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Fire Department Security Screening Form

  1. High School graduate or equivalent?*

  2. Currently 21 year of age?*

  3. US Citzen or possess legan authorization to work in the United States?*

  4. Ability to read and write English?*

  5. Valid Drivers License?*

  6. Possess a current National registry EMT license and or Oklahoma state basic EMT or higher?*

  7. Any felony?*

  8. Any fire-related crime?*

  9. Any theft-related crime?*

  10. Any burglary-related crime?*

  11. Any sexual assault-related crime?*

  12. Any stalking or personal assault-related crime?*

  13. Any impersonation or falsification-related crime?*

  14. Any intimidation, harassment or threat-related crime?*

  15. Any drug, narcotics or substance abuse-related crime?*

  16. Any careless, imprudent, reckless, or negligent driving convictions?*

  17. Any fraud, dishonesty, misrepresentation or license-related crime?*

  18. Any crime or violation of law, regulation or rule that will prevent the applicant/candidate from obtaining or maintaining the required EMS license(s)?*

  19. Loss of driver’s license due to suspension or revocation for 90 or more days at any time in the past?*

  20. Three or more moving violations in the 36 months immediately preceding background check or five or more moving violations in the 60 months preceding background check date?*

  21. Conviction of, plea of guilty to, plea of nolo contendere to, a plea of no contest or equivalent in connection with operation of a motor vehicle while under the influence of alcohol, drugs or other subtances?*

  22. Conviction of, plea of guilty to, plea of nolo contendere to, a plea of no contest or equivalent in connection with hit-and-run, manslaughter or similar crime while operating a motor vehicle?*

  23. Any aggressive use of a vehicle that posed a hazard to persons or property?*

  24. Leave This Blank:

  25. This field is not part of the form submission.