• Please provide the following contact information:

  First Name :
  Last Name :
  Middle Initial :
  Street Address :
  Address 2 :
  City :
  State/Province :
  Zip Code :
  Country :
  Work Phone :
  Home Phone :
  E-mail :

  Date of Birth :

The following information is voluntary and will only be used for statistical comparison purposes.  This information will be kept separate from all other application information

• Please check the appropriate box for the position you are interested in:

  Firefighter/Paramedic
  

• Sex

  - - - Please make a selection - - - Male Female
  

• Age

  - - - Please make a selection - - - 21 - 25 26 - 30 31 - 35 other (if other, please fill in age below)
  

• Race

  - - - Please make a selection - - - African American Asian American Caucasian American Hispanic American Native American Other (Please fill in below)
  

• Additional Comments

  
  

• How did you learn about this position?

  Newspaper
  School
  Friend
  Career Fair
  Bulletin Board
  Recruiter
  Web Site
  Other
  

  It is the express policy of the Village of Mount Prospect and the Board of Fire and Police Commissioners to recruit, select, hire, retain and promote the most qualified available persons for positions in the Mount Prospect Fire Department without regard to race, color, religion, sex, age, national origin, or disability (except where specific requirements constitute a bona fide occupational qualification). In keeping with this policy, the Village of Mount Prospect and the Board of Fire and Police Commissioners commit themselves to ensure that all of the functions which they perform are administered in a responsible manner in conformance with the law, public policy and the policy expressed by the Equal Opportunity Plan of the Mount Prospect Fire Department.