasonable accommodation? *

Are you able to meet the mandated minimum requirements for a position with LFPD? *

By signing below I certify that all statements made in this application are true and complete. I authorize the Lyons Fire Protection District (LFPD) to investigate all statements made as part of this application and to secure any necessary information from all prior employers, references, academic institutions, law enforcement agencies, other persons and entities, and public records. I hereby release all such persons, entities, employers, references, institutions, agencies and the LFPD from any and all liability arising from their giving or receiving information about my history, academic credentials, qualifications, reputation, driving record and criminal record.

I understand that any false statements or misrepresentation by omission made by me as part of my application will be sufficient for rejection of my application for my immediate discharge should one be discovered after acceptance to the LFPD.

NOTICE
EACH EMPLOYEE OF LFPD IS AN “AT WILL” EMPLOYEE.

THE RULES, POLICIES, AND PROCEDURES SET FORTH BY THE LYONS FIRE PROTECTION DISTRICT (LFPD) APPLY TO ALL EMPLOYEES OF LFPD. THIS APPLICATION AND ACCEPTANCE THEREOF DOES NOT CONSTITUTE AN EXPRESSED OR IMPLIED CONTRACT FOR EMPLOYMENT. NOTWITHSTANDING ANY STATEMENT TO THE CONTRARY, ANY REPRESENTATIONS CONTAINED IN ANY SERVICE APPLICATIONS, LFPD FORMS, OR OTHER LFPD DOCUMENTS, OR ANY STATEMENTS MADE BY ANY AGENT OR MEMBER OF LFPD, ANY EMPLOYEE MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE, AND IN THE SOLE DISCRETION OF LFPD, SUBJECT ONLY TO THE APPLICABLE REQUIREMENTS OF STATE OR FEDERAL LAW.

Applicant Signature *

Date: