Spruce Pine Volunteer Fire Department Application

Spruce Pine Volunteer Fire Department Application
Please complete and submit the online volunteer application below, after completion the Spruce Pine Volunteer Fire Department membership committee will review your submission and contact you via email within ten business days.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Drivers License Number*
Social Security Number*
Marital Status*

SingleMarried
Present Employer*
Employer Address
Occupation
Immediate Supervisor
Work Phone
Please enter a valid phone number.
Typical Work Shift
Does your job require frequent travel out of the area?*

YESNO
If you work in the area, will you be able to respond during work?*

YESNO
Will your work shift hinder you from attending evening training sessions?*

YESNO
Education*

Still in High School (Jr Firefighter)GEDGraduated High SchoolTrade SchoolSome CollegeCollege Degree
High School Attended*
College / Technical School Attended
College Degree / Major
Current Medical Condition*

ExcellentGoodFairPoor
List any medical conditions which may lead to an emergency situation (examples: high blood pressure, diabetes, allergies, etc.)
Personal Physician (type none if you do not have a private physician)*
Primary Emergency Contact Person (name)*
Relationship
Emergency Contact Phone Number*
Please enter a valid phone number.
Have you ever been a member of a fire department, rescue squad or similar?*

YESNO
Name of Organization
Date of Service

MonthDayYear
Date
Position Held
List any emergency response related training you have completed
List and current Spruce Pine Volunteer Fire Department personnel who you are related to or acquainted with
References (List three references who are familure with your education or work experience)
Ref #1

First NameLast Name
Ref #1 Phone
Please enter a valid phone number.
Ref #2

First NameLast Name
Ref #2 Phone
Please enter a valid phone number.
Ref #3

First NameLast Name
Ref #3 Phone
Please enter a valid phone number.
Have you ever been arrested, summoned into court as a defendant or indicted, convicted, fined, imprisoned, or placed on probation, or has and case been filed against you? If yes, please explain:*
List any comments and or information which you feel may be pertinent to your application process:
I have read and completed all the above question to the best of my knowledge. I understand that misrepresentation or omission of facts is cause for dismissal.
Application Signature*

Clear
Application Date*

MonthDayYear
Date
Should be Empty: