LFPD Application

Full Name*

First NameMiddle NameLast Name

The minimum age to be a firefighter with the Lincoln Fire Protection District is 18 years of age. There is no maximum age. Applicants who are at least 16 years old, but not yet 18 can apply to join the Cadet program. Please choose the option that best fits you.*

I am at least 18 years oldI am between 16 and 18 years old and am seeking to join the Cadet program.Other

Email Address*

example@example.com

Phone Number*

Current Address*

Street Address

Street Address Line 2

CityState

Zip Code

Number of years at current address*

Former Address*

Street Address

Street Address Line 2

CityState

Zip Code

Number of years at former address*

Drivers License Number, State, and Expiration*

Position applying for*

How did you hear about us*

Name of relative(s) on the Lincoln Fire Protection District

Have you ever been a member of the Lincoln Fire Protection District?*

YesNo

If yes, when and why did you leave?

Please describe any previous fire/emergency service experience.

Include department name, your occupation/role/position, location, time served, department phone number, and supervisor name.

May we contact your previous department(s)?*

YesNoOther

Educational Experience

High SchoolCollegeOther (Trade, Certificates, etc.)

Please describe your education experience and list any pertinent certifications/licenses.

Are you currently in school?*

YesNo

If yes, what school and area of study?

Is there any reason any of your present health conditions would prevent you from being a firefighter?*

YesNo

If yes, please explain.

Do you suffer from any fears/phobias that would restrict your activities as a firefighter?*

YesNo

If yes, please explain.

Have you ever trained others?*

YesNo

If yes, state nature of training.

Have you ever supervised others?*

YesNo

If yes, state nature of supervision.

Have you ever been convicted of a crime?*

YesNo

If yes, please explain.

Reference 1*

First NameLast NameOccupation

Reference 1 Phone Number*

Please enter a valid phone number.

Reference 2*

First NameLast NameOccupation

Reference 2 Phone Number*

Please enter a valid phone number.

Reference 3*

First NameLast NameOccupation

Reference 3 Phone Number*

Please enter a valid phone number.

Why do you want to be a member of the Lincoln Fire Protection District?

Membership Notice --- Read Carefully Before Signing and Submitting Your Application

I hereby authorize the department to conduct an investigation concerning all statements contained in my application for membership, to interview all references and employers, and to conduct any other investigation that it deems appropriate. I request any duty constituted law enforcement agency or judicial officer to furnish the department with all information pertaining to me concerning convictions and arrests for which convictions were obtained and I hereby release the company and any law enforcement agency, judicial officer or other individual from any liability arising from disclosure of such information pertaining to me which is obtained during said investigation.
I understand that any false statements or omissions of information in this application will be sufficient cause for discharge of membership.
I hereby give permission for a complete physical examination, if requested, including x-rays, and consent to the release of any and all medical information as deemed necessary by the department.
I hereby give permission for a Pre-Employment Drug Screening (PEDS) examination, and consent to the release of any and all medical information as may be deemed necessary by the department.
I understand that if I am accepted, my membership will be for no definite period, regardless of the period of payment of my wages. I further understand that I have the right to terminate my membership at any time, with or without notice, and the department has the same right.
I understand my application will remain active for six (6) months.

Signature*

Date*

Date

Lincoln Fire Protection District Application

Please list three personal references (other than relatives or previous employers)