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Butler Volunteer Fire Department


Special Skills


Please give accurate, complete, full-­‐time and part-­‐time employment history including military service. Start with your most recent employer FIRST. If self-employed, give firm name and business references. If necessary, attach additional sheets using the same format.

Add other Employeer
Criminal History

If yes, list convictions and pending also all traffic offenses:


Please list three persons who have knowledge of your experience and qulifications for this position, preferably current or previous supervisors, co-workers, instructors, etc.. Do not inclued relatives. If you are know to your references by another name, please note.

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Other Information

Emergency Contact

Add additonal Emergency Contact

I agree to permit the Butler Volunteer Fire Dpartment, Inc. to conduct an investigation into my background through the police department, state law enforcement organizatinos, FBI, or any other recongnized law enforcement organization. The Butler Volunteer Fire Departmnet, Inc. will hold this information in confidence.