Volunteer Application Form
Laramie County Fire District #3
Name
*
First Name
Middle Name
Last Name
Have you used any other names?
*
Yes
No
Name(s)
*
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Social Security Number
Phone Number(s)
*
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Volunteer Application Form
Laramie County Fire District #3
Physical Details
*
Are you color blind?
*
Yes
No
If Yes, please provide an explanation
*
Can you perform the duties of the firefighter as outline in our Standard Operating Procedures?
*
Yes
No
If Yes, please provide an explanation
*
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Volunteer Application Form
Laramie County Fire District #3
Are you currently receiving any benefits pursuant to a disability pension?
*
Yes
No
If Yes, please provide an explanation
*
Have you served in the Armed Forces of the United States?
*
Yes
No
If Yes, please provide an explanation
*
Current Employer
*
Please list three references we may contact that are not employers or relatives.
*
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Volunteer Application Form
Laramie County Fire District #3
Driver's License
*
Has your driver's license ever been suspended or revoked?
*
Yes
No
If Yes, please provide an explanation
*
Have you ever been convicted of a felony?
*
Yes
No
If Yes, please provide an explanation
*
Have you ever been convicted of theft or false statements?
*
Yes
No
If Yes, please provide an explanation
*
Are you currently on probation or parole?
*
Yes
No
If Yes, please provide an explanation
*
Have you ever been denied bond?
*
Yes
No
If Yes, please provide an explanation
*
Do you currently use/abuse drugs in a manner which is contrary to this state's laws?
*
Yes
No
If Yes, please provide an explanation
*
Have you ever belonged to a paid or volunteer fire department, rescue service, or other first responder organization?
*
Yes
No
If Yes, please provide the following
*
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Volunteer Application Form
Laramie County Fire District #3
Electronic Signature
*
This serves as my electronic signature
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: