FSTB Training Specialist 1 Application

Training Specialist

APPLICATION FORM

Personal Information

Name

Home Address

Home Phone

Cell Phone

Email Address

Education

School Name

Dates

Location

Did you Graduate?

Yes

Certificate/Degree Received

School Name

Dates

Location

Did you Graduate?

Yes

Certificate/Degree Received

Add More Education?

Yes

School Name

Dates

Location

Did you Graduate?

Yes

Certificate/Degree Received

Add More Education?

Yes

School Name

Dates

Location

Did you Graduate?

Yes

Certificate/Degree Received

Work Experience

Employer Name

Position Title

Dates of Employment

Hours Per Week

Employer Address

Supervisor

Work Phone Number

May We Contact This Employer?

Yes

Employer Name

Position Title

Dates of Employment

Hours Per Week

Employer Address

Supervisor

Work Phone Number

May We Contact This Employer?

Yes

Add More Work Experience?

Yes

Employer Name

Position Title

Dates of Employment

Hours Per Week

Employer Address

Supervisor

Work Phone Number

May We Contact This Employer?

Yes

Add More Work Experience?

Yes

Employer Name

Position Title

Dates of Employment

Hours Per Week

Employer Address

Supervisor

Work Phone Number

May We Contact This Employer?

Yes

Fire Service Experience

Are you now or have you ever been a member of a fire department?

Yes

Please summarize any special training or coursework related to the fire service.

Please list any community activities (other than the fire department) in which you have been involved to include 1) Activity 2) Office Held and 3) Approx. Dates.

Certifications

Do you hold Iowa/National Firefighter Certification?

Yes

Please upload a copy of your Iowa/National Certificate

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Do you hold Iowa/National Fire Service Instructor Certification?

Yes

Please upload a copy of your Iowa/National Certificate

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Do you hold Iowa/National Fire Officer Certification?

Yes

Please upload a copy of your Iowa/National Certificate

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Do you hold any other Iowa/National Certifications?

Yes

Please upload a copy of your Iowa/National Certificate(s)

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Please list any other Certifications, including 1) Type of Certification 2) Certification Agency, and 3) Approx. Date (mm/yyyy)

Teaching Experience (Within last Two Years)

Dates

Class or Subject Title

Location of Class

Dates

Class or Subject Title

Location of Class

Dates

Class or Subject Title

Location of Class

Dates

Class or Subject Title

Location of Class

Dates

Class or Subject Title

Location of Class

Dates

Class or Subject Title

Location of Class

Please indicate 1) Committee and 2) Dates Served.

Please list the topics in which you are interested in teaching in order of preference. You are not restricted to only those classes that are presently available through the FSTB. You will not be bound by your selections as indicated here. We will use this information as a guide to program planning.

The Fire Service Training Bureau has the expectation that Training Specialist 1s should help market courses and services available. Do you believe that you could support the Bureau in this type of activity?

Yes

Please explain your response.

About how many hours do you feel that you would be comfortable teaching per month?

0-5 hours

5-10 hours

10-15 hours

15 - 20 hours

Applicant's Signature