CONDITIONS OF EMPLOYMENT AGREEMENT
|
|
- Rosalind Bridges
- 5 years ago
- Views:
Transcription
1 THE STATE OF TEXAS COUNTY OF HARRIS CONDITIONS OF EMPLOYMENT AGREEMENT WHEREAS, the City of Webster seeks to obtain the best possible candidates for employment within the Webster Fire Department; and WHEREAS, to obtain the best possible employees, the Webster Fire Department requires applicants to have and maintain certain minimum qualifications, training, and certification; and WHEREAS, the City requires every new probationary employee in the Webster Fire Department to agree to various conditions and qualifications of employment for the duration of the employee s tenure with the City; and NOW THEREFORE, the City of Webster and employee agree as follows: 1. I, THE UNDERSIGNED, AN APPLICANT/PROBATIONARY EMPLOYEE FOR THE CITY OF WEBSTER FIRE DEPARTMENT, IN CONSIDERATION FOR EMPLOYMENT WITH THE CITY OF WEBSTER, DO UNDERSTAND AND VOLUNTARILY AGREE, AS A CONDITION OF INITIAL AND CONTINUED EMPLOYMENT, TO THE FOLLOWING CONDITIONS OF EMPLOYMENT. 2. EMT Certifications. The Webster Fire Department provides emergency medical service for the citizens. (a) Paramedic Certification. The City of Webster desires that each applicant and employee already be EMT certified at the Paramedic level. Therefore, as a condition of my initial and continued employment, I agree I am EMT (Emergency Medical Technician) certified at the Paramedic level. (b) Future Requirements. Upon completing the appropriate emergency medical training and receiving State Certification, I acknowledge that I am subject to being detailed and assigned to the emergency medical services to include ambulance activity. Upon receiving State Certification, I agree to comply with and fulfill all existing and future requirements of the Texas Department of State Health Services to maintain my level of certification. Furthermore, once I obtain my EMT- Paramedic level of certification, I agree to comply with and fulfill all existing and future requirements of the Webster Fire Department and/or Medical Director. It is understood that if I fail to maintain any and all required certifications at a level established by the Department, or if I fail to comply with and fulfill all existing and future requirements of the Webster Fire Department, Texas Department of State Health Services and/or Medical Director providing Medical Control for the Webster Fire Department, I shall be in breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. It is understood that all continuing education and/or annual training, attended voluntarily on off-duty time, to maintain present certification or to attain a higher level of certification is non-compensable under federal and state law, and that by my signature below acknowledges that I will voluntarily attend such training, as required to maintain my certification or attain a higher level of certification. Page 1
2 3. Outside Employment. I recognize that the fire service is a physically and mentally challenging job requiring that I come to work in top physical and mental shape. Outside employment may have a detrimental effect on my physical condition and mental acumen. As an employee, I acknowledge that I am prohibited from engaging in outside employment, including self-employment, unless specifically approved by the prior to commencement. It is further understood that the criteria used by the Department when considering requests for outside employment shall be determined solely by the Department and shall be subject to change at any time. The criteria shall include, at a minimum, employee performance evaluations, disciplinary actions, attendance, sick leave usage, lost time injuries, safety record, the type of outside work to be performed, hours of work, workers compensation coverage, sick leave and medical insurance coverage, and possible conflicts of interest. It is understood that I must obtain approval before commencing in any form of employment outside of the Department and each year thereafter as established by Department policy. Further, I understand that all decisions rendered by the relevant to the review, approval, or denial of requests to engage in employment outside of the Department by employees shall not be subject to review or appeal. I understand that if I fail to comply with and fulfill all existing and future requirements of the Webster Fire Department regarding employment outside of the Department, I shall be in breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. 4. Outside Fire Service and EMS Activities. I recognize that the fire service and EMS service is a physically and mentally challenging job requirement that I come to work in top physical and mental shape. Outside fire service and EMS activities may have a detrimental effect on my physical condition and mental acumen, and may be incompatible with my employment with the City. As an employee, I acknowledge that I am prohibited from engaging in the provision of fire service or EMS activities, to include, but not limited to, fire suppression, fire prevention, fire investigation, fire education, hazardous materials, and emergency medical services, for any entity, public or private, with or without remuneration, unless specifically approved by the. Further, I understand that the criteria used by the Department when considering requests for fire service and EMS activities shall be determined solely by the Department and shall be subject to change at any time. The criteria shall include, at a minimum, employee performance evaluations, disciplinary actions, attendance, sick leave usage, lost time injuries, safety record, the type of fire service activities to be performed, hours of work, workers compensation coverage, sick leave and medical insurance coverage, and possible conflicts of interest. I understand that I must obtain approval before commencing in any form of fire service or EMS activities outside of the Department and each year thereafter as established by Department policy. It is further understood that all decisions rendered by the relevant to review, approval, or denial of requests to engage in fire service or EMS activities outside of the Department, shall not be subject to review or appeal. Further, I understand that if I fail to comply with and fulfill all existing and future requirements of the Webster Fire Department regarding fire service or EMS activities outside of the Department, I shall be in breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. 5. Drivers License. The City of Webster desires that each applicant and employee already have a Class B, Texas Drivers License. However, to obtain the best possible employee, the City may hire a desirable applicant who does not yet have said license, provided the applicant agrees to obtain the license within the time frame specified by the. Therefore, as a condition of my initial and continued employment, I agree to obtain a Class B, Texas Drivers License within one (1) year following employment of a firefighter position or within (1) month of accepting any higher position within the department. I understand that any time spent studying, practicing to drive, and taking Page 2
3 the State examination is non-compensable under federal and state law, and shall be on my non-work time. I also understand that as a condition of initial and continued employment, I could be required to obtain a Class A, DOT Commercial Drivers License at some time during my employment with the Department. Furthermore, as an employee obtaining a Texas Drivers License as required by the Department, I shall comply with and fulfill all existing and future requirements of the Webster Fire Department and State of Texas. I understand that failure to obtain and maintain a Texas Drivers License at a level required by the Department shall constitute a breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. 6. Drug and Alcohol Abuse Policy. I understand and acknowledge that I have received and read the City of Webster s Drug Free Workplace Policy and agree to comply with all of its requirements and subsequent modifications. I understand that failure to comply with and fulfill all requirements and future requirements of the Webster Fire Department related to the City s Drug Free Workplace Policy shall constitute a breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. 7. Tobacco-free. I agree to be tobacco free upon appointment and throughout the length of my service to the Webster Fire Department. It is understood that the use of tobacco or tobacco products at any time during my length of service with the Webster Fire Department is prohibited and shall constitute a breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. 8. Wellness/Fitness. I recognize that the fire service is a physically challenging job requiring that I be in top physical condition. I acknowledge that I am required to participate in, and maintain the standards established by the Webster Fire Department Wellness-Fitness Program. Participation in this program shall include, but is not limited to, medical fitness, physical fitness, emotional fitness, and rehabilitation when indicated or mandated by the Department. Further, I understand that I am to cooperate fully with the City in the review or investigation of sick leave usage, injury leave, and wellness-fitness standards and maintenance to include, but not limited to, the release and production upon request of all medical records, medical test results, and other medical records if specifically related to the review or investigation of sick leave or injury leave usage in question, regardless of origin, repository, or proprietary nature throughout their length of service to the Webster Fire Department. I understand that failure to comply with and fulfill all requirements of the Webster Fire Department Wellness-Fitness Program as established by Department policy shall constitute a breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. I understand that failure to comply with and fulfill all requirements of the Webster Fire Department related to the review or investigation of sick leave, injury leave, or wellness-fitness standards and maintenance shall constitute a breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. 9. Occupational Qualifications. As a condition of initial and continued employment, I agree to obtain and maintain all current and future occupational qualifications, as established solely by the Department. These include, but are not limited to, educational requirements set by the Texas Commission on Fire Protection or other state and/or Page 3
4 federal agencies in order to obtain or retain various certifications; higher-educational requirements; training, seminars, conferences, or continuing education deemed necessary by the employer; special skills, certifications, or abilities. As a condition of initial and continued employment, I further understand that I may be required to obtain additional certifications and/or licenses within a time frame established by the department. I understand that any continuing education, training and/or travel necessary in order to obtain and retain such certifications and/ or licenses shall be considered voluntary on my part, and shall not be considered compensable if attended or occurring on non-work time. The may at his/her discretion extend the deadline for completion. As a condition of initial and continued employment, I understand and acknowledge that I may be required at some time during my service with the Department to be certified as: Fire Officer I, II, III, and IV; Fire Inspector; Fire Investigator; Wildland Firefighter; Peace Officer; Any other certifications and/or licenses I understand that any training necessary in order to obtain and retain the certifications above shall be considered voluntary, and shall not be considered compensable if attended on non-work time. It is understood that failure to satisfactorily complete any instruction or training required by the Department or to obtain and maintain any certificate, license, or vocational proficiency required by the Department during my length of service with the Department shall constitute a breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. 10. Criminal Offenses. As a condition of initial and continued employment, I acknowledge and agree that I must report to the Department and Department Fire Marshal within twenty-four (24) hours of occurrence any arrests, detainments, or charges filed by appropriate law enforcement agencies for all felonies and/or misdemeanors to include DWI offenses. Final disposition of all charges filed and/or adjudicated by the courts shall be reported to the Department within twenty-four (24) hours. This section does not pertain to minor Class C traffic offenses unless they result in incarceration and/or detainment by a law-enforcement agency. It is understood that failure to comply with this provision at any time during the length of service with the Webster Fire Department is prohibited and shall constitute a breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. Page 4
5 11. Required Education, Certification, Licensure. I understand that as an employee, I must obtain the educational degree, certificate and/or licensure, as a Condition of Employment and that I must meet these requirements within the designated time frame(s). I further understand that I must maintain the required level of education, certification, and/or licensure obtained during the remainder of my employment. It is understood that my failure to obtain the required education, certification, and/or licensure or my failure to maintain the required education, certification, and/or licensure for the duration of my employment I shall be in breach of this agreement and, by my signature below, I agree to automatic resignation and forfeiture of my position with the City of Webster in this event. 12. Other Remedies Not Precluded. I fully understand the above requirements, and I agree to comply fully with each requirement. This instrument is executed to acknowledge my understanding and acceptance of these conditions of employment. I agree that failure to comply with and fulfill all aforementioned requirements of Webster Fire Department during my length of service with the Department constitutes a breach of this agreement and automatic resignation and forfeiture of my position with the City of Webster. I understand that if I forfeit my position for violating any of the aforementioned requirements, said action is not disciplinary in nature, but is solely on account of my not meeting all job requirements. It is understood that automatic resignations for any breach of the terms and conditions of this Conditions of Employment Agreement are voluntary in nature and are considered as non-disciplinary resignations, and there is no right of appeal before the Webster and the Webster City Manager. Notwithstanding the above, the, at his/her discretion, may elect to accept a penalty less than forfeiture of my position for a breach under this agreement, and/or may elect to pursue disciplinary action, if warranted. Nothing herein shall preclude the City from exercising any other remedies granted by law or equity. 13. Joint Severability. Any invalidity of any part of this agreement will not cause the remaining parts to be invalid. 14. Venue. This agreement is governed by the laws of the State of Texas, and venue for any legal proceeding relating to this agreement shall lie in Harris County, Texas. Page 5
6 THE ABOVE REQUIREMENTS HAVE BEEN FULLY DISCLOSED TO ME DURING THE PRE-HIRE AND/OR PROBATIONARY PERIOD, AND I UNDERSTAND THAT MY AGREEMENT TO MEET THE REQUIREMENTS IS A PRE-CONDITION TO MY EMPLOYMENT AND CONTINUED EMPLOYMENT WITH THE WEBSTER FIRE DEPARTMENT. SIGNED this the day of A.D. 20. Signature: Printed Name: Address: Telephone: THE STATE OF TEXAS COUNTY OF HARRIS BEFORE ME, the undersigned authority, a notary public in and for said county and state, on this day personally appeared, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that he/she (strike one) executed the same for the purposes and consideration therein expressed. Notary Public in and for the State of Texas Printed Name: My Commission Expires: Page 6
CITY OF LAKE MARY 100 N. COUNTRY CLUB RD MAILING ADDRESS: P. O. BOX LAKE MARY, FL PHONE
Date - - S.S. # - - CITY OF LAKE MARY 100 N. COUNTRY CLUB RD MAILING ADDRESS: P. O. BOX 958445 LAKE MARY, FL 32795-8445 PHONE 407-585-1445 EMPLOYMENT APPLICATION This City is an Equal Opportunity Employer
More informationYOU MUST FULLY COMPLETE THE APPLICATION AND SUBMIT ALL REQUIRED CERTIFICATIONS STATED IN THE APPLICATION PROCESS.
