ࡱ> RTQ#` bjbj *<PPPd%%%8%%ld/Jp&p&p&p&p&O'O'O'!/#/#/#/#/#/#/$0hT3G/PA+K'O'A+A+G/p&p&\/------A+d8p&Pp&!/--A+!/----8P--p&d& ze*8%+*--M-r/0/--3,3--3P-- O'(--(t)$O'O'O'G/G/,^O'O'O'/A+A+A+A+dddD dddddd  Fire District 3 APPLICATION FOR MEMBERSHIP POSITION APPLIED FOR: E-MAIL: (Required) NAME: SSN: - - (First) (Middle) (Last) ADDRESS: (Street Address) (City) (Zip) HOME PHONE: ( ) WORK PHONE: ( ) CELL PHONE: ( ) ALTERNATE PHONE: ( ) DATE OF BIRTH: (Month/Date/Year) DRIVERS LICENSE: (Number/State) GENERAL INFORMATION: False information on this application shall be considered sufficient cause for discharge. The District, prior to appointment, may check education and work experience. Complete both sides of the application form, including the special questions relating to experience and education. You may attach additional pages if necessary to fully answer all questions. Do you have any activities, commitments or responsibilities that may prevent you from meeting activity requirements? YES ___ NO ___ If yes, explain: Do you have any physical, mental, or sensory limitations or disabilities, which relate reasonably to fitness to perform the duties or the position for which you are applying? YES ___ NO ___ If yes, explain: List special training, skills and experience that you have which you believe would benefit the District: Within the past seven years, have you been convicted of any crime? YES ___ NO ___ If yes, please attach details to this application. New District members must be non-tobacco users. THE SELECTION PROCESS: Applications and resumes will be evaluated to determine each applicants experience and training relevant to the position. The best qualified applicants will be invited to continue in the selection process. AFFIRMATIVE ACTION EMPLOYER: Clark County Fire District 3 is an equal opportunity employer and does not discriminate on the basis of race, color, national origin, gender, sexual orientation, religion, age or disability in employment or the provision of services. FEDERAL REGULATIONS: Are you authorized to work in the United States? Yes No The Federal Immigration and Reform Act requires individuals to provide, to an employer, documented proof that they are authorized to work in the United States. This proof must be provided to and verified by the District at the time of appointment or no longer than three (3) business days after the date of appointment. EDUCATION NAME AND LOCATION MAJOR GRADUATED LAST ATTENDED High School College Grad School Business/Trade/Other Other EMPLOYMENT HISTORY (Attach Description of Duties, reference by number) Employer NameAddressJob TitleFrom - ToSupervisor/Phone1) 2) 3) 4) 5) 6) 7)  APPLICANT AGREES TO THE FOLLOWING CONDITIONS OF APPLICATION: A pre-placement health and psychological evaluation if required; background and driving record checks; meeting minimum age requirements of applicable laws and submitting proof of true age if required; submitting proof of citizenship or U.S. work permit if required; completing and executing surety bond application if required; meeting attendance and performance requirements; conforming to other District rules, regulations, and instructions. I certify and affirm that I have read the notice above, personally completed this application or requested its completion and all statements contained herein are true and complete. By signing below, I also agree that any or all information required for background or drivers information may be released to the District. NOTICE: Any oral or written false statements in this