EMPLOYMENT APPLICATION Mountain View Fire Protection District 

3561 N. Stagecoach Road Longmont, CO  80504 Phone: 303.772.0710 

 INSTRUCTIONS  A Mountain View Fire Rescue application is required for all positions. Human Resources will accept applications for OPEN positions only. Resumes are not accepted in lieu of an application. 

The information you provide in this employment application will be used in determining your suitability for the position for which you are applying, and to complete a preliminary background investigation.  Please complete the questionnaire keeping in mind that:  

The Employment Application must be completed in its entirety. 

All statements are subject to verification. 

Inaccuracies or incomplete statements may cause your application to be rejected and your name to be removed from further consideration. 

All time periods in your background must be accounted for. 

Include both day and evening telephone numbers for all references you list.  It is to your advantage to be timely and open in your response.  Any negative factor in your background will be evaluated in terms of circumstances and fact surrounding its occurrence and its degree of relevance for the position for which you are applying.  The investigating official will inquire into facts surrounding the occurrence.  Any evaluation will then be made on the relevance of these facts to the requirements of the position.  Please print legibly in ink or type your responses in the spaces provided.  If a question does not apply to you, write “N/A” (not applicable) in the space provided for your response.  Do not leave any portions blank.  If you need more space than provided to respond to the question, use the reverse side of the page, or attach additional pages, and identify the additional information by the question number.  Any questions concerning the Employment Application should be directed to the Human Resources Division at 303.772.0710.  Applications for current vacancies must be received on or before the application deadline by Mountain View Fire Protection District, Human Resources Department, 3561 N. Stagecoach Road, Longmont, CO  80504.  If mailing your application, please ensure adequate mailing time in order to be received on or before the application deadline.  You may scan and email your application and all required supporting documentation (including certifications and licenses) so long as all pages are clearly legible to hr@mvfpd.org.  Faxed applications are not accepted.  Late and/or incomplete applications will not be considered.    Note: You may use a clip to keep items together. However, please do NOT place your application and attachments in a binder, folder or sheet protectors. Do NOT use staples on the application or attached documents.    Mountain View Fire Protection District is an Equal Opportunity Employer.  Applicants are considered for positions for which they have applied without regard to race, religion, sex, age, national origin, disability or other characteristics protected by federal or Colorado law. 

NON‐FIREFIGHTER EMPLOYMENT APPLICATION Mountain View Fire Rescue 

3561 N. Stagecoach Road, Suite 200 Longmont, CO  80504 Phone: 303.772.0710 

  Thank you for your interest in Mountain View Fire Rescue.  The attached application is for non‐firefighter positions (such as Fire Investigator, administrative positions and Community Outreach).  If you are interested in a firefighting position, please visit www.mvfpd.org, “Employment Opportunities” for current hiring processes.  Unsolicited applications will not be accepted.  The attached application must be completed and returned to our Administrative Office at 3561 N. Stagecoach Road, Longmont, Colorado  80504.  In order to be considered for any position, you must meet all of the minimum required and applicable certifications, licenses and educational degrees, by the application deadline.  In addition to returning the completed application, please include the following items: Your application cannot be processed unless these items are included.   Cover Letter  Resume  Copy of valid Drivers License  Copy of Social Security Card and Birth Certificate or Passport  Copy of high school diploma or equivalent; or college degree or transcript  Copy of Motor Vehicle record from Dept. of Motor Vehicles (current within the last 30 days of 

the completed application)  Copy of any pertinent certifications / licenses, such as: 

Colorado State Certified FFI, FFII, etc.  

Colorado State Certified EMT‐B or EMT‐P 

Current CPR card 

Colorado State HAZMAT OPS 

Red Card 130/190 

Etc.  Late and/or incomplete applications will not be considered.  Should you have any questions, please feel free to contact me at 303.772.0710, Ext. 1124, or via email at HR@mvfpd.org.  Best regards,    Kyra L. Matkovich, SHRM‐CP, PHR Human Resource Manager 

EMPLOYMENT APPLICATION Mountain View Fire Protection District 3561 N. Stagecoach Road, Suite 200 

Longmont, CO  80504 Phone: 303.772.0710 

  APPLICANT NAME (Please print):                   The information you provide in this employment application will be used in determining your suitability for the position for which you are applying, and to complete your background investigation.  Please complete the questionnaire keeping in mind that:  

The Employment Application must be completed in its entirety. 

All statements are subject to verification. 

Inaccuracies or incomplete statements may cause your application to be rejected and your name to be removed from further consideration. 

All time periods in your background must be accounted for. 