FORT MYERS BEACH FIRE DEPARTMENT APPLICATION FOR EMPLOYMENT SUBMIT FORM (PLEASE PRINT CLEARLY) DATE: 20 YOU MUST FULLY COMPLETE THE APPLICATION AND SUBMIT ALL REQUIRED CERTIFICATIONS STATED IN THE APPLICATION
More informationGrand Prairie Fire Department Applicant Identification Form
Revised 07/15 Grand Prairie Fire Department Applicant Identification Form Place Picture Name: Last First Middle DOB: Weight: Height: Hair Color: Eye Color: Social Security No.: D.L. #: Complete the areas
More informationTownship of Lower Salford, Montgomery County 379 Main Street, Harleysville PA 19438
Township of Lower Salford, Montgomery County 379 Main Street, Harleysville PA 19438 Application for Employment as a Probationary Police Officer Instructions: Before completing this form, carefully read
More informationPLEASE TYPE OR PRINT CLEARLY USING A PEN. Today s Date:
Name: Previous Name/s: Home Phone No: Work Phone No: E-mail: What class of Administrative Certificate do you hold? PLEASE TYPE OR PRINT CLEARLY USING A PEN Today s Date: If you do not possess an administrative
More informationTownship of Lower Salford, Montgomery County 379 Main Street, Harleysville PA 19438
Township of Lower Salford, Montgomery County 379 Main Street, Harleysville PA 19438 Application for Employment as a Probationary Police Officer Instructions: Before completing this form, carefully read
More informationEmployment Application Fulshear Simonton Fire Department
Employment Application Please keep the following in mind while completing the application. 1. Please read each question and all instructions carefully while completing the application. Answer all questions
More informationCAMDEN COUNTY SHERIFF S OFFICE
Position: Date: JAMES K. PROCTOR, SHERIFF CAMDEN COUNTY P.O. BOX 699 209 E. 4 TH STREET WOODBINE, GEORGIA 31569 Phone (912) 510-5100 CAMDEN COUNTY SHERIFF S OFFICE EMPLOYMENT APPLICATION Thank you for
More informationFirefighter Application Packet City of Texarkana, Texas
Firefighter Application Packet City of Texarkana, Texas Fire Department Human Resources 220 Texas Blvd. PO Box 1967 Texarkana, TX 75503 Texarkana, TX 75504 (903) 798-3994 (903) 798-3916 Thank you for your
More informationSIDNEY VOLUNTEER FIRE DEPARTMENT
SIDNEY VOLUNTEER FIRE DEPARTMENT APPLICATION FOR MEMBERSHIP P.O. BOX 79 Sidney, NE 69162 Dear Applicant, Thank you for your interest in joining the Sidney Volunteer Fire Department. This Application is
More information2012/2013 ST. JOSEPH MERCY OAKLAND Pontiac, Michigan HOUSE OFFICER EMPLOYMENT AGREEMENT
2012/2013 ST. JOSEPH MERCY OAKLAND Pontiac, Michigan SAMPLE CONTRACT ONLY HOUSE OFFICER EMPLOYMENT AGREEMENT This Agreement made this 23 rd of January 2012 between St. Joseph Mercy Oakland a member of
More informationRockton Fire Protection District. Application for Membership
Rockton Fire Protection District Application for Membership 1 Rockton Fire Protection District Mission Statement The Rockton Fire Protection District is dedicated to protecting the lives and property of
More informationState of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training
State of Florida Department of Health Board of Osteopathic Medicine Application for Registration as an Osteopathic Physician in Training Board of Osteopathic Medicine 4052 Bald Cypress Way, #C-06 Tallahassee,
More information(2) The satisfactory completion of a 1,000 hour AIT program will satisfy the experience requirement set forth in rule 620-X (f).
620-X-5-.07 Administrator-in-Training General Information (1) An Administrator-in-Training is a supervised internship during which the Administrator-in- Training (the AIT) works under the guidance and
More informationHampton Division of Fire and Rescue & Newport News Fire Department CANDIDATE BACKGROUND INFORMATION PACKET
Hampton Division of Fire and Rescue & Newport News Fire Department CANDIDATE BACKGROUND INFORMATION PACKET ** This packet along with the required documents listed on the next page MUST be submitted on
More informationHillsborough County Fire Rescue Reserve Responder Program 9450 E Columbus Ave Tampa, FL Office: Fax:
Application For Reserve Responder Full Name: Last First M.I. Date Submitted: Street Address Apartment/Unit # City State ZIP Code Email Name As It Appears On Driver s License: Driver s License #: State
More informationStaff & Training. Contra Costa County EMS Agency. Table of Contents EMT Certification Paramedic Accreditation
Contra Costa County EMS Agency Staff & Training Table of Contents 2000 Administrative Policy Number Formally EMT Certification 2001 1 Paramedic Accreditation 2002 2 MICN Authorization / Reauthorization
More informationDRUG FREE WORKPLACE ACT AND POLICY PROCLAMATION
CLACKAMAS COUNTY EMPLOYMENT POLICY & PRACTICE (EPP) EPP # 5 Implemented: 12/31/92 Clerical Update: 03/07; 10/23/07 DRUG FREE WORKPLACE ACT AND POLICY PROCLAMATION PURPOSE: Clackamas County government is
More informationState of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training
State of Florida Department of Health Board of Osteopathic Medicine Application for Registration as an Osteopathic Physician in Training Board of Osteopathic Medicine 4052 Bald Cypress Way, #C-06 Tallahassee,
More informationUPPER PROVIDENCE TOWNSHIP MONTGOMERY COUNTY, PENNSYLVANIA ORDINANCE NO.
UPPER PROVIDENCE TOWNSHIP MONTGOMERY COUNTY, PENNSYLVANIA ORDINANCE NO. AN ORDINANCE REPEALING CHAPTER 85 OF THE CODE OF THE TOWNSHIP OF UPPER PROVIDENCE, FIRE AND EMERGENCY SERVICES, ADOPTING IN ITS PLACE
More informationCITY OF GLENDALE APPLICATION FOR POLICE OFFICER CHECK LIST
CITY OF GLENDALE APPLICATION FOR POLICE OFFICER CHECK LIST Be a U.S. Citizen. To apply you must: Have never been convicted of a felony (unless pardoned) Ability to lawfully possess a firearm Prior to appointment
More informationAttachment B ORDINANCE NO. 14-
ORDINANCE NO. 14- AN ORDINANCE OF THE COUNTY OF ORANGE, CALIFORNIA AMENDING SECTIONS 4-9-1 THROUGH 4-11-17 OF THE CODIFIED ORDINANCES OF THE COUNTY OF ORANGE REGARDING AMBULANCE SERVICE The Board of Supervisors
More informationCity of Pigeon Forge Police Department. Position: The City of Pigeon Forge Police Department is accepting applications for Communications Officer.
City of Pigeon Forge Police Department Position: The City of Pigeon Forge Police Department is accepting applications for Communications Officer. Qualifications: Must be at least eighteen years of age
More informationFiler Police Department 300 Main Street Office: P.O. Box 140 Dispatch: Filer, Idaho Fax:
Filer Police Department 300 Main Street Office: 208 326-4123 P.O. Box 140 Dispatch: 208 735-1911 Filer, Idaho 83328 Fax: 208 326-5004 www.cityoffiler.com 911 Emergency EQUAL OPPORTUNITY EMPLOYER Prospective
More informationFIRE RECRUIT CIVIL SERVICE COMMISSION CITY OF TYLER, TEXAS MINIMUM QUALIFICATIONS
>0?.\. CIVIL SERVICE COMMISSION CITY OF TYLER, TEXAS Announces an Examination for FIRE RECRUIT ANNOUNCEMENT OPENS: THURSDAY, JULY 19, 2018 AT 9:30 A.M. APPLICATION DEADLINE: FRIDAY, AUGUST l7, 2018 AT
More informationMatlacha/Pine Island Fire Control District 5700 Pine Island Road Bokeelia, FL APPLICATION FOR EMPLOYMENT
Position(s) Applied For Matlacha/Pine Island Fire Control District 5700 Pine Island Road Bokeelia, FL 33922 APPLICATION FOR EMPLOYMENT Date of Application PERSONAL INFORMATION Last Name First Name Middle
More informationGLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER
100 Sulphur Springs Road Brunswick, GA 31520 Telephone: (912) 554-7600 Web Page Address: www.glynncountysheriff.org INSTRUCTIONS AND INFORMATION PLEASE READ CAREFULLY BEFORE BEGINNING 1. Please complete
More informationMEDICAL LICENSURE COMMISSION OF ALABAMA ADMINISTRATIVE CODE CHAPTER 545 X 6 THE PRACTICE OF MEDICINE OR OSTEOPATHY ACROSS STATE LINES
Medical Licensure Chapter 545 X 6 MEDICAL LICENSURE COMMISSION OF ALABAMA ADMINISTRATIVE CODE CHAPTER 545 X 6 THE PRACTICE OF MEDICINE OR OSTEOPATHY ACROSS STATE LINES TABLE OF CONTENTS 545 X 6.01 545
More informationALABAMA DEPARTMENT OF MENTAL HEALTH BEHAVIOR ANALYST LICENSING BOARD DIVISION OF DEVELOPMENTAL DISABILITIES ADMINISTRATIVE CODE
ALABAMA DEPARTMENT OF MENTAL HEALTH BEHAVIOR ANALYST LICENSING BOARD DIVISION OF DEVELOPMENTAL DISABILITIES ADMINISTRATIVE CODE CHAPTER 580-5-30B BEHAVIOR ANALYST LICENSING TABLE OF CONTENTS 580-5-30B-.01
More informationState of Iowa Standard Teacher Employment Application
State of Iowa Standard Teacher Employment Application Application Date: Date Available: Name: Social Security #: U.S. Citizen: Are you legally eligible to work in the United States? Current Home Phone:
More informationMacon County Mental Health Court. Participant Handbook & Participation Agreement
Macon County Mental Health Court Participant Handbook & Participation Agreement 1 Table of Contents Introduction...3 Program Description.3 Assessment and Enrollment Process....4 Confidentiality..4 Team
More informationComplete the Attached Addendum
APPLICATION FOR EMPLOYMENT CITY OF BEAVER DAM FIRE AND RESCUE DEPARTMENT 205 S. Lincoln Ave. Beaver Dam Wisconsin 53916 920-887-4609 FAX 920-887-4671 www.cityofbeaverdam.com INSTRUCTIONS: 1. Application
More informationRequest for Proposal Youth Motivational and Workshop Speakers
851 Old Alice Brownsville, Texas 78520 www.wfscameron.org Request for Proposal Youth Motivational and Workshop Speakers Southwest Key Workforce Development (SWK) is seeking a dynamic speaker who can deliver
More informationPROPOSED REGULATION OF THE PEACE OFFICERS STANDARDS AND TRAINING COMMISSION. LCB File No. R September 7, 2007
PROPOSED REGULATION OF THE PEACE OFFICERS STANDARDS AND TRAINING COMMISSION LCB File No. R003-07 September 7, 2007 EXPLANATION Matter in italics is new; matter in brackets [omitted material] is material
More informationDo not drop off applications at the fire division offices.
Dear Firefighter/Paramedic Applicant: Thank you for your interest in employment with the City of Urbana. Please read this cover letter carefully prior to filling out the attached application packet for
More informationKARNS FIRE DEPARTMENT P.O. BOX 7184 * KNOXVILLE, TN * 37921
KARNS FIRE DEPARTMENT P.O. BOX 7184 * KNOXVILLE, TN * 37921 BUSINESS # (865) 691-1333 * BUSINESS FAX (865) 691-1039 KARNS * HARDJN VALLEY * SOLWAY * BALL CAMP APPLICATION FOR EMPLOYMENT PLEASE PRINT PLEASE
More information(1) Commission is the Commission on Law Enforcement Standards and Training. (2) Chairman is the Chairman of the Commission.
1001. DEFINITIONS (1) Commission is the Commission on Law Enforcement Standards and Training. (2) Chairman is the Chairman of the Commission. (3) Director is the Director of the Commission. (4) Political
More informationSECTION A PERSONAL INFORMATION
Emergency Medical Services Provider Certification Application (Please print legibly) SECTION A PERSONAL INFORMATION Last Name First Name Middle Initial Suffix (Jr, Sr, II, III) Mailing Address City State
More informationTRAVIS COUNTY EMERGENCY SERVICES DISTRICT #4 FIRE AND EMT ACADEMY CADET CLASS XV APPLICATION
TRAVIS COUNTY EMERGENCY SERVICES DISTRICT #4 FIRE AND EMT ACADEMY CADET CLASS XV APPLICATION 11800 North Lamar #4B Austin, Texas 78753 (512) 836-7566 Office Hours 8:00am - 4:00pm READ ALL OF THE MINIMUM
More informationUSABLE CORPORATION TRUE BLUE PPO NETWORK PRACTITIONER CREDENTIALING STANDARDS
USABLE CORPORATION TRUE BLUE PPO NETWORK PRACTITIONER CREDENTIALING STANDARDS ELIGIBLE DISCIPLINES: Chiropractors Optometrists Podiatrists Advance Nurse Practitioners Certified Nurse-Midwives Clinical
More informationMissouri Revised Statutes
Missouri Revised Statutes Chapter 344 Nursing Home Administrators August 28, 2010 Definitions. 344.010. As used in this chapter the following words or phrases mean: (1) "Board", the Missouri board of nursing
More informationCHAPTER ONE RULES PERTAINING TO EMS AND EMR EDUCATION, EMS CERTIFICATION, AND EMR REGISTRATION
CodeofCol or adoregul at i ons Sec r et ar yofst at e St at eofcol or ado DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT EMERGENCY MEDICAL SERVICES 6 CCR 1015-3 [Editor s Notes follow the text of the rules
More informationCOMMUNITY HOWARD REGIONAL HEALTH KOKOMO, INDIANA. Medical Staff Policy POLICY #4. APPOINTMENT, REAPPOINTMENT AND CREDENTIALING POLICY
COMMUNITY HOWARD REGIONAL HEALTH KOKOMO, INDIANA Medical Staff Policy POLICY #4. APPOINTMENT, REAPPOINTMENT AND CREDENTIALING POLICY 1.1 PURPOSE The purpose of this Policy is to set forth the criteria
More informationPACIFIC COUNTY CIVIL SERVICE
PACIFIC COUNTY CIVIL SERVICE EMPLOYMENT APPLICATION PACKET REQUIREMENTS: 21 Years of Age No Felony Convictions Prior to employment must obtain Valid Driver s License United States Citizen High School Diploma
More informationWEST HAVEN FIRE DEPARTMENT 366 Elm Street, P.O. Box 207 West Haven, Connecticut (203) Fax (203)
WEST HAVEN FIRE DEPARTMENT 366 Elm Street, P.O. Box 207 West Haven, Connecticut 06516 (203) 937-3710 Fax (203) 937-3721 FIRE COMMISSIONERS: BRUCE E. SWEENEY CHAIRMAN JOHN CAREW TREASURER NICHOLAS RUICKOLDT
More informationTown of Windham Request for Proposals (RFP s) for Animal Control Services
Town of Windham Request for Proposals (RFP s) for Animal Control Services PART A: PURPOSE OF REQUEST The Town of Windham is seeking Proposals from individuals or organizations interested in providing animal
More informationPawling Central School District 515 Route 22 Pawling, NY (845) (845) Fax
Pawling Central School District 515 Route 22 Pawling, NY 12564 (845) 855-2028 (845) 855-2152 Fax The Pawling Central School District is an equal opportunity school district/employer, which does not discriminate
More informationGUIDELINES FOR BUSINESS IMPROVEMENT GRANT PROGRAM BY THE COLUMBUS COMMUNITY & INDUSTRIAL DEVELOPMENT CORPORATION
GUIDELINES FOR BUSINESS IMPROVEMENT GRANT PROGRAM BY THE COLUMBUS COMMUNITY & INDUSTRIAL DEVELOPMENT CORPORATION Section 1. Purpose. The purpose of this program is to promote the development and expansion
More informationCITY OF MISSION CIVIL SERVICE APPLICATION
CITY OF MISSION CIVIL SERVICE APPLICATION City of Mission Civil Service Department 1201 E. 8 th Street Mission, TX 78572 Applicant Name: Position Applying For: Police Officer Fire Fighter Page 1 of 15
More informationRegulatory Council for Community Association Managers Telephone Conference Meeting Wednesday, December 6, 9:00 A.M. EST.
Regulatory Council for Community Association Managers Telephone Conference Meeting Wednesday, December 6, 2007 @ 9:00 A.M. EST. CALL TO ORDER The meeting was called to order at 9:10 a.m. by Mr. Millard
More informationASSEMBLY BILL No. 214
AMENDED IN SENATE AUGUST, 00 AMENDED IN SENATE AUGUST, 00 AMENDED IN SENATE AUGUST, 00 AMENDED IN SENATE JULY, 00 AMENDED IN SENATE JUNE, 00 AMENDED IN SENATE JUNE, 00 AMENDED IN SENATE AUGUST 0, 00 california
More informationCITY OF SLAYTON Application for Police Service APPENDIX A
CITY OF SLAYTON Application for Police Service APPENDIX A Directions: 1. PRINT clearly and give complete and accurate information. If you do not, you may be removed from further consideration. USE BLACK
More informationAPPLICATION FOR BENEFITS LAW ENFORCEMENT OFFICERS AND FIRE FIGHTERS DISABILITY BENEFITS TRUST FUND
EXHIBIT A M S Attorney General s Office Use Only: Application #: Receipt Date: G Approved G Disapproved Claim type: G Law Enforcement Officer G Fire Fighter STOP. Please read the fund policies and procedures
More informationPOLICY TITLE: Code of Ethics for Certificated Employees POLICY NO: 442 PAGE 1 of 8
POLICY TITLE: Code of Ethics for Certificated Employees POLICY NO: 442 PAGE 1 of 8 It is the policy of this district that all certificated employees shall adhere to the Code of Ethics for Idaho Professional
More informationPennsylvania Certification by Endorsement
Pennsylvania Certification by Endorsement Thank you for your interest in obtaining Pennsylvania EMS Certification by Endorsement. This is the process whereby a person certified by another state other than
More informationDEFENSE CONSULTING SERVICES, LLC DCS Operations Center IH 10 W San Antonio TX 78249
PART 1 Law Enforcement Officers Safety Act Application Notice In order for Defense Consulting Services (DCS) to process your application the following Personally Identifiable Information (PII) and Sensitive
More informationAPPLICATION FOR REINSTATEMENT OF AN EDUCATOR S LICENSE (PRINT OR TYPE ALL INFORMATION)
FORM 1R REINSTATEMENT MISSISSIPPI DEPARTMENT OF EDUCATION Office of Educator Licensure P. O. Box 771 Jackson, MS 39205-0771 TELEPHONE (601) 359-3483 OFFICE USE ONLY Application Complete / / APPLICATION
More informationNJ TRANSIT POLICE 1 Penn Plaza East 7 th Floor Newark, NJ ATTN: TRAINING UNIT
Citizen Police Academy Application Thank you for your interest in the NJ TRANSIT Police Citizen Police Academy. Attached is an application for the program. The NJTPD Citizen Police Academy is an exciting
More informationPOLICY NO Volunteer Policy (Replaces Policy Adopted 1/26/1998)
POLICY NO. 28-01 Volunteer Policy (Replaces Policy Adopted 1/26/1998) Policy Statement Hernando County recognizes that volunteers are essential to the productivity, efficiency and cost effectiveness of
More informationFishers Fire Department. Merit Commission
Merit Commission Table of Contents Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Section 7 Section 8 Chief and Deputy Chief(s) of Department Merit Commission Applicant Requirements Performance
More informationSHERIFF A. LANE CRIBB
SHERIFF A. LANE CRIBB GEORGETOWN COUNTY SHERIFF S OFFICE APPLICANT DISQUALIFIERS You are applying for a position with the Georgetown County Sheriff s Office. It is the Policy of the Sheriff s Office to
More informationEMPLOYMENT PRE-SCREEN QUESTIONNAIRE
POSITION TITLE: APPLICANT NAME: APPLICANT MAILING ADDRESS: CONTACT NUMBER: EMAIL: 1. Have you ever served in the Military? 2. What is your highest level of education? HS Diploma/GED 2 Year degree 4 Year
More informationRESIDENT PHYSICIAN AGREEMENT THIS RESIDENT PHYSICIAN AGREEMENT (the Agreement ) is made by and between Wheaton Franciscan Inc., a Wisconsin nonprofit
RESIDENT PHYSICIAN AGREEMENT THIS RESIDENT PHYSICIAN AGREEMENT (the Agreement ) is made by and between Wheaton Franciscan Inc., a Wisconsin nonprofit corporation ( Hospital ) and ( Resident ). In consideration
More informationCITY OF GLADSTONE APPLICATION FOR EMPLOYMENT (An Equal Opportunity Employer)
~C t y i M o f i s G s l o a u d r s i t o n e ~ CITY OF GLADSTONE APPLICATION FOR EMPLOYMENT (An Equal Opportunity Employer) In keeping with our commitment to maintain a drug and alcohol-free workplace,
More informationArizona Revised Statutes Annotated _Title 36. Public Health and Safety_Chapter 7.1. Child Care Programs_Article 1.
