Volunteer Firefighter Application Form
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
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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
Spouse's Name:
Dependents:
Iota Volunteer Fire Department
The Iota Volunteer Fire Department is tasked with providing an umbrella of protection to the citizens of our fire protection district through an aggressive delivery of safety education, fire prevention, disaster management, firefighting, rescue and emergency medical services by providing a highly trained and well equipped team of professional volunteer firefighters, emergency medical personnel, and public servants.
Division of Interest
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Firefighting
EMS
Support
Fire Prevention
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 possess a valid Louisiana Driver’s License and a good driving record?
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Drivers License #
Employer:
Shirt Size
Small
Medium
Large
XL
XXL
XXXL
XXXXL
Do you understand that applicants will be required to attend a formal interview with staff at the Iota Volunteer Fire Department?
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Do you understand that applicants will be required to pass a background check?
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Any previous felonies, misdemeanors, DUI/DWIS?
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If yes, please explain.
Physical Requirements of Firefighting
Performing in firefighter gear weighing approximately 70 lbs.; moving 100 lbs. by dragging, lifting, pulling, or pushing; be able to stand for periods of time; evolutions requiring to squat, crawl, and maneuver through obstacles while wearing firefighter gear.
Do you believe you are free of medical conditions that may preclude your participation as a volunteer firefighter?
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Please list any medical conditions that may affect your role as a firefighter?
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 firefighter tasks?
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Additional Comments
Requirements of Emergency Medical Services
Comfortable responding to critical injuries, severe illnesses, or incidents involving death; participate in training sessions consisting of emergency medical response; attend education sessions on EMS equipment and become proficient in utilizing EMS equipment in the field
Do you understand that volunteer firefighters in the EMS Division are expected to attain a base knowledge of medical care and attend continual education to maintain a professional level of service?
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Do you understand that volunteer firefighters in the EMS Division are expected to respond to EMS calls, structure fires, vehicle accidents and vehicle extrictitons, among other incidents?
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Requirements of Support Division
Comfortable responding to incidents as a non emergency entity to assist in equipment supplies or other non-hazardous tasks; preform duties around the station and grounds (grass cutting, sweeping, mopping, painting etc.); attending Fire Department events to assist in any aspect.
Do you understand that volunteer firefighters in the Support Division are to fulfill a non-hazardous role and assist the firefighters and Fire Department administration as needed?
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Requirements of Prevention Division
Comfortable responding to public events and educational sessions; comfortable with public speaking; capable of attending fairs and festivals and present prepared material to the public as a representative of the Fire Department.
Do you understand that volunteer firefighters in the Prevention Division are to fulfill a non-hazardous role and assist the firefighters and Fire Department administration as needed?
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Availability
If accepted by the Fire Department, you will be required to attend regular weekly Monday night trainings (approximately 6:30PM to 9:30PM). 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?
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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 sessions or work details?
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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
Fire Safety Systems - alarms, extinguishers
Rescue procedure - lifeguard, auto extrication
First Aid
Knowledge of breathing apparatus - scuba diving, etc
EMT/Paramedic
Occupational Health & Safety
Hazardous Materials
Other
Previous Emergency Service Experience, if any - Explain:
Please list any other skills that you believe would be useful to our organization (computer skills, record management, etc):
References
Terms and Conditions
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Month
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