Include both day and evening telephone numbers for all references you list.  It is to your advantage to be timely and open in your response.  Any negative factor in your background will be evaluated in terms of circumstances and fact surrounding its occurrence and its degree of relevance for the position for which you are applying.  The investigating official will inquire into facts surrounding the occurrence.  Any evaluation will then be made on the relevance of these facts to the requirements of the position.  Please print legibly in ink or type your responses to this questionnaire.  If a question does not apply to you, write “N/A” (not applicable) in the space provided for your response.  Do not leave any portions blank.  If you need more space than provided to respond to the question, use the reverse side of the page, or attach additional pages, and identify the additional information by the question number.  Any questions concerning the Employment Application should be directed to the Human Resources Department at 303.772.0710.  Applications for current vacancies must be received on or before the application deadline by Mountain View Fire Protection District, Human Resources Department, 3561 N. Stagecoach Road, Suite 200, Longmont, CO  80504.  If mailing your application, please ensure adequate mailing time in order to be received on or before the application deadline.  Late and/or incomplete applications will not be considered.    Mountain View Fire Protection District is an Equal Opportunity Employer.  Applicants are considered for positions for which they have applied without regard to race, religion, sex, age, national origin, disability or other characteristics protected by federal or Colorado law.  

MOUNTAIN VIEW FIRE RESCUE 3561 N. Stagecoach Road, Suite 200 · Longmont, CO 80504

(303) 772-0710 · FAX (303) 651-7702  

General (non‐Firefighter) Application Checklist ***Type or Print Legibly *** 

Do NOT place application or supporting documents in binder, folder or sheet protectors.   

Return this completed checklist with your application.  

All application materials must be received by 5pm on the application deadline, if applicable.    Legal Name:               

Email Address:               

Phone Number(s):   Cell:               Home:              

Position applying for:                 

Fill in the blanks for all that is applicable to you. All items with an asterisk are required. (A copy must be included with your application.) Mark items that are not applicable as N/A.  DO NOT LEAVE BLANK SPACES. 

For Office Use Only 

  Cover Letter* and  Resume*   

  Copy of valid Drivers License*   State: Exp:____/____/____

  Copy of the following documents*:   

      Social Security Card and Birth Certificate       OR  SS   Birth Certificate

      Passport  Passport  Exp:____/____/____

  Copy of high school diploma/equivalent     and/or      college diploma(s) or transcripts* 

HS Diploma     

Degree(s):  

  Copy of Motor Vehicle record from Dept. of Motor Vehicles (current within the last 30 days of the completed application)* 

Violations: 

  Have you or are you currently serving in the US Armed Forces or National Guard?*     Yes     No 

Notes: 

  Continue on to page 2 for certifications/licences.    

For Office Use Only Application Received by: 

(Initial)  

Date:  

General (non‐Firefighter) Application Checklist, Continued… Page 2  Check the appropriate fields for certifications that you have included with your application. 

      For Office Use Only 

 

 

 

 

 

 

 

 

 

EMT – Basic  Colorado State ID #             

  National Registry ID#             

Paramedic  Colorado State ID #             

  National Registry ID#             

BLS Certification 

ACLS Certification 

IV Cert  Date Received:               Preferred for EMT/B only. 

CPR Certification 

Exp:____/____/____

Exp:____/____/____ 

Exp:____/____/____ 

Exp:____/____/____ 

Exp:____/____/____ 

Exp:____/____/____ 

Date received:____/____/____ 

 

Exp:____/____/____ 

  Firefighter I  Exp:____/____/____ NIMS 100  Issued:____/____/____

  Firefighter II  Exp:____/____/____ NIMS 200  Issued:____/____/____

  HazMat Ops  Exp:____/____/____ NIMS 300  Issued:____/____/____

  HazMat Tech  Exp:____/____/____ NIMS 400  Issued:____/____/____

  S130/190  Issued:____/____/____ NIMS 700  Issued:____/____/____

  S230/290  Issued:____/____/____ NIMS 800  Issued:____/____/____

  Red Card  Exp:____/____/____ Car Seat Tech  Exp:____/____/____

  State of CO D/O Utility  Exp:____/____/____ State of CO D/O Pumper  Exp:____/____/____

  State of CO D/O Aerial  Exp:____/____/____ Fire Instructor  Exp:____/____/____

  ICC Inspector:  Exp:____/____/____ Other:   

  Other:    Other:   

  Other:    Other:   

 

 

 

 

 

 

For Office Use Only  Run CBI  Meets minimum Requirements   Disqualified (check all that apply):         App received after deadline.          Does not meet minimum qualifications.           List requirements not met:    

         Criminal history (describe):   

         Driving history (describe):   

         Incomplete application (describe):   

        Did not provide documentation (describe):   

2

PERSONAL INFORMATIONName: ____________________________________________________________ ____________________

(Print) Last First Middle Social Security #Other names (including nicknames, maiden names, former married names, name changes resulting fromadoptions, court actions, or other such matters) you have used or been known by: __________________________________________________________________________________________________________________

Have you used any other Social Security Numbers (SSN) in the past? _______Yes ______NoIf you answered “Yes”, please explain in detail and list:_______________________________________________________________________________________________________________________________________

Present address: ____________________________________________________________________________ Number Street City State Zip

Please list all addresses you have lived at for the last 10 years: (Attach additional sheets if necessary)Number Street City State Zip

Home/Cell Phone Number: __________ Work: __________ Other: __________ Email: ______________

Have you ever been convicted of a crime? _______ Yes _______ NoIf yes, please explain ________________________________________________________________________

If hired, can you furnish proof you are eligible to work in the U.S.? _______ Yes _______ No

EDUCATION/CERTIFICATIONS

Type of School Name, City & State Years AttendedFrom/To

Circle HighestYear Completed

Diploma, GEDor Degree

List Degree and/orArea of

ConcentrationHigh School 9 10

11 12 Yes ___ No ___

College (Undergrad) To 1 23 4 Yes ___ No ___

To 1 23 4 Yes ___ No ___

College (Grad) To 1 23 4 Yes ___ No ___

Trade School To 1 23 4 Yes ___ No ___

Current Emergency Medical Services Certification/Level: __________________ Expiration Date: _________Current Firefighter State Services Certification Level: __________________ Expiration Date: _________Current Hazardous Material State Certification Level: __________________ Expiration Date: _________Other Current State Certifications _____________________________________________________________

_________________________________________________________________________________________

3

List professional, trade, business or civic activities and offices held. You may exclude memberships (includingunion memberships) which would reveal gender, race, religion, national origin, age, ancestry, disability or otherprotected status.__________________________________________________________________________________________

MOTOR VEHICLE OPERATIONAn investigation of your driving history will be made. To expedite this procedure, please supply the followinginformation:

Do you have a valid Driver’s License? _______ Yes _______ NoDo you have a current Commercial Driver’s License? _______ Yes _______ NoDrivers License Number ________________ Expiration Date ____________State _________ Class ________Name as it appears on license _________________________________________________________________Has any license ever been suspended, revoked or have you been involved as a driver in a motor vehicle accidentwithin the last 36 months?____ Yes ____ No If yes, please explain (include when, where and why):

Nature of Violation Location Approximate DateFine or Other Action on

Driver’s License

Have you ever been convicted for a traffic offense? ______ Yes ______ No If yes, explain:__________________________________________________________________________________________

Have you ever been convicted for operating a motor vehicle while impaired or under the influence of alcohol ordrugs? ____ Yes ____ NoIf yes, explain:__________________________________________________________________________________________Have you ever failed to appear, failed to pay fines or failed to comply for any traffic offense?____ Yes ____ NoIf yes, explain:__________________________________________________________________________________________Do you currently have automobile insurance? ____ Yes ____ No If not, explain:__________________________________________________________________________________________

__________________________________________________________________________________________

Have you ever appeared in court or been charged with any offense? ____ Yes ____ No If yes, explain (you may omit any adjudications in a juvenile court)____________________________________

Other knowledge, skills & abilities relevant to position for which you are applying (ie: apprenticeships,correspondence courses, or other special training not shown above):__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

4

EMPLOYMENT HISTORYPlease duplicate this page if necessary to account for all work experiences.Start with your present or last job.Include any job-related military service assignments and volunteer activities. Account for all periods of time,including unemployment. You may exclude organizations which indicate race, color, religion, gender nationalorigin, age, disabilities or other protected status.

Employer Dates EmployedFrom To Work Performed

AddressRate of Pay

Starting FinalTelephone Number(s)

Starting/Present Job Title

Supervisor’s Name and Title May We Contact? ______Yes ______NoIf no, why not?

Reason for Leaving

Employer Dates EmployedFrom To Work Performed

AddressRate of Pay

Starting FinalTelephone Number(s)

Starting/Present Job Title

Supervisor’s Name and Title May We Contact? ______Yes ______NoIf no, why not?

Reason for Leaving

Employer Dates EmployedFrom To Work Performed

AddressRate of Pay

Starting FinalTelephone Number(s)

Starting/Present Job Title

Supervisor’s Name and Title May We Contact? ______Yes ______NoIf no, why not?

