Employment/Volunteer Interest Application

Date of Application

Date

Applicants Name

First NameMiddle NameLast NameSuffix

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Applicant Email

example@example.com

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Gender

State and Driver License Number

Date of Birth

Date

Legal guardians name, if you are under 18 years old.

First NameLast Name

Guardians phone number.

Please enter a valid phone number.Format: (000) 000-0000.

Volunteer, Part-time, or both

Do you have any health concerns that would interfere with you performing your duties as a firefighter or first responders?

Why do you want to become a member of the Stedman Volunteer Fire Department?

Who recommended you to the Stedman Volunteer Fire Department?

Personal reference’s name.

Personal reference’s phone number.

Select any certifications you have obtained.

If "Other" selected, please list other certifications obtained.

Have you had any motor vehicle violations in the last three years?

If Yes, please describe:

Personal reference # 2’s name.

Personal reference # 2’s phone number.

Personal reference # 3’s name.

Personal reference # 3’s phone number.

What was your highest grade of education you completed?

Do you have any previous training related to becoming a firefighter or first responder?

Emergency Contact name, Relationship to applicant, and phone number.

Before consideration for membership or employment with the Stedman Volunteer Fire Department, Inc., all applicants are required to undergo a comprehensive background check, or provide proof of a valid background check conducted within the last six months. Failure to comply with the background check requirement will result in the immediate rejection of your application. If approved, please attend the next Thursday night training session at 6:30 PM, located at 5256 Front St., Stedman, NC 28391.

I, First Name Last Name , understand that before I can be considered for membership or employment with the Stedman Volunteer Fire Department, Inc., I must consent to a background check.
I understand and agree to the following conditions:

Non-Compliance: Failure to comply with the background check requirement will result in my application being rejected.
Background Results: Information obtained during the background check that disqualifies me from service will result in my application being rejected.
Confidentiality: The results of this background check will remain confidential and will not be disclosed to outside parties without my explicit written authorization.

Signature