MEMBERSHIP APPLICATION (2025)

  • MEMBERSHIP APPLICATION

    CHOCTAW VOLUNTEER FIRE DEPARTMENT

  • This Membership Application is for the Choctaw Volunteer Fire Department, located in rural Southeast Louisiana. If you are attempting to apply for membership, please make sure you are applying to the correct fire department, as there are numerous other fire departments nationwide that operate as Choctaw Volunteer Fire Department.

  • NOTICE:

    You do not reside in our protection area and do not qualilfy for membership.

  • PERSONAL INFORMATION

  • Format: (000) 000-0000.
  • DATE OF BIRTH*
     - -
  • DO YOU HAVE A VALID DRIVERS LICENSE*

  • EMERGENCY INFORMATION

  • Format: (000) 000-0000.

  • EMPLOYMENT INFORMATION

  • ARE YOU EMPLOYED?*
  • Rows

  • PRIOR EXPERIENCE

  • ARE YOU A PREVIOUS/CURRENT MEMBER OF ANOTHER FIRE DEPARTMENT?*
  • DO YOU HAVE ANY FIREFIGHTING, EMS, OR RESCUE EXPERIENCE?*
  • PLEASE CHECK ANY OF THE FOLLOWING THAT APPLY TO YOU

  • PAST HISTORY

  • HAVE YOU EVER BEEN CONVICTED AS AN ADULT, OF A CRIMINAL OFFENSE? (NOT INCLUDING MINOR TRAFFIC VIOLATIONS)*
  • HAVE YOU HAD YOUR DRIVER’S LICENSE SUSPENDED OR REVOKED WITHIN THE LAST 3 YEARS?*
  • HAVE YOU PREVIOUSLY APPLIED FOR MEMBERSHIP IN THE CHOCTAW VOLUNTEER FIRE DEPARTMENT?*
  • IF YES, WHEN*
     - -
  • ARE YOU REQUIRED TO REGISTER AS A SEX OFFENDER?*
  • HAVE YOU EVER BEEN TURNED DOWN FOR MEMBERSHIP IN ANY OTHER FIRE/RESCUE/EMS DEPARTMENT?*
  • HAVE YOU BEEN CONVICTED OF A DWI/DUI WITHIN THE LAST 5 YEARS?*

  • MISCELLANEOUS INFORMATION

  • CERTIFICATION & AUTHORIZATION

  • I certify that I have read and that I fully understand this application. I also certify that all of the information is true and complete to the best of my knowledge.

    By accepting the terms of this application, I am acknowledging that I understand that should any information given on, or as a result of this application, be false, misleading, or erroneous, it may result in the rejection of my application for membership, or my discharge from the Choctaw Volunteer Fire Department. I hereby give permission to the Choctaw Volunteer Fire Department to conduct a criminal background check and a driving violation check through an authorized law enforcement agency.

    I agree to abide by all By-laws, Policies and Procedures, Regulations and other directives of the Choctaw Volunteer Fire Department, as well as all laws, rules and regulations of the State of Louisiana and the Parish of Lafourche. I agree to assist, to the best of my ability, in the voluntary work necessary for the operation and maintenance of the Choctaw Volunteer Fire Department.

    I understand that completing and signing this application is not a guarantee for admittance into the Choctaw Volunteer Fire Department and that a decision must be made by the general membership of the Choctaw Volunteer Fire Department.

  • Should be Empty: