Trempealeau/Caledonia Fire Department

Trempealeau/Caledonia Fire Department

Firefighter/First Responder Application
Full Name*

First NameMiddle InitialLast Name
Birth Date

MonthDayYear
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Current Address*

Street Address

Street Address Line 2

City/Village/TownshipState

Zip Code
Years at Current Address*
Position Applying For*
Sex*
Age*
Social Security Number
Why would you like to join the Fire Department?*
Do you have any experience in the Fire Service or Medical Field?*
List Your Employer*
Employer Address*

Street Address

Phone Number

CityState / Province

Postal / Zip Code
What is your work schedule?*
When would you be able to respond to calls?*
If you work in our coverage area, do you feel your employer would be interested in allowing you to answer Fire/Medical calls during work hours?*
If yes, would your employer like someone to contact them?*
Relationship*
Spouses Name (If Applicable)*
Spouses Employer (If Applicable)*
Spouses Work Number (If Applicable)*
List Two References Below
Reference #1*

Name

Street Address

CityState / Province

Phone Number
Reference #2*

Name

Street Address

CityState / Province

Phone Number
List any members that are currently on the Fire Department that you know.*
Should be Empty:

List Two References Below