Online Firefighter Application

  • Madison Township Fire Department

    66341 State Road 331

    Bremen, Indiana 46506

    Phone: (574) 633-4915

  • Date received
     / /
  • Background/Reference Check completed
  • Interview Date
     / /
  • Vote Date
     / /
  • Format: (000) 000-0000.
  • Are you a U.S. Citizen or an alien authorized to work in this country? Federal law prohibits the employment of unauthorized aliens. All persons appointed must submit satisfactory proof of employment and identity valid driver's license, birth certificate, Green Card, etc within three days of appointment. Failure to submit such proof within the required time shall result in immediate termination.*
  • Are you between the ages of 18 and 65?*
  • Have you served in the Armed Forces of the United States?
  • Do you have previous firefighting and/or EMS experience?
  • When are you available?
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Have you ever been arrested?*
  • Do you have a Driver's License?*
  • Has your license ever been suspended?*
  • Have you ever been denied auto insurance?*

  • **Please include a copy of any; certifications, diplomas, or training records that are relevant to your position on the fire department**

  • Have you had the Hepatitis B Series Vaccination?*
  • Have you had a TB test?*
  • Do you have a current DOT Physical?*

  • IN CASE OF AN EMERGENCY

    Please list (2) individuals
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • REFERENCES

    Please list (3) references
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • It is our policy that equal employment opportunities be available to all members and applicants without regard to; race, sex, age, color, religion, national origin, participation in military services, disability, or any other protected status. The Madison Township Fire Department will comply with its obligation to provide reasonable accommodations to qualified

    individuals with disabilities.

    This application is not intended to be a contract. Any resulting appointment to the position of On-Call firefighter and its subsequent positions is for no fixed time and can be terminated at any time by either party. No individual other than the Chief of the Department, the Trustee of the Township, or the Township Board; has the authority to enter into any agreement for any specific period of time or to make any agreement contrary to the statements above. Any such agreement contrary to this must be in writing and signed into binding.

    Further, any printed materials such as; policies, practices, handbooks, or other Department documents do not and are not intended to create any guarantee of employment. The Madison Township Fire Department has the right to modify or terminate policies, practices or other programs at any time.

    RELEASE

    I agree that the Madison Township Fire Department shall not be liable in any respect if my employment is terminated because of falsifying of; statements, answers or omissions by me in this application. I also authorize the Madison Township Fire Department to obtain information relevant to my bona fide qualifications from the; companies, schools, organizations and persons named above.

    I hereby release said companies, organizations, schools, and persons from all liability for any damages for issuing this information.

    I also understand that a physical examination is required and that periodic physical screenings will be required.

  • Date*
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