Sierra County Fire

Sierra County Fire

Prospective Active Member Application
Name

First Name Middle Name Last 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.?

YES NO
2. Are you 18 years of age:

YES NO
3. Do you have any physical or health limitations that could interfere with your performance in the job for which you are volunteering?

YES NO
If you answered yes, please explain:
4. Do you have any commitments or responsibilities that might prevent you from attending training and calls?

YES NO
If you answered yes, please explain:
5. Have you previously been a member of Sierra County FPD#1

YES NO
If Yes, when and why did you leave?
Education and Training
1. High School:
Did you graduate?

YES NO
2. College/Trade School:
Subject Major:
Did you earn your degree?

YES NO
3. Please list any skills which you feel relate to this position:
Have you received Firefighter/EMS training in the past?

YES NO
Type of Firefighter/EMS training:
Date:

Month Day Year
Date
5. Have you received first aid training in the past?

YES NO
Type of first aid training:
Date last certified:

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

YES NO
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

YES NO
3rd and 4th Thursdays of the month, Fire/Rescue Training 18:00 hrs

YES NO
3. Do you have a FF1 or other Fire Certification?

YES NO
4. Are you currently certified as an EMT or EMR?

YES NO
Date:

Month Day Year
Date
5. Can you attend Firefighter Training in addition to weekly drills?

YES NO
6. Can you attend an EMR or EMT course?

YES NO
7. Present Employer:
Supervisor's Name:
Address:
Phone:
Job Title:
Date Employed:

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

YES NO
If yes, please explain normally what hours are you out of town?
May we contact your employer?

YES NO
8. Please list your Military Service if applicable:
Branch of Service:
MOS:
9. Any mechanical, electrical or other specialized work experience?

YES NO
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:

Month Day Year
Date
Signature of Applicant:
SCFPD#1 Application, JULY 2020
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Sierra County Fire

Education and Training

Availability and Employment History

Volunteer Fire District, Acknowledged Requirements