City of Des Plaines Fire Department Application Instructions

City of Des Plaines Fire Department Application Instructions Public Safety Recruitment 1127 S. Mannheim Rd., #203 Westchester, IL 60154 1-800-343-HIRE www.publicsafetyrecruitment.com Thank you for your interest in the City of Des Plaines. Please read this document carefully, paying particular attention to deadlines and required documents: 1) Visit www.publicsafetyrecruitment.com to complete the online application for the position of Firefighter/Paramedic. Your online application must be completed no later than noon on Wednesday, February 21, 2007. 2) Return signed release forms and requested documents (SEE CHECKLIST) to Public Safety Recruitment before noon on Wednesday, February 21, 2007. Application documents received after noon on Wednesday, February 21, 2007 will not be accepted. Faxed release forms will not be accepted. Sending release forms and other required documents via traceable carrier is suggested to ensure timely delivery. Documents may also be delivered by hand to Public Safety Recruitment during business hours. 3) Attend Orientation and Written Exam on Saturday, March 3, 2007 at Maine West High School, 1755 South Wolf Road, Des Plaines, IL 60016. Check-in begins at 8:00 a.m. Bring your valid Driver s License or State ID to sign in. There will be NO ADMITTANCE after 8:45 a.m. Orientation will begin by 9 a.m. and the Written Exam will immediately follow. 4) The top 100 candidates will be invited to participate in the Physical Aptitude Evaluation on Saturday, March 17, 2007 at Des Plaines Fire Station #3, 130 East Thacker, Des Plaines, IL 60016. Arrive at your assigned time with a valid Driver s License or State ID to sign in. Firefighter/Paramedic Minimum Requirements $25.00 non-refundable application fee U.S. Citizenship No Felony Convictions High School Diploma or GED Valid Driver s License Residency in Illinois within 6 months of hire 21 to under 35 years as of March 3, 2007 unless exempt by statute. IDPH Paramedic License Vision correctable to 20/20 All portions of the testing process are mandatory. Failure to attend and complete any portion of the process will result in elimination from employment consideration. Please visit our website to pay the application fee and complete the online application at www.publicsafetyrecruitment.com. If you have any questions, please contact Public Safety Recruitment 1-800-343-HIRE ~ e-mail: info@publicsafetyrecruitment.com 9 am 5 pm Monday through Thursday and 9 am 3 pm on Friday

Overview: The City of Des Plaines and the Fire Department The City of Des Plaines, Illinois is approximately the 20th largest city in the state. With a landmass of 15.4 square miles and a population of over 59,000 residents, our city is a northwest suburb of Chicago and is in the midst of a new era of growth and rediscovery. Des Plaines is approximately 94.6% developed with 23.5% of the land used for industrial, manufacturing and commercial properties. Residential land use (32.4%) contains a wide variety of living options, from mobile homes to modern luxury homes. Most of the housing in Des Plaines was built around the turn of the last century and following the Second World War. The past decade has seen significant redevelopment of the old central business district with the construction of mid- and high-rise residential buildings. Ideally located, Des Plaines is proud of its uniquely diversified, vibrant and growing business community. In addition to being the home to several Fortune 500 companies and international businesses, there is a comfortable blend of commercial, financial, industrial, professional, service-oriented and retail sectors. Construction of mid and high-rise residential buildings and the redevelopment of several retail areas continue at a brisk pace. The combination of superior air transportation, good railroads, and a network of expressways continue to foster full development of Des Plaines. O Hare International Airport, which lies at our southern border, provides excellent domestic or international travel opportunities for pleasure, trade and business. The DPFD deploys its resources from three fire stations. In-service apparatus consists of three engine companies, two truck companies and three mobile intensive care units (ambulances). Fire Station One, the headquarters, houses the administrative staff, the shift commander (Battalion Chief), an engine company, truck company and paramedic ambulance. Fire Station Two houses an engine company and a paramedic ambulance. Fire Station Three houses an engine company, a truck company and a paramedic ambulance. Each company, when not responding to emergencies, participates in extensive daily training and conducting fire hazard inspections of businesses in their districts. In 2005, the DPFD responded to 7,267 emergency calls for service. Of that number 4,969 were for emergency medical services. In addition to protecting the City of Des Plaines, we respond to five neighboring cities on fire calls through long-standing automatic aid agreements. Salary and Benefits Work Schedule: 52 Hour week (24 hours on and 48 hours off) Salary: Based on the current collective bargaining agreement ending 12/31/06 Starting - $50,338.00 Top - $73,467.00 Paid Vacation: 1 year - 4 years = 5 shift days 5 years 11 years = 7 shift days 12 13 years = 8 shift days 14 years = 9 shift days 15 years and up = 10 shift days

CHECK LIST of REQUIRED DOCUMENTS Des Plaines Fire Department Application: Confirmed online WRITE YOUR CONFIRMATION NUMBER HERE: (The confirmation page immediately follows the references section of the online application) Release Forms: see pages 1-15 *No photocopies or fax copies will be accepted. You must submit the ORIGINAL DOCUMENTS WITH ORIGINAL SIGNATURES. Acceptable witness signatures include adult family members and friends. Consumer Reports* Alcohol, Drug & Substance Abuse Screening* Behavior Profile* Credit History* Criminal History Information/ Fingerprint* Driving Record* Employment Past and Present* High School, College, University* Diploma Medical Records* Personal Information Release to Municipality* Written Examination* Physical Ability Test* Physical Fitness Certificate* (doctor s signature required) Other Required Documents: COPY High School Diploma or GED (Copy of High School Transcripts with Graduation Date, Dated GED, or Signed Letter on High School letterhead is acceptable, COLLEGE DIPLOMA/TRANSCRIPTS NOT ACCEPTABLE ) COPY valid Driver s License (copy of front and back if you received a renewal sticker) COPY of IDPH Paramedic License COPY Birth Record READ CAREFULLY: Must contain the applicant s full name & date of birth & must be verifiable. To be verifiable, it must be possible to contact the regulatory authority to confirm the authenticity of the document. ONE OF THE FOLLOWING IS ACCEPTABLE AND REQUIRED: Copy of US Birth certificate (Copy of original or certified by a Board of Health or Bureau of Vital statistics within the U.S. State Department or U.S. territories Hospital copy not accepted.) OR Copy of valid US Passport OR Copy of Naturalization Papers OPTIONAL DOCUMENTS: In order to receive Preference Points, one or both of these must be submitted by the application deadline: Official College Transcripts reflecting 60 hours completed at an accredited college or university. COPY of your DD-214 reflecting an honorable discharge and one year of active duty. Applications will not be verified until after the deadline has passed. Candidates who submit applications lacking proper documentation as indicated above will not be admitted to orientation or testing and you will be eliminated from employment consideration. I/O Solutions Inc., d.b.a. Public Safety Recruitment, is not responsible for late, misdirected or incomplete application submissions. You must submit all required documents and have successfully CONFIRMED your online application by the deadline in order to be eligible to attend any portion of testing. You may drop your application documents off in person or by mail; however, all documents including your online application are due by the deadline as indicated. CALL 800.343.HIRE WITH QUESTIONS DEADLINE FOR REQUIREMENTS IS 2/21/07 AT 12 NOON. DO NOT SUBMIT REQUIRED DOCUMENTS TO THE CITY OF DES PLAINES OR THE DES PLAINES FIRE DEPARTMENT. PLEASE SUBMIT RELEASE FORMS & OTHER REQUIRED DOCUMENTS TO: PUBLIC SAFETY RECRUITMENT ATTN: DPFD 1127 S. MANNHEIM RD., SUITE 203, WESTCHESTER, IL 60154.

MAINE WEST HIGH SCHOOL: Park in the East and South Lots ONLY X X Maine West High School 1755 S. Wolf Rd. Des Plaines, IL 60018

PLEASE PRINT: LAST NAME... FIRST NAME........ SSN... IMPORTANT NOTICE TO APPLICANT: PLEASE READ THIS NOTICE AND CONSENT FORM CAREFULLY BEFORE SIGNING. YOU WILL BE PROVIDED WITH A COPY OF THIS FORM AT ANY TIME UPON REQUEST NOTICE AND CONSENT CONCERNING CONSUMER REPORTS FOR EMPLOYMENT PURPOSES This form, which you should read carefully, has been provided to you because I/O Solutions, Inc. (d.b.a. Public Safety Recruitment ) (hereinafter referred to as the Company ) or the Department(s) to whom you request the Company to forward your application (hereinafter referred to as the Department(s) ) may request consumer reports or investigative consumer reports. Any requests for consumer reports or investigative consumer reports from the Company will be made on behalf of any or all of the Department(s). The consumer reports or investigative consumer reports may then be reviewed by any or all of the Department(s). For the benefit of the Department(s), the Company may perform applicant background checks and employee investigations. These background checks and investigations may be performed by the Company, in whole or in part, at the Company s discretion. The Department(s) may also perform applicant background checks and employee investigations. These background checks and investigations may be performed by the Department(s), in whole or in part, at the discretion of the Department(s). The Company s and Department(s) background checks may also include the use of consumer reporting agencies to gather and report information in the form of consumer or investigative consumer reports regulated by federal law. Such reports, if obtained, will be prepared by consumer reporting agencies and may contain information concerning your credit standing or worthiness, character, general reputation, personal characteristics, or mode of living. Federal law defines a consumer reporting agency as any person (or entity) which for monetary fees, dues, or on a cooperative nonprofit basis, regularly engages in whole or in part in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing reports to third parties. The Company is not a consumer reporting agency nor are the Department(s). The types of reports that may be requested from consumer reporting agencies under this policy, include, but are not limited to, credit reports, criminal records checks, court records checks, driving records, and/or summaries of educational and employment records and histories. The information contained in these reports Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 1 of 15

may be obtained by a consumer reporting agency from public record sources or through personal interviews with your co-workers, neighbors, friends, associates, current or former employers, or other personal acquaintances. Any information contained in such reports may be taken into consideration by the Department(s) in evaluating your suitability for employment, promotion, reassignment or retention as an employee. Any information contained in such reports may be used for other purposes required by law or ethical business practices. If the Company or Department(s) request(s) an investigative consumer report to be performed by a consumer reporting agency, as defined by federal law, you will receive a notice indicating that the report has been requested no later than three days after the request is made to the agency. This additional notice, if issued, will provide you with further information pertaining to federal law governing investigative consumer reports. You will not receive such a notice if the investigation is performed by the Company or a person or entity other than a consumer reporting agency. If any adverse decision is made with regard to your application for employment or subsequent employment by a Department(s), based entirely or in part on the information contained in a consumer report or investigative consumer report prepared by a consumer reporting agency, the Department(s) are required to notify you and give you a copy of the report, as well as a summary of your applicable rights. If you have ever filed for bankruptcy, the Department(s) may not base an employment decision solely on this information. Your consent is required by law before the Company or the Department(s) may obtain a consumer report or investigative consumer report from a consumer reporting agency pertaining to your submission of an application for employment with a Department. Your signature below indicates that you have carefully read and understand that the Company and the Department(s) may request and review a consumer report or investigative consumer report regarding you, consistent with this policy, in connection with your application for employment and that you consent to the release of such consumer reports or investigative consumer reports to the Company and the Department(s) for employment purposes, including any future decisions concerning your employment, promotion, reassignment or retention. You also consent to release of this information to the Company and the Department(s) for other purposes required by law or ethical business practices. Your signature additionally reflects your understanding that such consent will remain in effect indefinitely until you revoke it (cancel it) in writing, as described below. Refusal to consent to a consumer report or investigative consumer report as required by this notice may result in rejection of an application, or withdrawal of an offer of employment. Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 2 of 15

CONSENT STATEMENT I have carefully read and understand this notice and consent form and, by my signature below, consent to the release of consumer or investigative consumer reports, as defined above, to the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners or I/O Solutions, Inc. (hereinafter referred to as the Company ) (and thereby to the departments to whom I have requested the Company to forward my application (hereinafter referred to as the Department(s) )). I further understand that this consent will remain in effect until revoked in a written document signed by me. In the event that I wish to refuse or revoke my consent at any time, I understand that I may do so by either signing the Refusal or Revocation of Consent Statement below and returning it to the Company, at 1127 S Mannheim Rd, Suite 203, Westchester, IL 60154, or sending a signed letter or statement to the Company at the same address, indicating that I revoke my consent to the Company s obtaining consumer reports or investigative reports about me for employment purposes. I further understand that any and all information contained in my job application or otherwise disclosed to the City of Des Plaines or to the Company by me may be utilized for the purpose of obtaining the consumer reports or investigative consumer reports requested by the Company and confirm that all such information is true and correct. Name of applicant (Printed) Social Security Number Date REFUSAL OR REVOCATION OF CONSENT STATEMENT DO NOT SIGN UNLESS YOU HAVE DECIDED THAT YOU WILL NOT CONSENT, OR WILL NO LONGER CONSENT TO THE CITY OF DES PLAINES OR THE COMPANY OBTAINING CONSUMER REPORTS OR INVESTIGATIVE CONSUMER REPORTS REGARDING YOU FOR EMPLOYMENT OR OTHER PURPOSES. I do not consent to the City of Des Plaines, City of Des Plaines Board of Police Commissioners or I/O Solutions, Inc. (hereinafter referred to as the Company ) obtaining consumer reports or investigative reports about me in connection with my employment or any other purposes. If I have previously granted my consent, I hereby revoke it and understand that such revocation will take effect immediately after the Company receives this written revocation and has actual knowledge of it sufficient to communicate the revocation to those employees or agents of the Company who typically request consumer reports for the Company. Name of Applicant (printed) Date Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 3 of 15

ALCOHOL, DRUG AND SUBSTANCE ABUSE SCREENING CONSENT I hereby consent for the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners or I/O Solutions, Inc., or either of its authorized representatives to collect blood, urine or saliva samples from me and to conduct other necessary medical tests to determine the presence in my body or use by me of alcohol, drugs or controlled substances. I understand that the presence of certain medications in my blood and/or urine may affect test results. To aid in the analysis of the test results I would like to inform the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners, I/O Solutions, Inc., and either of its authorized representatives that I have taken the following medications in the last seven (7) days:. RELEASE I understand that release of my medical records by this written authorization will results in disclosure of these test results. I hereby consent to the release of the test results and other relevant medical information to authorized representatives of the City of Des Plaines, the City of Des Plaines Board of Fire and Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the drug, alcohol and substance abuse screening or due to the disclosure of the test results as authorized herein by me. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 4 of 15

BEHAVIORAL PROFILE DISCLOSURE This is to inform you that in processing your application an investigation will be made whereby information is obtained from you which will be used for a Behavioral Profile. The tests, survey and interviews are designed to: measure your attitudes regarding drugs and alcohol, trustworthiness, and work; to predict your interpersonal skills, personality traits and motivations; and to predict your on the job mental abilities. CONSENT FOR BEHAVIORAL PROFILE I hereby grant my consent for the I/O Solutions, Inc., or its authorized representative to conduct the necessary interviews and administer the necessary examinations to determine my Behavioral Profile. RELEASE I understand that release of the results of my Behavioral Profile by this written authorization will result in disclosure of those test and survey results. I hereby consent to the release of the test and survey results and other relevant information to authorized representatives of I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police/Fire departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the City of Des Plaines, the City of Des Plaines Board of Police and Fire Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the Behavioral Profile or due to the disclosure of the test and survey results as authorized herein by me. In the event that I have a disability which will affect my ability to take any examination, I will so inform the I/O Solutions, Inc. prior to the administration of the examinations so that a reasonable accommodation can be made. I/O Solutions, Inc. reserves the right to require medical documentation concerning the need for the accommodation. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 5 of 15

DISCLOSURE CREDIT HISTORY This is to inform you that in processing your application an investigation will be made whereby information is obtained from private credit reporting agencies as to your credit history. This investigative consumer report includes, if applicable, information as to your character, general reputation, personal characteristics, and mode of living. You have the right to make a written request within a reasonable period of time to receive detailed information about the nature and scope of this investigation. CONSENT AND AUTHORIZATION TO INVESTIGATE CREDIT HISTORY I hereby authorize and consent to a thorough investigation of my past and present credit history and disclosure of the results of that investigation to third parties. I understand that release of my past and present credit records by this written authorization will result in the disclosure of those records. I understand that this investigative consumer report can include, if applicable, information as to my character, general reputation, personal characteristics, and mode of living. RELEASE I hereby consent to the release of the results of the investigation of my credit history and other relevant information to authorized representatives of the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners or I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police/Fire departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the investigation of my past and present credit history and the disclosure of the results of that investigation as authorized by me. I waive the right to written notice required of any former employer pursuant to the Personnel Records Review Act, 820 ILCS 40/7(1). I also acknowledge that I have had the opportunity to discuss the importance of this waiver with legal counsel of my own choosing. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 6 of 15

CRIMINAL HISTORY INFORMATION / FINGERPRINT DISCLOSURE This is to inform you that in processing your application an investigation will be made whereby information is obtained from Federal, State and local law enforcement agencies for any reportable criminal history information concerning you using your fingerprints. This information can include a record of any convictions, which are required by statute to be collected and maintained by government agencies. RELEASE I agree to be fingerprinted by the City of Des Plaines and acknowledge that these fingerprints will be used to investigate my criminal history and conviction record. I agree to and understand the release of the results of the investigation, to determine my criminal history information, will result in the disclosure of information concerning whatever criminal history exists regarding me to third parties. I hereby acknowledge the results of the investigation to determine my criminal history will be released to authorized representatives of the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners or I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police/Fire departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the City of Des Plaines, the City of Des Plaines Board of Fire and Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the investigation into my criminal history and the disclosure of any of that information. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 7 of 15

DRIVING RECORD DISCLOSURE This is to inform you that in processing your application an investigation will be made whereby information is obtained from the Secretary of State regarding your driving record. This information can include a record of your current driver's license issuance information (exclusive of information on judicial driving permits); convictions and orders entered revoking, suspending, or canceling your driver's license or privilege. RELEASE I hereby acknowledge the results of the investigation of my driving record will be released to authorized representatives of the City of Des Plaines or I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police/Fire departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners and I/O Solutions, Inc. its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the investigation into and the disclosure of my driving record. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 8 of 15

EMPLOYMENT: PAST AND PRESENT CONSENT I hereby consent to a thorough investigation of my past and present employment activities and agree to cooperate in such investigation. I hereby authorize my past and present employers to release the requested information and to comment on my work record. RELEASE I understand that by this written authorization my past and present employment records will be disclosed to third parties. I hereby consent to the release of the results of the investigation into my past and present employment and other relevant information to authorized representatives of the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners and I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police/Fire departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the City of Des Plaines, the City of Des Plaines Board of Fire and Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the investigation of my past and present employment and the disclosure of the results of that investigation as authorized herein by me. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 9 of 15

HIGH SCHOOL, COLLEGE, UNIVERSITY DIPLOMA CONSENT I hereby consent to an investigation to determine the authenticity of my high school or General Education Diploma, college, or University diploma. I hereby authorize my secondary school or its equivalent to release such information regarding the authenticity of my high school (or its equivalent), college, or university diploma to representatives of the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners or I/O Solutions, Inc. RELEASE I understand that by this written authorization that information gathered regarding the authenticity of my diploma or its equivalent will be disclosed to third parties. I hereby consent to the release of results of the investigation of the authenticity of my diploma or its equivalent to authorized representatives of the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners or to I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police/Fire departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the City of Des Plaines, the City of Des Plaines Board of Fire and Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the investigation of the authenticity of my high school (or its equivalent), college, or university diploma and the disclosure of the results of that investigation as authorized herein by me. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 10 of 15

MEDICAL RECORDS CONSENT I hereby consent for I/O Solutions, Inc., or its authorized representative to obtain my medical records from my primary physician for the period of time that my name appears on the City of Des Plaines Final Eligibility List. RELEASE I understand that release of my medical records by this written authorization will result in disclosure of my medical records. I hereby consent to the release of my medical records to authorized representatives of the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners or to I/O Solutions, Inc. for appropriate review and/or dissemination to those municipalities and/or Police/Fire departments to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the City of Des Plaines, the City of Des Plaines Board of Fire and Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the disclosure of my medical records as authorized herein by me. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 11 of 15

PERSONAL INFORMATION RELEASE TO MUNICIPALITY DISCLOSURE This is to inform you that in processing your application an investigation will be made whereby information is obtained concerning you. This information can include a record of all personal information, required by statute to be collected and maintained by government agencies. RELEASE I understand that release of the results of the historical investigation profile will result in the disclosure of information regarding me to third parties. I hereby acknowledge the results of the investigation will be released to authorized representatives of the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners or to I/O Solutions, Inc., for appropriate review and dissemination to this municipality and/or Police/Fire departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the City of Des Plaines, the City of Des Plaines Board of Fire and Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the investigation and the disclosure of any of that information. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 12 of 15

WRITTEN EXAMINATION RELEASE By this written authorization I understand that release of the results of my Written Examination will result in disclosure of those test results to third parties. I hereby consent to the release of the results of my Written Examination for dissemination to the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners and to those municipalities and/or Police/Fire departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the City of Des Plaines, the City of Des Plaines Board of Fire and Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the Police Officer Examination or due to the disclosure of the test and survey results as authorized herein by me. In the event that I have a disability which will affect my ability to take any examination, I will so inform the I/O Solutions, Inc. prior to the administration of the examinations so that a reasonable accommodation can be made. I/O Solutions, Inc. reserves the right to require medical documentation concerning the need for the accommodation. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 13 of 15

PHYSICAL AGILITY EVALUATION RELEASE I understand that as part of the examination process I must submit to a Physical Agility evaluation. I acknowledge that the Physical Agility evaluation is strenuous and there are risks of injury or death associated with participation in the Physical Agility evaluation and I voluntarily assume these risks. I certify that I am now in good health and know of no limitations that I have which would prevent me from performing the Physical Agility evaluation or which if communicated to the officers, servants, agents, and employees of I/O Solutions, Inc. would cause them to refuse to permit me to take the Physical Agility evaluation. I understand that by this written authorization I am consenting to the release of the results of my Physical Agility evaluation and that release will result in disclosure of those test results to third parties. I hereby consent to the release of my Physical Agility evaluation results and other relevant information to authorized representatives of the City of Des Plaines, City of Des Plaines Board of Fire and Police Commissioners, Lincoln-Way East High School and to I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police/Fire departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the City of Des Plaines, the City of Des Plaines Board of Fire and Police Commissioners, City of Des Plaines Fire Department and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of my participation in the Physical Agility evaluations (including but expressly not limited to: any and all injuries, losses, damage to my person or my death, which shall have been caused by, or contributed to by or resulted from my physical and/or medical condition) and/or by reason of the disclosure of the results of those tests as authorized herein by me. I further agree that I will not assign any right to which I may have to a cause of action against any of the foregoing persons or entities, to any person or legal entity. In the event that I have a disability which will affect my ability to take any examination, I will so inform I/O Solutions, Inc. prior to the administration of the examinations so that a reasonable accommodation can be made. I/O Solutions, Inc. reserves the right to require medical documentation concerning the need for the accommodation. This release is binding on myself, my heirs, assigns, executors and administrators. Agreed to: Applicant Name, printed Witness Name, printed Witness Signature Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 14 of 15

PHYSICAL FITNESS CERTIFICATE THIS CERTIFICATE SIGNED BY A PA, RN or LPN WILL NOT BE ACCEPTED A N D W I L L RENDER YOU INELIGIBLE TO TEST. I, the undersigned doctor, certify that I am a medical physician, licensed to practice in the state of, and that I have examined ( Applicant ) and have found that s/he is physically capable of participating in the Physical Agility Evaluation consisting of various strenuous exercises. DOCTOR S CERTIFICATION Signed this day of, 2007. *ATTACH DOCTOR S BUSINESS CARD HERE* *STAMP ACCEPTABLE IF CARD NOT AVAILABLE* APPLICANT S VERIFICATION Signed this day of, 2007. DOCTOR S SIGNATURE (M.D. OR D.O.) INK signature required; PA, LPN, RN, etc. not accepted APPLICANT SIGNATURE INK signature required Doctor s Name, printed SPECIFY M.D. or D.O. Applicant Name, printed Street Address, printed Street Address, printed City, State Zip Code, printed City, State Zip Code, printed Telephone Number Telephone Number This certificate must be returned to Public Safety Recruitment by the specified deadline. No applicant will be permitted to take the physical agility evaluation or the written testing process unless this signed certificate is completed and on file with the City of Des Plaines/City of Des Plaines Board of Fire and Police Commissioners. Only ORIGINAL documents with ORIGINAL SIGNATURES will be accepted; no copies or faxes. Copyright 2007 by I/O Solutions, Inc. DES PLAINES FIRE REQUIRED RELEASE DOCUMENT: 15 of 15

Des Plaines Fire Department Orientation and Preparation Guide For The DPFD Physical Ability Test

Des Plaines Fire Department Physical Aptitude Test Orientation and Preparation Guide This orientation and preparation guide has been developed to introduce you the Des Plaines Fire Department Physical Aptitude Test (PAT) for entry-level Firefighters. The information contained in this guide will familiarize you with the challenges you will face while taking the physical aptitude test and offer advice on how to prepare for the experience. The test consists of a series of job-related tasks designed to ensure that the candidate will be able to perform the necessary job functions they will face as a Firefighter in the City of Des Plaines. These simulation exercises were developed to mirror critical job tasks that Des Plaines Firefighter perform, and therefore, is a highly valid and realistic assessment of the physical aspects of this job. Based on the expert judgment of command-rank personnel from the Des Plaines Fire Department, the following six (6) physical aptitude test components were identified: Aerial Ladder Climb 28-foot extension ladder raise Charged hoseline advance Stair climb with equipment Confined space victim search simulation Victim rescue dummy drag Physical aptitude is one of several components that Firefighter are selected on, however, due to the extreme physical nature of this job, the inability of a candidate to pass this test will eliminate him/her from the selection process. The passing score will be based on times of current Des Plaines Firefighter, so expect to be required to perform at a high level. We encourage you to be as well prepared for this test as possible. This guide will help you on your way. Best of luck! Copyright 2000, I/O Solutions, LLC and Illinois Fire & Police Recruitment Administration, Inc. 1

Introduction to the PAT The Physical Aptitude Test will consist of 6 events designed to simulate such Firefighter activities as: climbing an aerial ladder, raising an extension ladder, moving with a charged hoseline into position, climbing stairs carrying hoseline and other equipment, search for victims in low visibility environments, and removing an unconscious victim from a building. The following points will help to familiarize you with the testing process: Candidates must wear a self-contained breathing apparatus (SCBA and composite bottle weigh approximately 25 pounds) through all of the PAT exercises except the aerial ladder climb component. The SCBA equipment will be provided at the test site. Candidates will begin the PAT with an untimed aerial ladder climb. After this event is successfully completed, the candidate will move on to the final five components of the PAT which will be timed as a series. There will be no breaks between these five components. The inability of the candidate to complete any of the six components will disqualify him/her from the testing process. During the sequence of timed events, candidates will be permitted to run, walk, or rest between components if they wish to do so. If the candidate chooses to rest, the clock keeps ticking! Given the extremely demanding nature of this test, it is recommended that candidates pace themselves in order to complete the entire series of events. If you are not successful at a particular component you may continue trying until you successfully complete that component. You will not be allowed to continue to the next component until the previous one has been successfully completed. Due to the nature of the simulated tasks, expect to get dirty/wet during the PAT. Also, applicants must wear athletic shoes and long pants for safety purposes. Prior to the actual test, a test administrator will provide an orientation and a test walk-through for all candidates. During the walk-through, candidates will not be allowed to touch any of the testing equipment. Candidates will be given a demonstration of each test component. We encourage you to ask questions concerning each component during the walk-through. Test monitors will time candidates as they proceed through the test components, and additional monitors will be located at each test station. The test is timed and failure to complete the PAT in the specified time will result in disqualification. Candidates will also be disqualified for failure to complete any of the individual components. Copyright 2000, I/O Solutions, LLC and Illinois Fire & Police Recruitment Administration, Inc. 2

