Employment/Volunteer Application

Employment/Volunteer Application
Date of Application

MonthDayYear
Date
Applicants Name*

First NameMiddle NameLast NameSuffix
Phone Number*
Please enter a valid phone number.
Cell Phone Provider ex: Verizon, AT&T etc.*
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*

MaleFemaleN/A
State and Driver License Number
Date of Birth *

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

First NameLast Name
Guardians phone number.
Please enter a valid phone number.
Volunteer or Paid*

VolunteerJr. VolunteerPart-TimePart-Time & Volunteer
Area of Interest*

FirefighterFirefighter/EMTEMTSupport StaffOther
Who recommended you to the Stedman Volunteer Fire Department?
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?
Do you have any health concerns that would interfere with you performing your duties as a firefighter or first responders?
Please provide your previous employers name and phone number.
Emergency Contact name and phone number.
I First Name* Last Name* consent to allowing the Stedman Volunteer Fire Department Inc. to investigation my background through the Police/Sheriff's Department, State Police, FBI, or any other recognized law enforcement organization, as required by North Carolina state law. This information will be held in the strict confidence by the Stedman Volunteer Fire Department, Inc.
Signature*

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