Reason for Leaving

Employer Dates EmployedFrom To Work Performed

AddressRate of Pay

Starting FinalTelephone Number(s)

Starting/Present Job Title

Supervisor’s Name and Title May We Contact? ______Yes ______NoIf no, why not?

Reason for Leaving

Have you ever been fired from a job or asked to resign? ______Yes ______NoIf yes, please explain: _______________________________________________________________________

5

If you have had no prior employment, please explain in the space below:____________________________________________________________________________________________________________________________________________________________________________________

Are you now or have you served in the military? ______Yes ______NoBranch: ___________ Status: ____________ Discharge Type: _____________________________________Dates: From: ___________ To: ___________

PERSONAL & PROFESSIONAL REFERENCES:Do you currently have any relatives working for Mountain View Fire Protection District? ______Yes _____NoIf yes, please list name and relationship: _________________________________________________________________________________________________________________________________________________

List three personal and three professional references who have knowledge of you and your qualifications.

Name of Personal References Address/City/State/Zip Telephone NumbersD=Day N=Night

Name of Professional References Address/City/State/Zip Telephone Numbers D=Day N=Night

6

AFFIDAVIT, CONSENT AND RELEASEPLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

I certify that all information provided in this employment application is true and complete. I understand thatany false information or omission may disqualify me from further consideration for employment and may resultin my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application. I also authorize, whetherlisted or not, any person, school, current employer, past employers, and organizations to provide relevantinformation and opinions that may be useful in making a hiring decision. I release such persons andorganizations from any legal liability in making such statements.

I understand I will be required to successfully pass a background investigation (criminal and employment) and adrug screening. I hereby consent to a pre-employment drug screen as a condition of employment.

I understand that if I am extended an offer of employment it may be conditioned upon successfully passing acomplete pre-employment physical examination, psychological examination and physical agility examination. Iconsent to the release of any or all medical information as may be deemed necessary to judge my capability todo the work for which I am applying.

I understand that this application, verbal statements by management, or subsequent employment does not createan express or implied contract of employment nor guarantee employment for any definite period of time. Onlythe Fire Chief of Mountain View Fire Protection District has the authority to enter into an agreement ofemployment for any specified period and such agreement must be in writing, signed by the Fire Chief and theemployee. If employed, I understand that I have been hired at the will of the employer and my employmentmay be terminated at any time, with or without reason and with or without notice.

I have read, understand, and by my signature below, consent to these statements.

________________________________________________ __________________________________etaDtnacilppA fo erutangiS

FAIR CREDIT REPORTING ACT DISCLOSURE &AUTHORIZATION DISCLOSURE

As an applicant for employment or a current employee of Mountain View Fire Protection District, you are aconsumer with rights under the Fair Credit Reporting Act. When any of the following circumstances exist,Mountain View Fire Protection District may choose to obtain and use information contained in either aconsumer report or an investigative consumer report from a consumer reporting agency about you when: (1)considering your application for employment, (2) making a decision whether to offer you employment, (3)deciding whether to continue your employment (if you are hired), or (4) making other employment-relateddecisions directly affecting you.

For explanation purposes, a consumer reporting agency is a person or business which, for monetary fees, dues,or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or otherinformation on consumers for the purpose of furnishing consumer reports to others, such as Mountain View FireProtection District.

A consumer report means any written, oral or other communication of any information by a consumer reportingagency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation,personal characteristics, or mode of living which is used or expected to be used or collected in whole or in partfor the purpose of serving as a factor in establishing your eligibility for employment purposes.

An investigative consumer report means a consumer report or portion thereof in which information on yourcharacter, general reputation, person characteristics, or mode of living is obtained through personal interviewswith your neighbors, friends, or associates reported on or with others with whom you are acquainted or whomay have knowledge concerning any such items of information.

In the event an investigative consumer report is prepared, you may request additional disclosures regarding thenature and scope of the investigation requested as well as a written summary of your rights under the Fair CreditReporting Act.

AUTHORIZATION

By signing below, I, ___________________________________, hereby voluntarily authorize Mountain ViewFire Protection District to obtain either a consumer report or an investigative consumer report about me from aconsumer reporting agency and to consider this information when making decisions regarding my employmentat Mountain View Fire Protection District. I understand that I have rights under the Fair Credit Reporting Act,including the rights discussed above. This report may be delivered in either written or electronic form.

___________________________________________________ ___________________Name Date

___________________________________________________ ___________________Social Security # Date of Birth

7