A.R.S. T. 36, Ch. 7.1, Art. 1, Refs & Annos A.R.S. 36-881 36-881. Definitions In this article, unless the context otherwise requires: 1. Child means any person through the age of fourteen years. Child
More informationMedical Licensure Commission ALABAMA DEPARTMENT OF MEDICAL LICENSURE COMMISSION ADMINISTRATIVE CODE APPENDICES TABLE OF CONTENTS
Medical Licensure Commission Appendices ALABAMA DEPARTMENT OF MEDICAL LICENSURE COMMISSION ADMINISTRATIVE CODE APPENDICES TABLE OF CONTENTS Appendix A/Ch. 2 Appendix B/Ch. 2 Appendix C/Ch. 2 Appendix D/Ch.
More informationVolunteer Acknowledgement and Agreement
Volunteer Acknowledgement and Agreement West Palm Beach, Florida 33407-3277 As a volunteer of, I will benefit working with other committed individuals, who are assisting people with disabilities and other
More informationFlight Nurse/ Educator Application Packet
Flight Nurse/ Educator Packet This application is for the position of Flight Nurse/ Educator. Island Air Ambulance is a service of San Juan Island EMS and MedEvac with aviation services provided by Island
More information2.3. Any amendment to the present "Terms and Conditions" will only be valid if approved, in writing, by the Agency.
TERMS AND CONDITIONS Nanny Agency Portugal develops its activity based on the conditions set out in this document. In order to protect your interests, read this document carefully. 1. Definitions 1.1.
More informationCATHOLIC CAMPAIGN FOR HUMAN DEVELOPMENT GRANT AGREEMENT
CCHD GRANT # CATHOLIC CAMPAIGN FOR HUMAN DEVELOPMENT GRANT AGREEMENT This Agreement is executed by and between the United States Conference of Catholic Bishops ( USCCB ), 3211 Fourth Street, N.E., Washington,
More informationCahokia Volunteer Fire Department. Application for Membership
Cahokia Volunteer Fire Department Application for Membership Minimum Requirements for Membership 1) Must be a resident within the residential boundaries for at least 6 months. 2) Must be a minimum age
More informationRULES OF DEPARTMENT OF COMMERCE AND INSURANCE DIVISION OF REGULATORY BOARDS CHAPTER PRIVATE PROTECTIVE SERVICES TABLE OF CONTENTS
RULES OF DEPARTMENT OF COMMERCE AND INSURANCE DIVISION OF REGULATORY BOARDS CHAPTER 0780-05-02 PRIVATE PROTECTIVE SERVICES TABLE OF CONTENTS 0780-05-02-.01 Purpose 0780-05-02-.13 Monitoring of Training
More informationSummerfield Township Volunteer Fire Department Ordinance
Summerfield Township Volunteer Fire Department Ordinance Ordinance Number #2017-001 An ordinance to establish the Summerfield Volunteer Fire Department; provide for the basic organizational structure of
More informationLompoc Police Department Explorer Post #700
Lompoc Police Department Explorer Post #700 APPPPLIICATIION FOR MEMBERSSHIIPP Print legibly all information required and answer all questions as completely and truthfully as possible. After filling out
More informationJefferson County Sheriff s Office 200 Courthouse Way, Rigby, ID PH# ~ FX#
Jefferson County Sheriff s Office 200 Courthouse Way, Rigby, ID 83442 PH# 208-745-9210 ~ FX# 208-745-9212 JOB APPLICATION Name: Application Date POSITION APPLIED FOR: Patrol Jail Dispatch Reserve Application
More informationEMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF
EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF PHASE I 1. Secure application form in person, mail, telephone, or website (www.pittsville.k12.wi.us). 2. Return the completed application form with a
More informationOrganizational Provider Credentialing Application
Prior to completing this credentialing application, please read and observe the following: INSTRUCTIONS This form should be typed (using a different font than the form) or legibly printed in black or blue
More informationMISSOURI. Downloaded January 2011
MISSOURI Downloaded January 2011 19 CSR 30-81.010 General Certification Requirements PURPOSE: This rule sets forth application procedures and general certification requirements for nursing facilities certified
More information(e) Revocation is the invalidation of any certificate held by the educator.