Test Components and Suggested Preparation UNTIMED EVENT Aerial Ladder Climb For this event you must climb up 50 to 100 feet on an aerial ladder apparatus and return back down. The ladder will be set approximately at a 60-degree climbing angle. You will be wearing a safety harness for protection. You must ascend and descend the ladder without stopping to successfully complete this component. You will only be allowed two attempts to complete this component. Candidates will not wear the SCBA for this event, but must wear a safety helmet. Purpose: This event is designed to measure your coordination and balance and to assess any fear of heights that you may have. Preparation: To prepare for this event you may want to practice climbing a sturdy ladder to the height of a typical two-story house. Practice carefully and slowly climbing up and down the ladder. This event is not timed so do not rush. TIMED EVENTS * The order in which these events appear on the following pages is not a reflection of the order of test events on the as they will occur. Ladder Extension You must extend a ladder and bring it back down without dropping it using the halyard (extension rope). You must hoist the halyard in a hand over hand fashion until the ladder is fully extended. You must then lower the ladder in a hand over hand fashion. You must not lose control of the rope or drop the ladder. If this happens, you will be required to start this event over. Purpose: The purpose of this event is to test upper body strength and endurance. This event will also assess grip strength and ladder control. Preparation: To prepare for this event, you might attach a 75lb. bag to one end of a rope threaded through a pulley or hung over a smooth round wooden or metal pole. The pole or pulley should be located 20 feet above the ground. Make sure the weighted bag moves freely. You can practice pulling the weighted bag up to the top of the pole or pulley and back down again using a hand over hand movement throughout the process. Maintaining control over the bag is the most important element of this exercise. Copyright 2000, I/O Solutions, LLC and Illinois Fire & Police Recruitment Administration, Inc. 3

Charged Hoseline Advance You must pick up and advance a charged (water-pressurized) 1 3/4" hoseline for a distance of 100 feet. The nozzle will be closed on the hoseline. Purpose: The purpose of this event is to test overall muscular strength and endurance. This exercise will test leg and upper body strength. Preparation: To prepare for this event, you might tie a 20-foot rope to a bag or object weighing approximately 50 lbs. You can then throw the end of the rope over your shoulder, grasp it, and drag the weight a distance of 100 feet. Because the weight of the charged line increases as you approach the finish line, it might be a good idea to use a 100 lb. weight to practice for this event as well. Stair Climb with Equipment You must pick up a 1 3/4" high-rise hosepack (i.e., wrapped hose) and carry it up to the fourth floor using the stairway and then carry it back down the stairs. The hosepack weighs approximately 50 lbs. Please note that this is an extremely difficult test component given the weight of the equipment worn and carried. Do not underestimate its difficulty. Purpose: The purpose of this event is to test muscular strength and endurance as well as general stamina and cardiovascular endurance. Preparation: This is an extremely demanding physical event. To prepare for this exercise, you might carry a duffel bag or similar object weighing 60 lbs., up and down four stories. In preparing for this exercise, you should be aware that you will be wearing a self-contained breathing apparatus weighing approximately 25 lbs. Copyright 2000, I/O Solutions, LLC and Illinois Fire & Police Recruitment Administration, Inc. 4

Confined Space Victim Search You will wear a blackened facepiece to block your vision and be directed to enter a room where you will have to crawl on your hands and knees up and down following a 50-foot laid out hoseline. Due to the nature of this event, you will get dirty. Purpose: The purpose of this event is to test muscular strength and endurance, as well as the ability to maintain spatial orientation and freedom from claustrophobia. Preparation: To prepare for this event, you might practice maneuvering on all fours wearing a backpack weighing approximately 25 lbs. It would be a good idea to do this with your eyes closed or in a darkened room. Be sure to have a friend/helper if you are maneuvering in an area and you cannot see. Victim Rescue Dummy Drag You must drag a 165-pound human form dummy for a distance of 50 feet. Purpose: The purpose of this event is to test muscular strength, power, and stamina. Preparation: To prepare for this event, you might practice dragging a duffel bag weighing 165 lbs. In preparing for this exercise, you should be aware that you will be wearing a self-contained breathing apparatus weighing approximately 25 lbs. PAT Score Your score on the physical aptitude test will be determined by the amount of time that elapses from the start the first timed component to the end of the fifth and final timed component. The passing score is based on the times of present Des Plaines Firefighter who completed an identical course. You will be informed of your pass/fail status after you have completed the testing session. Copyright 2000, I/O Solutions, LLC and Illinois Fire & Police Recruitment Administration, Inc. 5