Required fields are marked with asterisks (*)

Lafayette Parish Fire Department Firefighter Application

We consider applications for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job related medical condition or handicap, or any other legally protected status.

(Please Note: All information must be supplied in order for application to be considered.)

Date

Last Name

First Name

Date of Birth

Address

City

State

Zip Code

Phone

Email Address

Have you taken the Firefighter entrance exam?

Yes

Have you ever been convicted of a felony?

Yes

Education

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Employment History (List your last two employers. (Starting with most recent)

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Employment History (List your last two employers. (Starting with most recent)

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List any additional skill and/or training:

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By submitting this form, I understand that I am submitting to a background check by Lafayette Consolidated Government.

I Agree

I Disagree

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding

I Agree

I Disagree

Signature of Applicant Print