Employment/Volunteer Interest Application

Date of Application

Date

Applicants Name

First NameMiddle NameLast NameSuffix

Date of Birth

Date

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone Number

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

Cell Phone Provider

Used for messaging and notification apps.

Applicant Email

example@example.com

Driver License Number

State

Driver's License Class

Expiration Date

Date

Gender

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?

If answered yes to health concerns, please explain:

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

Who recommended you to the Stedman Volunteer Fire Department?

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

If answered yes to motor vehicle violations, please explain:

Have you obtained:

Select any certifications you have obtained.

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

Previous Employers

Rows	Employer Name	Phone Number
1
2

Personal References

Rows	Personal Referance Name	Phone Number
1
2

Emergency Contact

Rows	Contact Name	Phone Number
1

Before consideration for membership or employment with the Stedman Volunteer Fire Department, Inc., all applicants are required to undergo a comprehensive background check through Sterling Volunteers. After completing this application, an email invite will be sent to the provided email address. Background check is at no cost to the applicant. Failure to comply with the background check requirement will result in the immediate rejection of your application. If approved, additional documents will be emailed to the address provided on this application.

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