Bethel Fire Department Volunteer Membership Application
Personal Information
Name
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First Name
Last Name
Phone Number
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Area Code
Phone Number
Home/Work Phone
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Area Code
Phone Number
Email
*
example@example.com
Residence Address
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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?
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Are you 18 years of age or older?
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Do you have a current State of Alaska Driver's License, or the ability to obtain within 90 days of membership?
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Do you understand that applicants will be required to provide a Driver’s History report and a Criminal History Report?
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Do you believe you are free of medical conditions that may preclude your participation as a volunteer firefighter or EMT?
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Do you believe you are free of medical conditions that may preclude your participation as a volunteer firefighter or EMT?
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Are you willing to participate in a medical check required of volunteer firefighters?
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Are you willing to participate in a medical check required of volunteer firefighters?
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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?
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Are you willing to complete a fire department physical ability test (CPAT) to assess your physical capabilities to meet firefighter and EMT certification requirements?
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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?
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Availability
Please select your availability for the given days and time phases
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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 biweekly Thursday night Fire Meetings (approximately 7:00PM to 10:00PM, 2nd & 4th Thursdays each month). Can you meet this requirement?
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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?
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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?
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Are you willing and able to retain and wear an emergency pager and respond to emergencies?
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Are you willing and able to participate in the occasional weekend training program?
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Skills and Experience
Please indicate if you have any of the following skills or training
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CPR - Cardiopulmonary resuscitation
Certified Trade - mechanic, electrician, teacher, etc.
Fire Safety Systems - alarms, extinguishers
Rescue procedure - lifeguard, auto extrication
First Aid
Knowledge of breathing apparatus - scuba diving, SCBA, respirators, etc.
Occupational Health & Safety
Other
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
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Month
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Day
Year
Date
Signature
Submit
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