Nederland Fire Protection District Volunteer Firefighter Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Can you perform the essential functions of the job with or without reasonable accommodation?
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Yes
No
Are you 18 years of age or older?
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Yes
No
Have you ever been employed by, or provided volunteer service to the District before?
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Yes
No
If yes, give dates.
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Employment Experience
List names of employers and those you have volunteered for in consecutive order with present or last work listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references.
Are you currently employed?
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Yes
No
Name of Current Employer
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Job title
*
Name of Supervisor
*
Start Date
*
-
Month
-
Day
Year
Date
Work Performed
*
Add another employer?
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Yes
No
Additional Employment History
Add additional employment history, going back three (3) years.
Name of Employer
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Job title
*
Name of Supervisor
*
Start Date
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Work Performed
*
Add another employer?
*
Yes
No
Name of Employer
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Job title
*
Name of Supervisor
*
Start Date
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Work Performed
*
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References
Give name, address and telephone number of three references who are not related to you and who are not previous employers.
Name
*
First Name
Last Name
Email
*
example@example.com
Relationship
*
Name
*
First Name
Last Name
Email
*
example@example.com
Relationship
*
Name
*
First Name
Last Name
Email
*
example@example.com
Relationship
*
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Educational Background
Do you have a high school diploma or GED?
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Yes
No
Do you have a college/university degree?
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Yes
No
College/university name
*
Highest degree obtained
*
Course of study
*
Did you attend vocational or technical school?
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Yes
No
Vocational/Technical school name
*
Course of study
*
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Special Skills
Do you have past firefighting experience (either career or volunteer)?
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Yes
No
Department Name
*
Location
*
Years
*
Months
*
Add another department?
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Yes
No
Department Name
*
Location
*
Years
*
Months
*
Add another department?
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Yes
No
Department Name
*
Location
*
Years
*
Months
*
What skills or additional training do you have that are related to the volunteer position?
What machines or equipment can you operate?
Upload Certification(s) that would pertain to the volunteer position. (must be in PDF format as a single file).
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We are looking in particular for the following: Medical - EMR, EMT or Paramedic (NRMET, Colorado or both). Structure - Completion of an exterior fire academy or completed Firefighter I with DFPC. Wildland - Hold an active Red Card (S-130/190). ICS - 100, 200, 700 and 800
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Affidavit and Consent Release
Please read and acknowledge by checking the box next to each statement below.
Applicant's Certification
*
I certify that all information provided in this application is true and complete. I understand that any false information or omission may disqualify me from further volunteering either now or if discovered at a later date.
Release of Information
*
I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making the volunteering decision. I release such persons and organizations from any legal liability in making such statements.
Drug & Alcohol Testing
*
I understand that I will be required to undergo a drug/alcohol test if the District makes a conditional offer of Volunteer Membership to me.
Background Check
*
I understand that I will be required to pass a formal background check if the District make a conditional offer of Volunteer Membership to me.
Consent
*
I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT VOLUNTEERING DOES NOT CREATE AN EXPRESSOR IMPLIED CONTRACT OF EMPLOYMENT WITH NEDERLAND FIRE PROTECTION DISTRICT.
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