Sierra County Fire

Sierra County Fire

Prospective Active Member Application
Name

First NameMiddle NameLast Name
Address
City
Email Address*
Home Phone
Cell Phone*
Pleas let us know why you are interested in becoming a member of SIerra County FPD.
1. Are you legally authorized to work in the U.S.?

YESNO
2. Are you 18 years of age:

YESNO
3. Do you have any physical or health limitations that could interfere with your performance in the job for which you are volunteering?

YESNO
If you answered yes, please explain:
4. Do you have any commitments or responsibilities that might prevent you from attending training and calls?

YESNO
If you answered yes, please explain:
5. Have you previously been a member of Sierra County FPD#1

YESNO
If Yes, when and why did you leave?
Education and Training
1. High School:
Did you graduate?

YESNO
2. College/Trade School:
Subject Major:
Did you earn your degree?

YESNO
3. Please list any skills which you feel relate to this position:
Have you received Firefighter/EMS training in the past?

YESNO
Type of Firefighter/EMS training:
Date:

MonthDayYear
Date
5. Have you received first aid training in the past?

YESNO
Type of first aid training:
Date last certified:

MonthDayYear
Date
a. Driver's license number:
State of issuance:
b. Do you have truck driving experience?

YESNO
Type of vehicle:
c. Driver's license class-A, B, C:
d. Endorsements:
Availability and Employment History
1. What hours are you available to respond to emergency calls?
Approximate minutes from home to nearest Fire Station.
Approximate minutes from work to Fire Station.
2. Can you be available for the following meetings and training sessions?
2nd Thursday of the month, EMS Training 18:00hrs

YESNO
3rd and 4th Thursdays of the month, Fire/Rescue Training 18:00 hrs

YESNO
3. Do you have a FF1 or other Fire Certification?

YESNO
4. Are you currently certified as an EMT or EMR?

YESNO
Date:

MonthDayYear
Date
5. Can you attend Firefighter Training in addition to weekly drills?

YESNO
6. Can you attend an EMR or EMT course?

YESNO
7. Present Employer:
Supervisor's Name:
Address:
Phone:
Job Title:
Date Employed:

MonthDayYear
Date
Total Years Employed:
Working hours:
Specific Duties:
Does your job take you out of town?

YESNO
If yes, please explain normally what hours are you out of town?
May we contact your employer?

YESNO
8. Please list your Military Service if applicable:
Branch of Service:
MOS:
9. Any mechanical, electrical or other specialized work experience?

YESNO
If so, please explain:
10. References-please list three references that are not related to you.
1. Name:
Address:
Phone:
Phone:
2. Name:
Address:
Phone:
3. Name:
Address:
Address:
Address:
Phone:
SCFPD#1 Application (15JUL20)
Volunteer Fire District, Acknowledged Requirements
I acknowledge and understand that the process to become a Firefighter with SCFPD#1 requires:
- An interview with the District Chief.
- A live Scan.
Selected applicants will be subject to a 1 year probationary period with review after six (6) months. The following is expected during the probationary period: 1. Attend weekly training on the 2nd, 3rd and 4th Thursdays of each month (if unable to make it to training, notify the training officer or Chief of planned absence). 2. Show up to calls when availble and able to do so.

Obtain Firefighting and EMS training, if not currenty certified.

Employment with Sierra County Fire Protection District #1, is at-will and may be terminated at any time with or without notice and with or without cause. This application involves volunteer service only and does not create or confer any employment rights on the volunteer.

I have read these requirements and agree to them.
Date:

MonthDayYear
Date
Signature of Applicant:
SCFPD#1 Application, JULY 2020
Should be Empty:

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Sierra County Fire

Education and Training

Availability and Employment History

Volunteer Fire District, Acknowledged Requirements