Quapaw Fire Department Application
Personal Information
Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Home/Work Phone
*
Format: (000) 000-0000.
Email
example@example.com
Residence Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Place of Employment
Occupation
*
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Availability
Please select your availability for the given days and time phases
*
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
Recommended By:
Basic Requirements
Are you legally entitled to work in the United States?
*
Are you 18 years of age or older?
*
Do you possess a valid Class D Driver’s License and a good driving record?
*
Do you have a current CDL License?
*
Do you understand that applicants will be required to provide a Driver’s License and a Criminal Record Check?
*
Do you believe you are free of medical conditions that may stop you from being able to participate as a firefighter?
*
Are you willing to participate in a medical check prior to becoming a firefighter?
*
Are you willing to participate in a drug test prior to becoming 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 a physical fitness related test as part of the selection process?
*
Do you understand that successful applicants are required to remain without facial hair that may hinder a seal with a self-contained breathing apparatus mask on the face?
*
If accepted by the Quapaw Fire Department, you will be required to attend two fire meetings each month, one being a training meeting (approximately 6:00PM to 8:00PM). Can you meet this requirement?
*
Are you willing and able to retain and wear an emergency pager and respond to emergencies?
*
Are you willing and able to participate in the occasional weekend training program?
*
Skills and Experience
Please indicate if you have any of the following skills or training
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
AED/Defibrillation Training
Occupational Health & Safety
Other
Additional Comments
Previous Emergency Experience - Explain:
Previous Firefighter Experience – Explain:
References
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Recommended By:
Social Security Number
Date of Birth
Occupation
Place of Employment
Should be Empty: