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2. Village of Elm Grove Employment Fire and/or EMSApplication

   Hello! thank you for your interest in the Village of Elm Grove Fire and/or EMS department. Below is the employment application for these departments. This does not guaranty a position within these departments. We are an Equal Opportunity Employer.

3. This application is for...*

   1. FIRE
   2. EMS

   An email will automatically be sent to the hiring manager for either Fire or EMS depending on your selection. 

5. Name as it appears on your Driver License*
6. Email Address*
8. Address (street, city, state, zip code)*
10. Contact Phone Number*
12. Are there other names under which you have worked or attended school?*

    1. Yes
    2. No
13. If yes, list the other names under which you have worked or attended school.
15. Are you legally authorized to work in the US?*

    1. Yes
    2. No

    If not, your employment will be subject to verification that you meet state/federal minimum age requirements for the type of work you are applying for and have obtained a work permit. 

17. Are you at least 18 years old?*

    1. Yes
    2. No
19. Have you ever been convicted of a crime or pleases no contest for any offense or violation other than minor traffic violations?*

    1. Yes
    2. No
20. If yes, explain the violation, when it occurred, and where.

    Convictions are not an automatic bar to employment. 

22. Do you have any pending criminal changes against you?

    1. Yes
    2. No
23. If yes, describe the nature of the charge, date issued, and where.
25. Have you ever applied at the Village of Elm Grove before?*

    1. Yes
    2. No
27. have you ever worked for the Village of Elm Grove before?*

    1. Yes
    2. No
29. Do you have any relatives employed with the Village of Elm Grove?*

    1. Yes
    2. No
30. If yes, please list name and relationship.
34. Position applying for:*
35. When can you start?*
37. Are you able to perform all essential functions/duties of the position you are applying for?*

    1. Yes
    2. No
38. If no, please identify which functions you could perform with reasonable accommodation.
42. Driver License Number*
43. Driver License State of issuance.*
45. Are you licensed with any groups, associations, or societies relating to the position for which you are applying?*

    1. Yes
    2. No
46. If yes, please list.
50. Education
52. High School
53. # Years Attended
54. Course of Study
55. Degree/Diploma Received
57. College
58. # Years Attended
59. Course of Study
60. Degree/Diploma Received
62. Graduate
63. # Years Attended
64. Course of Study
65. Degree/Diploma Received
67. Other (Specify)
68. # Years Attended
69. Course of Study
70. Degree/Diploma Received
72. Training Courses

    Please list any relevant training programs completed and if possible, upload a certification. Examples include: State EMT License, Nursing License, National Registry, CPR, ACLS, PALS, BTLS, TEMS, Etc. Feel free to take a photo of multiple and upload as one as long as the licenses are legible. 

74. Training Course 1
75. Training Course Upload 1
77. Training Course 2
78. Training Course Upload 2
80. Training Course 3
81. Training Course Upload 3
83. Training Course 4
84. Training Course Upload 4
86. Training Course 5
87. Training Course Upload 5
89. Special Skills
91. Please list any special skills aside from the education and training above you feel would be beneficial to the position. This may include machinery, equipment, software knowledge, office equipment experience. *
95. Employment History (start with most recent)
97. Employer Name*
98. Employer Address*
100. Phone Number*
101. Your Job Title*
103. Job Duties*
105. Supervisor Name*
106. May we contact this employer?*

     1. Yes
     2. No
108. Start Date*
     Start Date
109. End Date
     End Date
110. Present

     1. I am still employed at this job.
112. Salary Start*
113. Salary End*
115. Reason for leaving*
119. Employer Name*
120. Employer Address*
122. Phone Number*
123. Your Job Title*
125. Job Duties*
127. Supervisor's Name*
128. May we contact this employer?*

     1. Yes
     2. No
130. Start Date*
     Start Date
131. End Date
     End Date
132. Present

     1. I am still employed at this job.
134. Start Salary*
135. Salary End*
137. Reason for leaving*
141. Employer Name*
142. Employer Address*
144. Phone Number*
145. Your Job Title*
147. Job Duties*
149. Supervisor's Name*
150. May we contact this employer?*

     1. Yes
     2. No
152. Start Date*
     Start Date
153. End Date*
     End Date
155. Start Salary*
156. End Salary*
158. Reason for leaving*
162. References

     List individuals familiar with your job qualifications (no relatives of personal friends)

164. Name*
165. Phone Number*
166. Relationship*
168. Name*
169. Phone Number*
170. Relationship*
172. Name*
173. Phone Number*
174. Relationship*
176. Please Read Carefully Before Sending This Form

     1. All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired.

     2. I authorize the Village of Elm Grove to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly release and hold harmless any person or organization that provides information pertaining to me or my employment.

     3. I understand that upon receiving a job offer, a physical examination and drug screening may be required. (Note: if this is a job requirement, you will be notified).

     4. Regardless of whether or not I become employed by the Village of Elm Grove, I recognize that this application is not and should not be considered a contract of employment. I understand that employment at the company is on an at will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the Village of Elm Grove’s, unless specifically provided otherwise in a written employment contract.

180. Equal Employment Opportunity Policy Statement/Survey

     It is the policy of the Village of Elm Grove to provide equal employment opportunity to all individuals regardless of their race, color, religion, sex, age, national origin, disability, military and veteran status, sexual orientation, marital status, or any other characteristic protected by state or federal law. We are strongly committed to this policy, and believe in the concept and spirit of the law.

     The Village of Elm Grove is committed to assuring that:

     All recruiting, hiring, training, promotion, compensation and other employment related programs are provided fairly to all persons on an equal opportunity basis without regard to race, creed, color, religion, sex, age, national origin, disability, military and veteran status, sexual orientation, marital status or any other characteristic protected by law;

     Employment decisions are based on the principles of equal opportunity;

     All personnel actions such as compensation, benefits, transfers, training, and participation in social and recreational programs are administered without regard to race, creed, color, religion, sex, age, national origin, disability, military and veteran status, sexual orientation, marital status or any other characteristic protected by law, and; 

     Employees and applicants will not be subjected to harassment, intimidation, threats, coercion or discrimination because they have exercised any right protected by law.

182. The Village of Elm Grove is required by federal regulations to report information as requested below. Your contribution of this information is completely voluntary. The information you provide is strictly confidential and will be maintained separate from you application.
184. Please check one:

     1. Male
     2. Female
     3. Other
185. Please Check One

     1. American Indian/Alaska Native
     2. Asian/Pacific Islander
     3. Black/African American
     4. Hispanic
     5. White/Caucasian
     6. Other
186. Are you a veteran?

     1. Yes
     2. No
187. How were you referred to the Village of Elm Grove?

     1. Agency
     2. Friend/Relative
     3. Newspaper
     4. School
     5. Walk-in
     6. Other
Leave This Blank:


189. 1. Receive an email copy of this form.
190. Email address

     This field is not part of the form submission.

191. Submit

* indicates a required field