Application Form

	Tulsa Fire Department Online Application Form
Use the TAB key to move from field to field. Do NOT use the ENTER key! * Denotes required field

I. PERSONAL INFORMATION

Full Legal Name (last, first, middle)*	Social Security Number*

List all other Names (Include any Maiden Names and Legal Name Changes, List Date and Reason for Change)

Drivers License	State	Class	Expiration Year	Date of Birth*	Birthplace
				//

Residence Address	City	State	Zip

Home Phone Number	Work Phone Number	Pager Number
( )	( )	( )
Alternate Message Number	Fax Number	Cellular Number
( )	( )	( )

Are you a citizen of the United States?*

If naturalized, List Date, Location and Judge

Yes No

II. EMPLOYMENT HISTORY

Your Current Employer

From	To	Address	Telephone

Hrs. Worked/Week	Shift	Supervisor	Salary/Wage

Job Title and Duties

Reason For Leaving

If Other, Please Explain

Laid Off School Quit Fired Forced Other

III. EDUCATION HISTORY

Are you currently enrolled in any School, College or University?

Yes No

Projected Graduation Date

The most recently attended/currently enrolled school, including business colleges, technical/vocational, correspondence and military schools.

College/Universities

School Name	Address	From	To

Year Graduated	Degree Obtained	Hours Earned	GPA	Additional Comments

Vocational/Technical/Military or other Post Secondary Schools

School Name	Address	From	To

Year Graduated	Degree Obtained	Hours Earned	GPA	Additional Comments

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Tulsa Fire Department
Online Application Form

IV. MILITARY HISTORY

Have you ever served in the military?*

Yes No

If yes, list branch and units below

Branch	Type of Unit	MOS	Job Title/Description

Date of Enlistment	Dates of Active Duty	Highest Rank on Active Duty

Type of Discharge or Separation

Honorable Dishonorable Bad Conduct General-Under Honorable General-Under Other than Honorable Not Applicable

Date of Discharge	Rank at Discharge	Date of Rank	Total Amount of Military Service
			Years	Months	Days

Unit Name and Address	Commanding Officer Name and Phone	Your Current Rank

V. CRIMINAL AND DRIVING HISTORY

List all official contact you have had with any law enforcement agency or court system. This includes Municipal, County, State and Federal Agencies or Court Systems, including Military Courts, Military Police and Military Investigative Units. List all incidents where you have been questioned, warned, issued a summons, detained, arrested or convicted. This includes all infractions, ordinance violations, misdemeanors and felonies.
NOTE: The existence of an arrest record and/or conviction is NOT an automatic disqualifying factor. Giving a false answer IS a disqualifying factor.

Date	Agency or Court	Charge	Sentence	Disposition
1.

Have you ever been questioned, detained, arrested, investigated, warned or issued a citation for any misdemeanor or felony, other than traffic, either as an adult or juvenile? *

Yes No

Have you ever been convicted of a felony?*

Yes No

VI. DRUG AND ALCOHOL USE

Do you currently use ANY drug?*

Yes No

If Yes, List what drug and to what extent

Do you now, or have you ever, used, possessed, supplied or sold any narcotic or controlled substance such as but not limited to Marijuana, Hashish, Cocaine, LSD, Methamphetamine, Heroin, Steroid Pharmaceuticals or drugs of a similar nature ?*

Yes No

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Tulsa Fire Department
Online Application Form

My email address is	PRIVACY POLICY
How did you learn about the Tulsa Fire Department?
Fire Department Recruiter City Jobline Newspaper Internet	Tulsa Firefighter Television Radio Other

By clicking on the Submit button I hereby certify that there are no willful misrepresentations, omissions or falsifications in the questionnaire and that all answers are true and correct to the best of my knowledge and belief. I understand that if at any time during the background investigation questions should arise concerning this questionnaire I could be required to submit to a polygraph examination.