Bethel Fire Department Volunteer Firefighter Application Form

Bethel Fire Department Volunteer Membership Application
Personal Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Home/Work Phone*

Area CodePhone Number
Email*
example@example.com
Residence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / 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 have a current State of Alaska Driver's License, or the ability to obtain within 90 days of membership?*
Do you understand that applicants will be required to provide a Driver’s History report and a Criminal History Report?*
Do you believe you are free of medical conditions that may preclude your participation as a volunteer firefighter or EMT?*
Do you believe you are free of medical conditions that may preclude your participation as a volunteer firefighter or EMT?*
Are you willing to participate in a medical check required of volunteer firefighters?*
Are you willing to participate in a medical check required of volunteer firefighters?*
Do you understand that volunteer firefighters are expected to be in good physical condition, and do you feel you are physically able to participate in a physical fitness related test as part of the selection process?*
Are you willing to complete a fire department physical ability test (CPAT) to assess your physical capabilities to meet firefighter and EMT certification requirements?*
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 - DaysMonday - NightsTuesday - DaysTuesday - NightsWednesday - DaysWednesday - NightsThursday - DaysThursday - NightsFriday - DaysFriday - NightsSaturday - DaysSaturday - NightsSunday - DaysSunday - Nights
If accepted by the Fire Department, you will be required to attend regular biweekly Thursday night Fire Meetings (approximately 7:00PM to 10:00PM, 2nd & 4th Thursdays each month). Can you meet this requirement? *
If accepted by the Fire Department, you will be required to attend regular biweekly Tuesday night EMT meetings (approximately 7:00PM to 9:00PM, 1st & 3rd Tuesdays each month). 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 an emergency pager and respond to emergencies? *
Are you willing and able to participate in the occasional weekend training program?*
Skills and Experience
Please indicate if you have any of the following skills or training*

CPR - Cardiopulmonary resuscitationCertified Trade - mechanic, electrician, teacher, etc.Fire Safety Systems - alarms, extinguishersRescue procedure - lifeguard, auto extricationFirst AidKnowledge of breathing apparatus - scuba diving, SCBA, respirators, etc.Occupational Health & SafetyOther
Previous Firefighter or EMS Experience – Explain:
Tell us what motivated you to apply to become a volunteer first responder.
What are your hobbies and interests?
What are your hobbies and interests?
References
Please provide three references, with at least one being a professional reference.
Date

MonthDayYear
Date
Signature
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Bethel Fire Department Volunteer Membership Application

Personal Information

Basic Requirements

Availability

Skills and Experience

References