Effective October 15, 2009 505-6-.01 THE CODE OF ETHICS FOR EDUCATORS (1) Introduction. The Code of Ethics for Educators defines the professional behavior of educators in Georgia and serves as a guide
More informationACADIA PARISH SHERIFF S OFFICE K.P.GIBSON Sheriff and Ex-Officio Tax Collector JOB APPLICATION FORM
ACADIA PARISH SHERIFF S OFFICE K.P.GIBSON Sheriff and Ex-Officio Tax Collector JOB APPLICATION FORM Position applying for: Date of Application: Full-Time: Part-Time: Date available for work: Personal Information
More informationPOLICY NO Volunteer Policy (Replaces Policy Adopted 12/13/2011)
POLICY NO. 28-01 Volunteer Policy (Replaces Policy Adopted 12/13/2011) Policy Statement Hernando County recognizes that volunteers are essential to the productivity, efficiency and cost effectiveness of
More information1.2 General Authority for the promulgation of these rules is set forth in C.R.S
Section 1 - Purpose and Authority for Establishing Rules 1.1 The purpose of these rules is to replace the existing rules pertaining to emergency medical services with rules that will more adequately address:
More informationGuard Force International 7301 Ranch Rd N. 620 N. Suite 155 #284, Austin, TX 78726
Guard Force International 7301 Ranch Rd N. 620 N. Suite 155 #284, Austin, TX 78726 Rev 4-2010 GFI Employment Form Received Applications will be active for 6 months Position applying for: Location: PERSONAL
More informationApplication Form TYPE OF EMPLOYMENT DESIRED: PERSONAL INFORMATION EMERGENCY CONTACT INFORMATION EMPLOYMENT INFORMATION CURRENT EMPLOYER:
Application Form Williamson County Emergency Services District #7 PO Box 422 Florence, TX 76527 (254) 793-2591 Form 1-E-01A (02 November 2005) Date of Application: / / 2 0 ** Applicant Must Submit DPS
More informationWoodstock Volunteer Fire Association
Information Sheet The Woodstock Volunteer Fire Association (WVFA) is a nonprofit volunteer organization whose purpose is to provide emergency services to the Town of Woodstock. The WVFA is made up of people
More informationVolunteer Application
Volunteer Application Applicant Information First Name: Middle Initial: Last Name: Address: City: State: Zip: Home Phone: Cell Phone: Email: Occupation: Special Skills: Volunteer Preferences Have you previously
More informationEmergency Medical Services Regulation. Adopted October 1, 2009
Emergency Medical Services Regulation Adopted October 1, 2009 WHEREAS, the Boston Public Health Act established the Boston Public Health Commission ("Commission") as the board of health for the City of
More informationGuidelines for Professionalism, Licensure, and Personal Conduct The American Board of Family Medicine (ABFM) Version
I. Professionalism Guidelines for Professionalism, Licensure, and Personal Conduct The American Board of Family Medicine (ABFM) Version 2017-5 Adopted Effective 1/29/2017 Professionalism is the basis of
More informationCIVIL SERVICE COMMISSION CITY OF TYLER, TEXAS. Announces an Examination for FIRE RECRUIT
CIVIL SERVICE COMMISSION CITY OF TYLER, TEXAS Announces an Examination for FIRE RECRUIT ANNOUNCEMENT OPENS: THURSDAY, MAY 8, 2014 AT 9:30 A.M. APPLICATION DEADLINE: FRIDAY, JUNE 6, 2014 AT 5:00 P.M. TEST
More informationThis chapter shall be known and may be cited as the "Alabama Athletic Trainers Licensure Act."
AL AT Act 12/04 Section 34-40-1 Short title. This chapter shall be known and may be cited as the "Alabama Athletic Trainers Licensure Act." Section 34-40-2 Definitions. As used in this chapter, the following
More informationMelbourne Beach Volunteer Fire Department FIREFIGHTER VOLUNTEER APPLICATION PACKAGE
Melbourne Beach Volunteer Fire Department 507 Ocean Avenue Melbourne Beach, FL 32951 (321) 724-1736 FIREFIGHTER VOLUNTEER APPLICATION PACKAGE Thank you for your interest in the Melbourne Beach Volunteer
More informationSABRE Instructor Certification Course Application
1 Date SABRE Instructor Certification Course Application By submitting the following application, you understand that you are applying solely for the opportunity to participate in a training class designed
More informationCITY OF GAUTIER VACANCY ANNOUNCEMENT
Post Date: September 4, 2017 End Date: October 4, 2017 CITY OF GAUTIER VACANCY ANUNCEMENT POSITION: DEPARTMENT: HOURS: PAY GRADE: Police Officer Police Department 12 Hours Rotating Shift $28,086.24 - $49,140.00
More informationNON-RESIDENT NON-DISPENSING PHARMACY Permit application instructions
The pharmacist-in-charge for the applicant must be a S.C. licensed pharmacist. The facility must be in compliance with S.C. Board of Pharmacy Policy and Procedure #147. The pharmacist-in-charge for the
More informationSECTION ONE - PERSONAL INFORMATION SECTION TWO - EDUCATION INFORMATION
Attachment H ALLIED HEALTH PROFESSIONALS INITIAL APPOINTMENT ADDENDUM TO THE TEXAS DEPARTMENT OF INSURANCE (TDI) STANDARDIZED CREDENTIALING APPLICATION SECTION ONE - PERSONAL INFORMATION Last Name: First
More information10111 Richmond Avenue, Suite 400, Houston, Texas (713) / (866) (Toll Free) / (713) (Fax)
Application Date: \ \ Date Available: \ \ Provider s Name: O MD O DO O PA O NP SS # : City: State: Zip: Home Phone ( ) Work Phone ( ) Pager ( ) Cell Phone ( ) E-Mail address: Driver s Lic. # Expires: \
More informationCAPTAIN - TRAINING OFFICER I (Fire Rescue)
*** This position is covered by a collective bargaining agreement *** **This position may require a physical ability/agility test** *This is a transitional, career ladder position requiring additional
More informationCITY OF BRANDON POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT. ALL applicants MUST attach items 1, 2, 3, 4 I. PERSONAL HISTORY
CITY OF BRANDON POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT MAIL OR DELIVER TO: THE CITY OF BRANDON 1000 MUNICIPAL DRIVE P.O. BOX 1539 BRANDON, MS 39043 ATTN: PERSONNEL Date: Notice: Application MUST
More informationChapter 329A Child Care 2015 EDITION CHILD CARE EDUCATION AND CULTURE
Chapter 329A Child Care 2015 EDITION CHILD CARE EDUCATION AND CULTURE OFFICE OF CHILD CARE 329A.010 Office of Child Care; Child Care Fund 329A.020 Duties of office 329A.030 Central Background Registry;
More informationVOLUNTEER APPLICATION SATELLITE BEACH POLICE DEPARTMENT
Updated: 6/29/17 VOLUNTEER APPLICATION SATELLITE BEACH POLICE DEPARTMENT Return Completed Application to: 510 Cinnamon Drive, Satellite Beach, FL 32937 Personal Information Last Name: First Name: MI: Home
More information