Career Opportunities – Winchendon Fire Department

The Winchendon Fire Department is constantly looking for highly motivated, community-oriented, and
dedicated candidates to join our growing staff. WFD is committed to our employees and focuses on areas
of mental and physical wellness.

If you’re looking for an honorable career in a great, supportive community with highly competitive pay
and benefits, look no further. Our department offers numerous opportunities for development and
growth.

If you are interested in applying for a position within the Winchendon Fire Department, please fill out the form below, and we will contact you as soon as possible!

Applications are considered for all positions without regard to race, gender, color, disability, religion, national origin, national ancestry, sexual orientation, genetics, military background, gender identity, age, or any other protected class under the law.

"*" indicates required fields

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Date

MM slash DD slash YYYY

Name

First Last

Position(s) Applied For:

Address

Street Address City State ZIP Code

Phone

Cell Phone

Have you applied to the department before?

Yes

If yes, when?

Have you ever been employed here before?

Yes

If yes, when?

On what date are you availible to start?

Are you availible to respond for calls:

Days

Nights

Weekends

Select all that apply

If otherwise employed, what is your ability to respond to calls while working?

If you have not already attedned Massachusetts Call/Volunteer Firefighting Training Program, are you willing to d so if appointed?

Yes

What qualifications or licenses do you posses that should be considered?

Prior expience as firefighter? If so, please list starting with most current

Do you have CPR certification?

Yes

If yes, provide number and date of expiration

Do you have First Responder training?

Yes

Do you have First Aid training?

Yes

Do you have EMT training?

Yes

Please provide brief statement explaining why you wish to become a firefighter

Are you able to attend trainings and meetings up to foure nights a month?

Yes

List the kinds of office equipment/computer software you can operate:

Do you have a valid drivers license?

Yes

What Class/State/ Expiration Date

Education

Highest Grade Level Completed

Name of high school, year of graduation, City/Town

IF APPLICABLE

Name of college, Major of study, Year of graduation

Licenses/ Certificates/ Training

Employment History

Start with your present or most recent job. Include military service assignments and volunteer activities if related to position(s) for which you are applying. Exclude organization names which indicate race, gender, color, disability, religion, national origin, national ancestry, sexual orientation, genetics, gender identity, age, or any other protected class under the law.

Employer

Dates employed from/to

Address

Job Title

Work Preformed

Supervisor Phone

May Contact?

Yes

Employer

Dates employed from/to

Address

Job Title

Work Preformed

Supervisor Phone

May Contact?

Yes

Employer

Dates employed from/to

Address

Job Title

Work Preformed

Supervisor Phone

May Contact?

Yes

References

Please list three references (one should be in the field in which you are applying).

Name

Position

Address

Phone

Day or Evening?

Reference 2: Name

Postion

Phone

Day or Evening?

Reference 3:Name

Position

Address

Phone

Day or Evening?

Acknowledgement of Application

These statements made by me in this application are true and complete to the best of my knowledge and belief. I understand and authorize that the information provided may be certified and that any willful misstatement of material facts herein will cause forfeiture on my part of all rights to any employment in the service of the Town of Merrimac. I authorize investigation of all statements contained in this application and the release of any pertinent information regarding my education, past employment history, driving history, and background. I authorize the Town of Merrimac to obtain any information from schools, employers or individuals relating to my activities. This information may include, but is not limited to: academics, achievement, performance, attendance, personal history and discipline. Further, I hereby authorize all references, persons, schools, my current employer (if applicable) and previous employers and organizations named in this application, unless otherwise stated, to provide the Town of Merrimac any relevant information that may be required to arrive at an employment decision. I understand that the information released is for the Town of Merrimac use only. I hereby voluntarily release, discharge and exonerate the Town of Merrimac Massachusetts, its agents and representatives, and any person so furnishing information from any and all liabilities of every nature and kind arising out of the furnishing or inspection of such documents, records and other information or the investigations made by or on behalf of the Town of Merrimac. I understand that all appointments are at will and that I must demonstrate my ability for continued employment. I also understand that I must be available to work outside normal business hours, as the needs of the department require. If required for the position I am seeking, I agree to take a physical examination, which may include testing for drugs or a psychological examination, as required, and/or to a Criminal Offender Record Information Search and recognize that any offer of employment may be contingent upon the results of such an examination or search. I understand that any employment offer by the Town is conditional upon my ability to establish employment eligibility under the Immigration Reform and Control Act of 1986 within three days of the date of hire.

Consent*

I represent that I have read and fully understand the foregoing and seek employment under these conditions.

Date

MM slash DD slash YYYY

CORI Check Acknowledgement

Name

First Last

Former Last Names

Address

Street Address City State ZIP Code

Date of Birth

MM slash DD slash YYYY

Sex

Last Six SSN

Race

Fathers Name

First Last

Mothers Name

First Last

Mothers Maiden Name

Consent

I acknowledge that a Criminal Offender Record Information (CORI) check will be performed as part of the municipality’s hiring process. I further acknowledge that a refusal to allow the CORI check to be performed will cause my application to no longer be considered for employment