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City of Westfield Civilian Medic - Employment Application
The City of Westfield is an affirmative action/equal opportunity employer and will not discriminate, or tolerate discrimination, against any employee or applicant in any manner prohibited by law.
Please fill out this application in its entirety. Any applicant who provides unrequested information will be automatically rejected. View the Civilian Medic job description (PDF).
2025 WFD Benefits at a Glance (PDF)
First Name*
Last Name*
Address Line 1*
Address Line 2
City*
State*
ZIP Code*
Phone Number*
Email Address*
Date Available*
Date Available
Are you at least 19 years of age?*
Must be 21 years of age upon employment (hiring lists are generally approved for 2 years)
1. Yes
2. No
Do you have a valid driver's license?*
1. Yes
2. No
Are you legally eligible for employment in the United States?*
1. Yes
2. No
Are you currently a member of the '77 Fund in PERF?*
1. Yes
2. No
Are you able to perform the functions of the job for which you are applying with or without reasonable accommodation?*
1. Yes
2. No
Have you been convicted of a felony?*
1. Yes
2. No
If you have been convicted of a felony, please explain.
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Education

High School, Address & Degree*
Did you graduate?*
1. Yes
2. No
College, Address & Degree*
Did you graduate?*
1. Yes
2. No
Do you currently hold a valid Paramedic (EMT-P) license?*
1. Yes
2. No
Professional Licenses or Certificates*
Please provide any education not previously listed.
Did you graduate?
1. Yes
2. No
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References

List four persons, other than relatives or personal friends, who have knowledge of your work experience and/or education.
First Name*
Last Name*
Phone Number*
Relationship*
Company*
Address*
First Name*
Last Name*
Phone Number*
Relationship*
Company*
Address*
First Name*
Last Name*
Phone Number*
Relationship*
Company*
Address*
First Name*
Last Name*
Phone Number*
Relationship*
Company*
Address*
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Previous Employment

Please list most recent employer first.
Company*
Phone Number*
Address*
Supervisor*
Responsibilities*
Date From/To & Reason for Leaving*
May we contact your previous supervisor for reference?*
1. Yes
2. No
Company*
Phone Number*
Address*
Supervisor*
Responsibilities*
Date From/To & Reason for Leaving*
May we contact your previous supervisor for reference?*
1. Yes
2. No
Company*
Phone Number*
Address*
Supervisor*
Responsibilities*
Date From/To & Reason for Leaving*
May we contact your previous supervisor for reference?*
1. Yes
2. No
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Disclaimer & Signature

Please Read Carefully Before Signing
By signing this application, I declare that the information provided by me is complete and true to the best of my knowledge. I understand that any misrepresentation or omission on this application may preclude an offer of employment, or may result in a withdrawal of an employment offer, or may result in my discharge from employment if I am already employed at the time the misrepresentation or omission is discovered.
In connection with my application for employment, the City of Westfield, its employees and its agents are authorized by me to conduct a background investigation to assess my suitability for employment, and may contact any sources necessary to do so. I hereby release the City of Westfield, its employees, agents, officers, affiliates, successors and assigns, and any persons or entities contacted by the City of Westfield in order to undertake an investigation of my suitability for employment, from any legal claims I might assert arising from such investigation ( including, but not limited to, claims of invasion of privacy or defamation).
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date*
Date
Please Upload Your Resume*
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City of Westfield Important Notice to Applicants

Disability Accommodation Available for Applicants
I understand that if I require an accommodation for a disability so that I may participate in the selection process I am encouraged to contact the City of Westfield Human Resources Manager at 317-804-3005, or via email.
Equal Opportunity / Affirmative Action Employer & Educator
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability, genetic information, or any other characteristic protected by law.
Application Fraud & Misrepresentation
I certify that all statements (verbal and written) made on any and all material collected during the hiring process are true, complete and accurate and I understand that misrepresentation or omission of facts called for in the employment application, resume, interview process or other application material may prohibit consideration for employment at the City of Westfield and is cause for immediate termination if employed.
Reference & Background Checking
Applying for a specific job authorizes the City of Westfield to contact any of your schools, your current* and former employers, or other references for the purpose of verifying information and/or obtaining an account of your education, work experience and skills. By applying for a job you agree to hold any and all of your reference sources harmless and free of any liability for releasing such information. Please note that for some positions a more extensive background check is part of the employment decision making process and you will need to sign any necessary disclosure and release forms including, but not limited to, a "Disclosure and Release of Information Authorization" form as part of the hiring process. (* Please note that the point at which your prospective hiring supervisor will contact your employer may vary; however, this is most commonly done on a preemployment basis usually after the initial interview. This practice is rarely performed on a pre-interview basis. If you have concerns about having your current employer contacted, please communicate those concerns to the person who conducts your initial interview to determine what, if any, alternatives exist.)
Employment Eligibility Verification
All offers of employment by the City of Westfield are contingent on the provision of satisfactory proof of your identity and legal authority to work in the United States. You must comply with the requirements of the Immigration and Naturalization Service's Employment Eligibility Verification (I-9 Form).
Offers of Employment
Please be advised that the City of Westfield will not be bound by offers or conditions of employment other than those made in official offer letters.
Employment At-Will
Employment with the City of Westfield is at-will unless otherwise provided under an Indiana statute. At-will employment means the employer-employee relationship may be terminated at any time, for any reason or for no reason at all, with or without notice. If you have any questions regarding employment at-will, please contact the City of Westfield Human Resources Manager at 317-804-3005.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Westfield Fire Department - Civilian Medic Employment Application

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General Information

Education

References

Previous Employment

Disclaimer & Signature

City of Westfield Important Notice to Applicants

Disability Accommodation Available for Applicants

Equal Opportunity / Affirmative Action Employer & Educator

Application Fraud & Misrepresentation

Reference & Background Checking

Employment Eligibility Verification

Offers of Employment

Employment At-Will

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