Firefighter Application & Medical Evaluation

Dorchester County Fire Rescue Firefighter Application Checklist

You will have the option save your application.  Once SAVE is selected there will be a window for you to enter your email address so that you can be sent the link to get back to your application, otherwise you will need to complete the application it in one session.

 

The link that will be sent to your email address will come from OnlineForms@dorchestercountysc.gov

 

The following items should be submitted, along with the completed Application and Medical Questionnaire attached. 

Dorchester County Fire Rescue Volunteer Firefighter Application

Personal Information

Driver's License Class
Have you ever been employed with Dorchester County before?
Do you have any relatives currently working for Dorchester County?

Personal Reference

LIST THREE (3) PERSONAL REFERENCES WHO HAVE KNOWN YOU FOR AT LEAST TWO (2) YEARS. (NO RELATIVES PLEASE)

Education

High School Graduate or GED?

Fire Academy Classes

Employment Record

STARTING WITH YOUR CURRENT EMPLOYER, LIST YOUR LAST THREE (3) EMPLOYERS 

Criminal Record

Have you ever been convicted of a Felony?

Dorchester County Fire Rescue Medical Evaluation Form

1. Do you currently smoke or have you smoked in the last month?

2.    Have you ever had any of the following conditions?

a. Seizures
b. Diabetes
c. Allergic reactions that interfere with breathing
d. Claustrophobia (fear of closed in places)
e. Trouble smelling odors

3.    Have you ever had any of the following lung problems?

a. Asbestosis
b. Asthma
c. Chronic bronchitis
d. Emphysema
e. Pneumonia
f. Tuberculosis
g. Silicosis
h. Pneumothorax
i. Lung cancer
j. Broken ribs
k. Any chest injuries or surgeries
l. Any other lung problems that you’ve been told about

4.    Do you currently have any of the following symptoms of pulmonary or lung illness?

a. Shortness of breath
b. Shortness of breath when walking fast on level ground
c. Shortness of breath when walking up a slight hill or incline
d. Shortness of breath when walking at an ordinary pace
e. Shortness of breath that interferes with your job
f. Coughing that produces phlegm
g. Coughing that wakes you up in the morning
h. Coughing that occurs mostly when you are lying down
i. Coughing up blood within the last month
j. Wheezing
k. Wheezing that interferes with your job
l. Chest pain when you breathe deeply
m. Any other symptoms that you think may be lung-related

5.    Have you ever had any of the following cardiovascular or heart problems?

a. Heart attack
b. Stroke
c. Angina
d. Heart failure
e. Swelling in your legs or feet
f. Heart arrhythmia
g. High blood pressure
Any other heart problem that you’ve been told about

6.    Have you ever had any of the following cardiovascular or heart symptoms?

a. Frequent pain or tightness in your chest
b. Pain or tightness in your chest during physical activity
c. Pain or tightness in your chest that interferes with your job
d. In the past two years, have you noticed your heart skipping a beat
e. Heartburn or indigestion that is not eating related
f. Any other symptoms that you think may be related to heart problems

7.    Do you currently take medication for any of the following problems

a. Breathing or lung problems
b. Heart trouble
c. Blood pressure
d. Seizures

8.    Have you ever had any of the following problems while using a respirator?

a. Eye irritation
b. Skin allergies or rashes
c. Anxiety
d. General weakness or fatigue
e. Other problems related to respirator use

9.

Have you ever lost vision in either eye (temporarily or permanently)?

10.    Do you currently have any of the following vision problems?

a. Wear contact lenses
b. Wear glasses
c. Color blind
d. Other eye or vision problems

11.

Have you ever had an injury to your ears, including a broken eardrum?

12.    Do you currently have any of the following hearing problems?

a. Difficulty hearing
b. Wear a hearing aid
c. Any other hearing or ear problems

13.

Have you ever had a back injury?

14.    Do you currently have any of the following musculoskeletal problems?

a. Weakness in any of your arms, hands, legs, or feet
b. Back pain
c. Difficulty moving your arms and legs
d. Pain or stiffness when you lean forward or backward at the waist
e. Difficulty moving your head up or down
f. Difficulty moving your head side to side
g. Difficulty bending at your knees
h. Difficulty squatting to the ground
i. Difficulty climbing a flight of stairs or carrying more than 25 lb.

15.

Have you ever been exposed to hazardous solvents, airborne chemicals, or have you come in skin contact with hazardous chemicals either at home, a second job, or side business?

16.

Have you ever been exposed to any biological or chemical agents in the military, either in training or combat?

17.

How often do you wear a respirator?

18. 

Are you currently taking any medication for any reason?

Please Read before Signing

DORCHESTER COUNTY FIRE RESCUE IS AN EQUAL OPPORTUNITY EMPLOYER AND WILL NOT DISCRIMINATE AGAINST ANY APPLICANT ON THE BASIS OF ANY CHARACTERISTIC THAT IS PROTECTED BY STATE OR FEDERAL LAW. DORCHESTER COUNTY FIRE RESCUE IS AN AT-WILL EMPLOYER, MEANING THAT EITHER THE EMPLOYER OR EMPLOYEE CAN ENT THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY REASON OR NO REASON.  

BY SIGNING BELOW, I UNDERSTAND THAT DORCHESTER COUNTY FIRE RESCUE MAY INVESTIGATE ALL OF THE STATEMENTS MADE ON THIS APPLICATION FORM AND THAT ANY MISREPRESENTATION OR OMISSION IS CAUSE FOR IMMEDIATE DISMISSAL.  

I FURTHER UNDERSTAND THAT THIS APPLICATION WILL RECEIVE ACTIVE CONSIDERATION FOR A PERIOD OF THIRTY (30) DAYS ONLY AND WILL BE DESTROYED AND DISCARDED AFTER THIS DATE.