2026 PTFD Part-time Firefighter Application

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* 1. Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Are You 18 Years or Older?

Yes

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* 3. Employment Position Desired

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* 4. Date you can start?

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* 5. Have you ever applied to the Plain Township Fire Department before? If so, when?

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* 6. Are you a U.S. Citizen?

Yes

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* 7. US Military or Naval Service? Rank?

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* 8. Current Employer

Name of Employer

Date of Employment

Salary

Position

Start Date

End Date

Reason for Leaving

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* 9. Former Employer

Name of Employer

Date of Employment

Salary

Position

Start Date

End Date

Reason for Leaving

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* 10. Former Employer

Name of Employer

Date of Employment

Salary

Position

Start Date

End Date

Reason for Leaving

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* 11. References (List three references. Use questions 11, 12, and 13 to enter references.)

Name

Phone Number

Years Acquainted

Relationship

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* 12. Reference

Name

Phone Number

Years Acquainted

Relationship

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* 13. Reference

Name

Phone

Years Acquainted

Relationship

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* 14. May we contact your references?

Yes

Not at this time.

Other (please specify)

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* 15. High School Attended

Name of High School:

Address:

Number of Years Attended:

Graduation Date:

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* 16. College Attended

Name of College:

Address:

Number of Years Attended:

Graduation Date:

Major:

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* 17. List additional education such as trade school or business school.

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* 18. This position requires possession of an appropriate valid State of Ohio driver's license on the date of application and maintenance thereafter. Do you possess a current valid driver's license?

Yes

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* 19. NIMS Courses: check the courses you have completed.

IS-100

IS-200

IS-700

IS-800

None of the above.

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* 20. Do you possess any of the following certifications? If so, list the expiration date.

OH Firefighter II Certification

State of Ohio Paramedic Certification

State of Ohio EMT

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* 21. Do you possess a current valid American Heart Association CPR certification (BLS certification)? If yes, list the date of expiration. If not, state not applicable.

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* 22. Do you possess a current valid American Heart Association Advanced Cardiac Life Suppor (ACLS) certification? If yes, list the date of expiration. If not, state not applicable.

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* 23. I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.

Electronic signature required. I agree that by entering my name in the text box this is my legal signature.

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100% of survey complete.