application, fraudulent or misleading, whether made by me or by others at my request, will result in rejection of my application or denial of acceptance and dismissal. APPLICANTS SIGNATURE DATE Washington State provides reasonable accommodation to persons requiring testing assistance due to reading disability, English as a second language, or other conditions that may interfere with taking a test. Please indicate whether you require any such assistance, and the nature of the assistance requested. Information provided will be kept confidential and will only be used to provide the resources needed. ( I do require testing assistance in SUBMITTING YOUR APPLICATION: Please mail this application along with the testing fee to the following address: Clark County Fire District 3 17718 NE 159 Street Brush Prairie, WA 98606     ,-DQYe # T b   , 8 W e f { y w;ڿźӮh?!v56CJOJQJh?!v5;>* h?!v>* h?!v5>* h?!v5 h?!vCJ h?!vCJH* h?!v5CJ h?!v>*CJ h?!vCJ h?!v>*h?!v!h?!v56B*CJ(OJQJph h?!vCJ<,-.e# T U f { Y  ^ `  ^`    :; 9z{|}~ &dP$a$$a$-058z~"VW!'/8jh?!vU h?!v>*CJ jh?!vCJ h?!vCJ h?!v5CJ h?!vCJ h?!v5 h?!v5CJ h?!v>* h?!v5>*h?!v9  VWemw $$Ifa$ &dPYSSSSSSS$Ifkd$$Iflr~ X ) 2 ~ 04 laYSSSSSSS$Ifkd$$Iflr~ X ) 2 ~ 04 laYSSSSSSS$Ifkd$$Iflr~ X ) 2 ~ 04 laYSSSSSSS$Ifkd|$$Iflr~ X ) 2 ~ 04 laYSSSSSSS$IfkdP$$Iflr~ X ) 2 ~ 04 laYSSSSSSS$Ifkd$$$Iflr~ X ) 2 ~ 04 laYSSSSSSS$Ifkd$$Iflr~ X ) 2 ~ 04 laYWWWWWWWWWkd$$Iflr~ X ) 2 ~ 04 la 789:%wx`^` @ ^@` (/ =!"#h$% $$If!vh5 52 555~ #v #v2 #v#v#v~ :V l05 52 555~ 4$$If!vh5 52 555~ #v #v2 #v#v#v~ :V l05 52 555~ 4$$If!vh5 52 555~ #v #v2 #v#v#v~ :V l05 52 555~ 4$$If!vh5 52 555~ #v #v2 #v#v#v~ :V l05 52 555~ 4$$If!vh5 52 555~ #v #v2 #v#v#v~ :V l05 52 555~ 4$$If!vh5 52 555~ #v #v2 #v#v#v~ :V l05 52 555~ 4$$If!vh5 52 555~ #v #v2 #v#v#v~ :V l05 52 555~ 4$$If!vh5 52 555~ #v #v2 #v#v#v~ :V l05 52 555~ 48@8 Normal_HmH sH tH @@@ Heading 1$$@&a$5::@: Heading 2$@&5>*8@8 Heading 3$@&5B@B Heading 4$$@&a$5CJDAD Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List 8>@8 Title$  a$CJDJ@D Subtitle$  a$ 5>*CJ2B@2 Body Text64@"4 Header  !4 @24 Footer  !JP@BJ Body Text 2$a$56CJOJQJ< 9 z { | } ~      V W e 00 000000000000000000000000000000( 00` 0000Ђ00 0 0  0 0  00ăf!000000000000 0000000 0,-.e#TUf{Y :;  9 z { | } ~      V W e m w 789:%wx00000000000000000000000000000000000000000000000000000000000000000000000F0F0F0F#TU0H0H0H 0H 0H 0H 0H Y 0J0J0J 0J 0J 0J 0J   0L0L0L 0L 0L 0L 0L  0N0N0N 0N 0N 0N 0N ),0P0P0P 0P 0P 0P 0P ))0R0R0R 0R 0R 0R 0R ))0T0T0T 0T 0T 0T 0T ),0000000000000000000000000000000000000000@00 000  8@0(  B S  ?Om Om|Om Omtt Om\تOm Omd OmZOmlYOmJOm\OmDOmOOm,  ::E     & & DJJ   >*urn:schemas-microsoft-com:office:smarttags PostalCode9*urn:schemas-microsoft-com:office:smarttagsState8*urn:schemas-microsoft-com:office:smarttagsCityB *urn:schemas-microsoft-com:office:smarttagscountry-region=*urn:schemas-microsoft-com:office:smarttags PlaceType= *urn:schemas-microsoft-com:office:smarttags PlaceName9*urn:schemas-microsoft-com:office:smarttagsplace }     ?C hjXo"3O ^ x 33333333333333333?!vdV W e m w 3@@UnknownGz Times New Roman5Symbol3& z Arial?& Arial BlackSMonotype SortsSymbol"1 hF2F2Ff # #!4d2HP ?d2Clark County Fire District 3 FIRE DIST 3Donavon MatternOh+'0 $ D P \ ht| Clark County Fire District 3 FIRE DIST 3 Normal.dotDonavon Mattern2Microsoft Office Word@@L@WF*8@WF*8՜.+,0 hp|   #  Clark County Fire District 3 Title  !"#$%&()*+,-./0123456789:;<=>?@BCDEFGHJKLMNOPSRoot Entry F|e*8UData 1Table'3WordDocument*<SummaryInformation(ADocumentSummaryInformation8ICompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q