FIREFIGHTER

PRE-APPLICATION

The Carmel Fire Department is an Equal Opportunity Employer. The Department is interested in good citizens who are seeking a career in the fire service. From time to time the City will have openings for firefighters. The active pool of applicants will include all individuals who have submitted an application prior to the posted deadline and who meet the minimum qualifications for the position.

Beginning July 1, 2005, each applicant must pass the Candidate Physical Ability Test (CPAT) before applying to the Carmel Fire Department. The applicant must maintain a current CPAT certification card at all times while on the department testing and eligibility list.
A copy of the certification must be submitted with the pre-application.

All applicants will be sent a letter (at the address listed on the application) advising them of a written examination session. The letter will indicate the date, location, and time of the exam. It will also include a brief explanation of the exam’s content and procedure. All applicants desiring to participate in the examination will be required to pay a non-refundable fee of twenty dollars ($20), which is a portion of the exam fee. The Carmel Fire Department will pay the remainder of the fee. Individuals who have a personal hardship and cannot afford the test fee may make alternative arrangements at the time of testing. Failure to appear for scheduled tests and/or appointments may result in disqualification.

Applicants who pass the written exam may then be scheduled for a structured interview. After the interview phase, the written exam and interview scores will be averaged together and the applicant’s name will be placed on an eligibility list in the order of the applicant’s score averages. Upon completion of the entry level testing process, selected applicants will be required to complete an in-depth personal history packet. The data provided in this packet will be used to conduct the background investigation phase of the hiring process. All applicants must give truthful answers to all questions. Any misrepresentation or omission of facts may disqualify the applicant from further consideration. During the investigative process applicants will be required to take a polygraph examination or Computer Voice Stress Analysis (CVSA). Areas of inquiry include, but are not limited to, criminal activity (including illegal drug use and theft), employment and driving history.

DUE TO THE SPECIAL DEMANDS OF A CAREER IN THE FIRE SERVICE, ALL APPLICANTS MUST MEET CERTAIN REQUIREMENTS. The following page lists the minimum requirements for firefighter applicants to the Carmel Fire Department.

If you meet these minimum standards and wish to apply, please fill out the three page pre-application COMPLETELY AND TRUTHFULLY and return it.

CARMEL FIREFIGHTER PRE-APPLICATION

(PLEASE PRINT LEGIBLY OR TYPE)

NAME ______________________________________________________________________
            Last    First    Middle

MAIDEN NAME (if applicable) ___________Date________

SOCIAL SECURITY NUMBER ____-___-______

DATE OF BIRTH __________

HOME PHONE ( ) __________

HOME ADDRESS _________________________

CITY ______________________ STATE ________ ZIP _____________

E-MAIL ADDRESS ____________________________________________

CELLULAR PHONE: ___________________ PAGER: __________________

DRIVERS LICENSE NUMBER ____________ STATE _______ EXP DATE ________

CURRENT EMPLOYER___________________________________________________________

ADDRESS _____________________________ CITY ___________ STATE ____ ZIP _______

PHONE ( ) _______________ POSITION HELD_________________________

DUTIES _________________________________________________________

PREVIOUS WORK EXPERIENCE_____________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

EDUCATION:

HIGH SCHOOL __________________________ CITY _____________ ST_______

COLLEGE _____________________ CITY __________________ ST______

CREDIT HOURS_______ DEGREE ATTAINED___________________

COLLEGE _____________________ CITY __________________ ST______

CREDIT HOURS________________ DEGREE ATTAINED_________________________

ADDITIONAL SCHOOLING, TRAINING AND/OR CERTIFICATIONS

__________________________________________________________

HAVE YOU EVER BEEN CONVICTED OF A FELONY?
 _____ YES _____ NO

HAVE YOU EVER BEEN ARRESTED FOR A FELONY?
 _____ YES _____ NO

IF YES, EXPLAIN _______________________________________________________________

_______________________________________________________________

_______________________________________________________________

HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR?
 _____YES _____ NO

HAVE YOU EVER BEEN ARRESTED FOR A MISDEMEANOR?
 _____YES _____ NO

IF YES, EXPLAIN ________________________________________________

________________________________________________________________

________________________________________________________________

HAVE YOU EVER RECEIVED A TRAFFIC TICKET? (INCLUDE PARKING)
 _____YES _____ NO

IF YES, EXPLAIN (INCLUDE DATE, LOCATION, CHARGE, FINE OR SENTENCE)

___________________________________________________________________

HAS YOUR DRIVERS LICENSE EVER BEEN SUSPENDED/REVOKED?
_____YES _____ NO

IF YES, EXPLAIN _____________________________________________________

______________________________________________________________________

______________________________________________________________________

HAVE YOU EVER COMMITTED OR ASSISTED ANOTHER PERSON IN THE CRIME OF MURDER, KIDNAPPING, RAPE, ROBBERY, BURGLARY, ARSON, THEFT OR CONVERSION?
 _____ YES _____ NO

IF YES, EXPLAIN_________________________________________________________________

_________________________________________________________________________

HAVE YOU EVER PURCHASED OR SOLD ANYTHING YOU KNEW OR SUSPECTED WAS STOLEN?
 _____ YES _____ NO

IF YES, EXPLAIN__________________________________________________________________

__________________________________________________________________________

HAVE YOU EVER POSSESSED, PURCHASED, SOLD OR DISTRIBUTED ANY ILLEGAL DRUGS?
 _____ YES _____ NO

IF YES, EXPLAIN__________________________________________________________________ __________________________________________________________________________

HAVE YOU EVER USED AN ILLEGAL DRUG?
 _____YES _____ NO

IF YES, EXPLAIN (INCLUDE DRUG USED AND WHEN LAST USED)__________________________________________________________________________

__________________________________________________________________________

HAVE YOU EVER ABUSED A PRESCRIPTION DRUG?
 _____YES _____ NO

IF YES, EXPLAIN___________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

HAVE YOU EVER BEEN ARRESTED FOR AN ALCOHOL-RELATED VIOLATION? (i.e., public intoxication, operating while intoxicated, illegal possession or consumption of alcohol)
 _____ YES _____ NO

IF YES, EXPLAIN ____________________________________________

____________________________________________________________________

__________________________________________________________________________

HAVE YOU EVER BEEN DISMISSED OR ASKED TO RESIGN FROM A POSITION OF EMPLOYMENT?
 _____YES _____ NO

IF YES, EXPLAIN __________________________________________________________

__________________________________________________________________________ __________________________________________________________________________

I CERTIFY THAT THE INFORMATION CONTAINED IN THIS PRE-APPLICATION IS CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT THE MISREPRESENTATION OR OMISSION OF FACTS IS CAUSE FOR REJECTION OF MY APPLICATION OR DISMISSAL AFTER APPOINTMENT. IF ANY OF THE INFORMATION PROVIDED IN THIS PRE-APPLICATION CHANGES, I UNDERSTAND THAT I AM RESPONSIBLE FOR PROMPTLY UPDATING THAT INFORMATION IN WRITING.

I AUTHORIZE THE CARMEL FIRE DEPARTMENT TO CONDUCT A PRE-APPLICATION BACKGROUND INVESTIGATION.

SIGNED: ________________________________________ DATE ____________________

PLEASE REMIT TO:

APPLICATION PROCESS
CARMEL FIRE DEPARTMENT
2 CIVIC SQUARE
CARMEL, INDIANA 46032

NOTE: ALL PRE-APPLICATIONS FOR THE NEXT TESTING DATE MUST BE TURNED IN BY DECEMBER 31ST OF 2007. FAILURE OF THE APPLICANT TO UPDATE ANY AND ALL INFORMATION ON THE APPLICATION, IF CHANGES OCCUR, MAY INVALIDATE THE APPLICATION DURING THE UPCOMING PROCESS.

CARMEL FIRE DEPARTMENT REQUEST FOR DATA

Information on this form is requested for the sole purpose of evaluating the effectiveness of the City's recruiting programs. All information is provided on a voluntary basis, and will not be used in making employment decisions. Failure to complete this form will not affect your chances of being offered a position.

NAME: _______________________________________________________________________

POSITION APPLIED FOR: ______________________________________________________

HOW DID YOU LEARN OF THIS POSITION? ______________________________________

AGE: Are you age 21 or older? Yes _____ No _____ GENDER: Male _____ Female _____

CITIZENSHIP: United States _____ Other Country __________________________________

ETHNIC DATA (please check one):

VETERAN STATUS: Are you a disabled veteran (a person entitled to disability compensation for disability at 30% or more, or a person whose discharge from active duty was for a disability incurred or aggravated in the line of duty)? Yes _____ No _____

The following CLASS B MISDEMEANORS may be cause for disqualification. Convictions will be evaluated by the Fire Chief on a case-by-case basis.