Firefighter Background Assessment Form
Please complete all sections to help us evaluate your suitability for a firefighter role. All information provided will be used for assessment purposes only.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Do you have prior firefighting or emergency response experience?
*
Yes
No
Relevant Certifications or Licenses (e.g., EMT, Firefighter I/II, CPR)
*
Firefighter I
Firefighter II
EMT Certification
CPR Certification
Other
Availability for Employment
*
Full-time
Part-time
Volunteer
Physical Capability Assessment
*
Rows
Not at all confident
Somewhat confident
Very confident
Lifting and carrying heavy equipment
1
2
3
Working in high-stress situations
4
5
6
Operating in confined spaces
7
8
9
Climbing ladders and stairs
10
11
12
Have you ever been subject to disciplinary action or conduct review in a previous role?
*
No
Yes (please explain below)
Supervisor or Reference Contact (Name and Phone Number)
*
Situational Judgment: Rate your readiness for the following scenarios.
*
1
2
3
4
5
Additional Background Notes (optional)
Submit Assessment
Should be Empty: