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.

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 or Paid

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?

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

If Yes, please describe:

Have you obtained any of the below certifications?

Please provide your previous employers name and phone number.

Personal reference # 1’s name.

Personal reference # 1’s phone number.

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 be tested for alcohol abuse and/or illegal drugs, or show proof that you have been tested for alcohol abuse and/or illegal drugs within the last six months. Failure to comply with testing will result in your application being rejected. When you interest application has been approved, please attend the next Thurday Night training at 5256 Front St., Stedman, NC 28391 at 6:30 pm.

I, First Name Last Name , understand that before I can be considered for membership or employment with the Stedman Volunteer Fire Department, I must consent to be tested for alcohol abuse and/or illegal drugs. Failure to comply with testing will result in my application being rejected. I also understand that a positive test result for alcohol and/or illegal drugs will result in my application being rejected. I also understand that the results of testing will not be disclosed without my written authorization.

Signature