Upperco Volunteer Fire Co, Inc. is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on the basis of race, religion, color, sex, national origin, age, marital status, citizenship, veterans' status, physical or mental disability that does not prohibit the performance of essential job functions (with or without a reasonable accommodation) or any other basis protected by federal, or applicable, state or local law.
Today's Date:
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05/06/2025 0634 |
Last Name:
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First name:
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Middle name:
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Street address:
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City:
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State:
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Zip Code:
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Mobile phone number:
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Email address:
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Social Security Number:
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Are you at least 18 years of age?:
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Are you lawfully permitted to work in this country?:
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Employment Information |
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Have you ever been employed by Upperco VFC?:
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If Yes, Dates?:
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Have you ever applied for employment with Upperco VFC :
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If Yes, when did you apply last?:
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How were you referred to Upperco VFC?:
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Have you previously volunteered for Upperco VFC (Arcadia or Boring VFC):
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Have you ever been rejected, suspended or expelled from membership in a volunteer emergency service organization?:
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Have you ever been terminated from employment or asked to resign by an employer?:
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Are you able to work all shifts offered at Upperco VFC?:
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Position for which you are applying for:
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Date available to begin employment?:
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Do you have reliable transportation? :
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Are you able to perform the essential functions of the job for which you are applying , with or without a reasonable accommodation?:
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If No, Please explain :
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Have you ever been convicted of a crime?:
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If Yes, list the conviction, it's date and circumstances. (NOTE: list only those convictions that have NOT been expunged):
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Have you ever served in the Armed Forces of the United States? :
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If Yes, indicate which service, date of discharge, and type of discharge:
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Education |
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Did you graduate from High School?:
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Highest education :
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Certifications |
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Do you have a Baltimore County Losap Number?:
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LOSAP number:
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What professional certifications (emt-B, IVT, EMT-P) do you have in the state of Maryland?:
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Please select all certifications your currently have:
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Please list any other certifications you may have that are relevant :
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Please attach all certifications you hold currently :
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Driving History |
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Drivers License number:
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Class:
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State of Issuance:
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How long have you had a valid driver's license? :
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Has your driver's license ever been suspended or revoked?:
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If yes, please explain :
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Attach a copy of the front and back of your driver's license:
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Employment History - Please include employment for the last 5 years (most recent employer first and work back in time) |
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Employer #1 :
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employer #1 phone number:
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employer #1 address:
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employer #1 dates of employment (month/ year - month/year):
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employer #1 job title and description of duties:
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employer #1 reason for leaving :
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employer #2:
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employer #2 phone number:
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employer #2 address:
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employer #2 dates of employment (month/ year - month/year):
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employer #2 job title and description of duties:
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employer #2 reason for leaving :
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employer # 3:
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employer #3 phone number:
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employer #3 address:
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employer #3 dates of employment (month/ year - month/year):
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employer #3 job title and description of duties:
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employer #3 reason for leaving :
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Tell us about yourself, and why you are interested in employment at Upperco VFC.:
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References |
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Reference #1 Name :
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Reference #1 Phone number:
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Reference # 1 email:
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Reference # 1 relationship to you:
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Reference #2 Name:
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Reference #2 Phone number:
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Reference #2 email:
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Reference #2 relationship to you:
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Schedule an Interview with our Paid Personnel Committee |
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Date and time you are available to interview :
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2nd date and time you are available to interview :
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3rd Date and time you are available to interview :
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UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT OR CONSTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.00
Thank you for your interest in becoming an employee of Upperco VFC. Someone from the Paid Personnel Committee will be in touch with you to schedule an interview.
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