Volunteer Firefighter Application Form
Personal Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Home/Work Phone
*
-
Area Code
Phone Number
Email
*
example@example.com
Residence Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Basic Requirements
Are you legally entitled to work in the United States?
*
Are you 21 years of age or older?
*
Do you possess a valid Driver’s License and a good driving record?
*
Do you have a current CDL Driver’s License with Air Brake & Tanker endorsement? (Not required to be a member, but need the information)
*
Do you believe you are free of medical conditions that may preclude your participation as a volunteer firefighter?
*
Are you willing to participate in a medical check possibly required of potential volunteer firefighters? (May be required if a grant application is approved)
*
Have you ever been convicted of a felony?
*
Firefighting or EMS Experience
Do you understand that successful applicants are required to remain without facial hair to ensure a self-contained breathing apparatus mask will form a positive seal on the face?
*
Availability
Please select your availability for the given days and time phases
*
Monday - Days
Monday - Nights
Tuesday - Days
Tuesday - Nights
Wednesday - Days
Wednesday - Nights
Thursday - Days
Thursday - Nights
Friday - Days
Friday - Nights
Saturday - Days
Saturday - Nights
Sunday - Days
Sunday - Nights
If accepted by the Fire Department, you will be required to attend regular monthly last Monday of the month drills (approximately 6:00PM to 8:00PM) followed by a meeting (Approximately 8:00pm to 9:00pm. Can you meet this requirement?
*
Do you understand that in order to be available for emergency call-outs, you must be able to arrive at the fire station promptly and have abstained from alcohol and drugs for the previous 8 hours?
*
Are you willing and able to retain and wear a fire department supplied radio and respond to emergencies?
*
Are you willing and able to participate in the occasional weekend training program?
*
Skills and Experience
Do you have any current firefighting or EMS certifications? If YES, please clarify below.
*
Previous Emergency Volunteer Experience - Explain:
Terms and Conditions
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: