Peoria Heights Fire Department Membership Application Packet Please turn in all completed applications in a sealed envelope to the Village Administration office during normal business hours, or mail to the following address: Peoria Heights Fire Department Attn: Membership Committee 4901 North Prospect Road Peoria Heights, IL 61616 You may contact our department Membership Committee with any questions at: (309) 686-2372. 1
Thank you for your interest in becoming a member of the Peoria Heights Fire Department. This letter will provide information about the department and the requirements for membership. The Peoria Heights Fire Department was originally chartered in 1917 to provide fire protection for the village. The fire department now provides fire suppression, fire prevention, technical rescue response (vehicle accidents, elevator rescues), and emergency medical services to the Village of Peoria Heights. We run approximately 850 calls per year, which on average equates to approximately 2.3 calls per day. It takes a lot of dedicated volunteers to answer those calls. As members retire, move out of the district, or leave due to personal reasons, we must continually recruit new members. New members enter the department on a probationary status, which lasts a minimum of 6 months. During this time, probationary firefighters are introduced to every facet of the operations of the department. An extensive training program gives the probationary the skills needed to function as a member of the department. Training includes radio communications, structural firefighting tactics, fire apparatus engineering and operation, auto extrication, rescue operations, first responder medical training, and many other topics. Probationary members are required to attend 12 monthly drills and respond to a minimum of 25% of calls during the probationary period. Veteran members assess the attitude, personality, and skills of the probationary during all phases of training and probation. After a minimum of 6 months, the supervisory staff of the department views the progress of the probationary member and makes a decision whether to promote that member to the position of Firefighter, extend his/her probation, or recommend that the member be removed from the department. Your probationary period will require a major commitment in time and effort. Initially, you are not allowed to respond on the first out apparatus and will be performing a limited amount of duties on the fire ground. While this period is difficult and sometimes boring, the department is looking hard at the intensity of your commitment. The rewards of serving on the department can be great. You will be a part of a team of highly trained individuals that depend on each other. You will be providing a service to the community that few people are prepared to undertake. Occasionally, you may be given the opportunity to make a real difference in someone s life, perhaps by even save that life. You will know that you are doing something that really matters. Requirements for Membership 1. Must be at least 18 years of age by date of hire. 2. Must live within 2.5 miles of the incorporated limits of the Village of Peoria Heights. a. Special consideration may be given to those that live outside this limit at the approval of the Membership Committee and the Fire Chief. Please call and speak with a member of the Membership Committee before applying if you live outside this limit. 3. Must be able to pass a physical, drug, and background screening. 4. Be willing to devote time to assist the public in various capacities. 5. Be willing to devote time to training to better prepare yourself to respond to emergencies. 2
Peoria Heights Fire Department Membership Application Please neatly print all information requested in blue or black ink. Do not leave any answers blank. For any questions that do not apply, please write NA for Not Applicable. You may submit a resume with application, but a resume will not be considered without an attached fire department application. Applications that are incomplete and/or not signed will T be considered. Please detach the cover pages and keep them for your records. Applicant Information Last First M.I. Date of Birth: Street Address Apartment/Unit # City State ZIP Code Email Social Security No: Marital Status: Number of Children: Driver s License Number State: Classification: Are you a citizen of the United States? If no, are you authorized to work in the U.S.? Have you ever worked for this department? If yes, when? Do you have any relatives with the department? If yes, who? Have you ever been convicted of any crime or traffic violation within the last 10 years? If yes, explain: Education High School: From: To: Did you graduate? Diploma: College: From: To: Did you graduate? Degree: Other: From: To: Did you graduate? Degree: 3
Current/Most Recent Employment Supervisor: Job Title: Responsibilities: From: To: Reason for Leaving: May we contact your supervisor for a reference? If no, why? Previous Employment Supervisor: Job Title: Responsibilities: From: To: Reason for Leaving: May we contact this supervisor for a reference? If no, why? Supervisor: Job Title: Responsibilities: From: To: Reason for Leaving: May we contact this supervisor for a reference? If no, why? Military Service Branch: From: To: Rank at Discharge: Type of Discharge: If other than honorable, explain: If no longer active duty, include a copy of your Member 4 DD-214 with your application. 4
References Please list three personal references (not previous employers or supervisors). Prior Fire Department Experience and Licensure If you have had any previous fire department/ambulance service experience, please list it here: If you have any licenses/training pertaining to this position, please list them here. Also include license numbers, dates valid, date first licensed, and/or date training was completed. Emergency Contacts Please list two persons to contact in case of an emergency. 5
Disclaimer and Signature EEO Statement Being an equal-opportunity employer, no application shall be denied based solely upon age, color, disability, national origin, political affiliation, race, religion, gender, sexual orientation, or other non-merit factors. I certify, under penalty of perjury, that the above information is true and complete to the best of my knowledge. I agree that any misrepresentation, false statement or omission made by me with respect to the information contained in the application or subsequent physical examination shall be sufficient cause to terminate my membership at any time or to deny acceptance of an applicant as a member. I agree that any offer of membership and any future statements by the membership does not constitute a binding contract, and that such membership is terminable at the will of either party. I also authorize you to obtain reports from previous employees, schools, law enforcement agencies (background check), personal, and other references as the department sees fit. I further recognize that being accepted for membership is subject to: 1. Meeting the qualifications of the position. 2. Undergoing a criminal background screen including past criminal history and encounters with law enforcement. 3. Undergoing a physical examination, including drug testing by the membership physician. 4. Undergoing a panel interview of 3 current members of the department, and a second interview with the fire chief upon successful completion of a drug screen, physical, and background check. 5. Passing a 1 year probationary period from date of hire with satisfactory remarks from the fire officers. I also hereby agree that within fourteen days after the date of termination or completion of services with the department, all equipment issued to me by the department will be returned to the department in reasonable condition or I agree to pay compensation for the replacement of said equipment. Persons who do not return issued equipment may be subject to civil and or criminal liabilities as allowed by law. Signature: Date: 6