TRAVIS COUNTY EMERGENCY SERVICES DISTRICT #4 FIRE AND EMT ACADEMY CADET CLASS XV APPLICATION

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1 TRAVIS COUNTY EMERGENCY SERVICES DISTRICT #4 FIRE AND EMT ACADEMY CADET CLASS XV APPLICATION North Lamar #4B Austin, Texas (512) Office Hours 8:00am - 4:00pm

2 READ ALL OF THE MINIMUM REQUIREMENTS AND AUTOMATIC DISQUALIFIRERS BEFORE COMPLETING THE APPLICATION. MINIMUM REQUIREMENTS Must be 18 years of age as of June 1, Must have High School or GED diploma. Must have a valid driver s license. Must be a U.S. citizen or have a USCIS document to obtain a criminal history. Must be able to commit to 40 + hours a week, including occasional weekends. Must complete a minimum of 2 12 hour authorized ride-outs with ESD #4 by July 31, Applicant must come to the District Office located at N. Lamar Blvd., Ste. 4B, M-F, 8am - 4pm, to complete a Visitor Release Form and schedule the rideouts. AUTOMATIC DISQUALIFIERS Important: If you are not sure if any of the automatic disqualifiers pertain to you, you are required to submit a detailed letter explaining the circumstances in question. Application Disqualifiers The following will disqualify the applicant from further consideration during any phase of the process. 1. Failure to submit the application and all required documents by the July 31, 2014 deadline. Criminal Disqualifiers Any of the following will disqualify the applicant from further consideration during any phase of the process. 1. Having a conviction for, or being under indictment for, or currently charged with any felony offense. 2. Having any conviction for any Class A or Class B misdemeanor offense, or currently being under indictment for, or currently charged with any Class A or Class B misdemeanor offenses within the past 5 years as of July 31, Having a conviction for driving under the influence (DWI/DUI) within the past 5 years, as of July 31, 2014 or being under indictment for, or currently charged with driving under the influence (DWI/DUI). 4. Currently serving community supervision/probation for any offense. For the purposes of the above requirements, a person is considered convicted of an offense when an ADJUDICATION OF GUILT is entered against said person by a court of competent jurisdiction, or a PLEA OF GUILTY is entered, including situations where: 1. The sentence is subsequently probated and the person is discharged from probation. 2. Deferred adjudication is granted. Having excessive records of traffic convictions or negligent traffic collisions. This is defined as: 1. Involvement as a driver in three or more motor vehicle accidents within the past 3 years as of July 31, 2014 where the applicant s actions contributed to the accident in any way, whether or not citations were issued. 2. Convictions for more than two moving violations within the past 3 years as of July 31, TCESD#4-Application

3 3. A driver s license suspension within the past 3 years as of July 31, 2014 for: DWI/DUI Failure to carry liability insurance Military Disqualifiers Having been discharged from military service with a DISHONORABLE discharge. Drug Use Disqualifiers (All cadets are subject to random drug testing.) 1. Illegal use of Marijuana, any controlled substance or illegal drug, within the past 3 years as of July 31, Having a police record of illegal drug usage or having illegally furnished any illegal or dangerous drug to another. General Disqualifiers 1. Currently, have belonged to, or been closely associated with any organization which advocates or engages in unlawful conduct directed at individuals or groups based upon the individual s or group s race, sex, religion, national origin, age, sexual preference, disability, or conduct otherwise commonly known as Hate Crimes. 2. Making any false statement of fact, being deceptive by statement or omission in this application, or by any means in any part of the hiring process will result in disqualification and may be grounds for future dismissal. TCESD#4-Application

