Cortland Fire Department » apptest

Contact Information







       Yes No
 Yes No


Education Information

High School

 Yes No


 Yes No

Graduate School

 Yes No

Trade School

 Yes No

Eligibility Status


 Yes No

 Yes No

 Yes No


Job History

List all jobs you have held for the last ten years. Include periods of unemployment. Put your most recent and/or present job first. Include military service in proper time sequence along with temporary or part time jobs.

Job 1


Job 2


Job 3


Job 4


Job 5


Job Performance

 Yes No

 Yes No

 Yes No

 Yes No


Please list three adults not related to you and not former employers, who have known you for more than three years. All persons to whom you refer will be
asked to appraise your character, ability, experience, personality and other qualities.

Reference 1


Reference 2


Reference 3


Emergency Contact

Please List up to 3 contacts to be notified in case of an emergency

Contact 1


Contact 2


Contact 3



Electronic Signature


CORTLAND FIRE DEPARTMENT IS AN EQUAL OPPORTUNITY EMPLOYER. This organization is committed to the policy of equal employment opportunity in recruitment, hiring, career advancement, and all other personnel practices. Your job related experience and other qualifications will be considered without discrimination on the grounds of race, color, religion, sex, national origin, age, or physical or mental handicap. All information provided in this application will be treated confidentially, and will be used only to help assure the best of your abilities if you are employed with us!