Volunteer Auxilary Member Application Form
Personal Information
Name
*
First Name
Last Name
Phone Number
*
-
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 18 years of age or older?
*
Do you possess a valid MI Driver’s License and a good driving record?
*
Do you understand that applicants will be required to undergo a Driver’s License Record and a Criminal Background Check?
*
Are you currently under investigation for any illegal activity?
*
Do you have any felonies or misdemeanors?
*
If yes what are they:
Additional Comments
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 Thursday meetings, trainings and truck checks (approximately 7:00PM to 9:00PM). Can you meet this requirement?
*
Do you understand that in order to be available for emergency call's, you must be able to arrive at the fire station promptly and have abstained from alcohol and drugs for the previous 8 hours?
*
Skills and Experience
Please indicate if you have any of the following skills or training
*
CPR/AED
Firefighter 1 & 2
Hazmat Awareness/ Operations
Any Fire Officer Series
Instructor 1
Knowledge of breathing apparatus - scuba diving, etc
First Aid
Occupational Health & Safety
MFR
EMT
Paramedic
Water Rescue
Dive
Other
Previous Volunteer Experience - Explain:
References
Provide 3 References
Terms and Conditions
Date
-
Month
-
Day
Year
Date
Signature
Submit
Should be Empty: