How Can I Join We are currently gathering a list of residents who may be interested in joining CERT. If you are interested please fill out the form below. Contact Information Name (required) Current Address (required) Phone (required) Email Address (required) CERT Areas Interested In Areas (required) CPR/AED First Aid Fire Safety Medical Response Assist Professional Responders Respond to disasters Assist with Community Events What days are you available? Are you available on weekends? (required)Yes No Are there any hours you are not available? (required)Yes No If yes, what hours are you not available? Are you at least 18 years old? (required)Yes No Do you have a reliable means of transportation? (required)Yes No Are you legally eligible to work in the United States? (required)Yes No Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? (required)Yes No If no, describe the functions that cannot be performed Note: We comply with Federal, State and Local regulations and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire maybe subject to passing a medical examination, and skill and agility tests.) Education, Training and Experience College/University Did you graduate? (required)Yes No Degree/Diploma? (required)Yes No Vocational/Business/Other Did you graduate? (required)Yes No Degree/Diploma? (required)Yes No Do you have any other experience, training, qualifications, license, certification or skills that you feel make you especially suited for this position? (required)Yes No If yes, please explain Employment History Job #1 Name City, state, zip Dates of Employment Job title Job responsibilities Job #2 Name City, state, zip Dates of Employment Job title Job responsibilities Job #3 Name City, state, zip Dates of Employment Job title Job responsibilities Acknowledgment: Please read carefully and sign below. I hereby certify that I have not knowingly withheld any information that might adversely affect my eligibility for employment and that the answers given by me are true and accurate. I understand that any omission or misstatement on this application or on any document used to secure employment shall be grounds for rejection of this application or termination of employment if employed, regardless of the time elapsed before discovery. I hereby authorize Mosquito Fire Protection District to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed, except those as noted, to disclose to Mosquito Fire Protection District any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Mosquito Fire Protection District and my former employers from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. I further agree to be fingerprinted, to submit to a medical examination, which will include drug testing, and, upon employment, to furnish such proof of age as may be required. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Today’s date mm/dd/yyyy (required) Your signature (required) There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