4 Please carefully read all of the material in the enclosed Application. All documents requested must be obtained and returned with the completed application. Each line item or question must be addressed, N/A (not applicable) if necessary. Unanswered items or questions will be considered incomplete and the application will not be processed. Instructions for obtaining requested documentation is enclosed, as well as an overview of the application process. 1. Applications can be typed or handwritten. Submit the completed application with required documents to the District Office, N Lamar Blvd., Ste 4B., Austin, TX The application cannot be submitted online. 2. After the application is submitted to the District Office, the criminal history and driving record will be reviewed by the Travis County ESD #4 Fire Chief. 3. The Fire Chief at this point can approve, deny, or make provisional recommendations. 4. All approved academy applicants will be required to go through a medical/physical exam and drug test. 5. The final cadet list for Class XV will be selected by August 15, ALL APPLICANTS MUST SUPPLY THE FOLLOWING DOCUMENTS Completed and signed application Original DPS criminal history * see below Original DPS driving record-type 3 *see below Copy of Immunization records * see below Copy of High School Transcripts or GED Test Scores Copy of Fire/EMT Certificates, if applicable Copy of College transcripts, if applicable Copy of Valid Driver s License Copy of Valid Social Security card Copy of Military DD214, if applicable *To obtain a DPS Criminal History go to: 108 Denson Dr., Austin, TX Need valid ID for Texas Criminal History Background - Monday Friday 8am-5pm - Will accept cash, check, or money order, NO credit cards ($24.95) - NO Fingerprint card needed - Allow 1 to 2 days to pick it up, or have it mailed to you *To obtain a Driving record online go to: - Click on services, then Driver s license/id, then Driver Record Request, then order now, follow instructions. - Type 3 Record is required - $7.50 *Immunization record to include: - Tetanus (Td) current within 10 years - MMR 2 doses - Varicella or proof of chicken pox disease - Hepatitis B 3 doses TCESD#4-Application

5 PERSONAL INFORMATION Date: Name: Last First Middle Address: Apt #: City: State: Zip: Social Security : Date of Birth: Driver s License Number : State: Class: Home Cell Number: Address: EDUCATION High School Name and location of High School Last Attended Did you Graduate? GED Business Yes No If you have not graduated from High School, have you passed the GED Test? Yes No Place: Name and Location of School Courses Completed Certification Received Technical Vocational Colleges or Universities Location Hours completed to date Graduated Yes No Degree Received Yes No TCESD#4-Application

6 MILITARY SERVICE Military Service : Yes No Branch of Service: Date of Enlistment: Year of Discharge: Type of Discharge: Grade/Rank: EMPLOYMENT EXPERIENCE Start with your present job. Include any job-related military service assignments and volunteer activities. Employer: Job Title: Starting Date: Reason for Leaving: Supervisor s Name: End Date: Employer: Job Title: Starting Date: Reason for Leaving: Supervisor s Name: End Date: Employer: Job Title: Starting Date: Reason for Leaving: Supervisor s Name: End Date: TCESD#4-Application

7 PREVIOUS FIREFIGHTER/EMT TRAINING Firefighter (if applicable) Volunteer Name of Department: EMT Training (if applicable) Basic Intermediate Paramedic Years of Service: Level of Training: Reason for leaving: TDSHS #: NREMT#: Expires: Expires: REFERENCES List three references (if applicable, use only one from Travis County ESD#4) Name: Address: City: State: Zip: Years known: Relationship: Name: Address: City: State: Zip: Years known: Relationship: Name: Address: City: State: Zip: Years known: Relationship: EMERGENCY CONTACT Name: Phone #: Name: Phone #: TCESD#4-Application

8 ACKNOWLEDGEMENT Please read carefully, initial each paragraph and sign below. I understand that this application and any attachment(s) are the property of Travis County ESD #4 and will become part of my personnel file. (Initial here) I hereby certify that the information in this application is true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any misrepresentation, falsification or omission of information from this application shall be grounds for rejection of this application or immediate discharge regardless of the time elapsed before discovery. (Initial here) I hereby authorize Travis County ESD #4 and its agents to thoroughly investigate the information on my application, my references, work record and education. In addition, I hereby release Travis County Emergency Services District #4, my former employers and all other persons or entities from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. (Initial here) I acknowledge that I may be subjected to random drug and alcohol testing at any time. (Initial here) I acknowledge that Travis County ESD #4 will not provide medical healthcare coverage at any time. (Initial here) I agree to abide by the Travis County ESD #4 policies, rules and regulations. I understand and agree that Travis County ESD #4 is an at will employer and my services may be terminated at any time. (Initial here) Applicant s Signature Date Printed Name TCESD#4-Application

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