Hardin County Fire Department Volunteer Application (age 18+)

Hardin County Fire Department Volunteer Application (age 18+)

Please fill out all required information to the best of your ability. Please be honest and forthcoming in your answers and include all information you would like for us to know including any legal depositions.
Requirements to Join the Department:

1. Age 18 or older.

2. Provide a valid State of Tennessee Driver's License.

3. Must live in Hardin County.

4. Must not be on disability from another department, probationary period. company, or organization.

5. No convictions of felonies and/or misdemeanors.

6. Attend all required training within the first two years.

7. Complete a 1-year probationary period.

Application Process Requirements:

1. Attach a copy of your current driver's license.

2. Complete and return this application to your district chief or a location listed below. a. Courthouse Office: 465 Main Street, Savannah, TN 38372 b. Station 12: 90 Walnut Street, Savannah, TN 38372

3.Your application will be sent for a background check. By signing and dating this application you are authorizing us to do so. Please note: You cannot attend training or calls until your application has been processed. You are welcome to attend district meetings per your district chief's approval.

Probationary Period Restrictions:

1. 1 year probationary period begins on the first day you attend your New Recruit Class.

2. During this period, you CANNOT obtain a firefighter tag.

3.You CANNOT drive county-owned vehicles or fire department apparatus EXCEPT for driver/operator training purposes only with an assigned department member such as the district

Expectations to be an Active Member of HCFD:

1. Attend 16 hours of firefighter training per year after your probationary period is complete.

2. Attend district meetings regularly and participate in district/department events and training.

3. Complete all required training courses within the first two years of being on the department.

Required Training within First 2 Years:
- ICS 100, 700, and 800 - Online Courses at FEMA
- New Recruit Class/Intro. to Fire - 16hrs
- Intro to FD Pumps - 16hrs
- Basic Firefighting - 64hrs
- BLS CPR - 4 hours
  
  Recommended Training: EVOC/EVDT - 16hrs + Required Driving Time (Only if you want to drive vehicle/apparatus) and Firefighter Live Burn - 16hrs (Only for Interior Firefighting)

HCFD Volunteer Application for Ages 18+
Today's Date*

MonthDayYear
Date
Which District are you Located In?*
District Locations: D1 Saltillo, D2 Crump/Morris Chapel, D3 Counce/Pickwick, D4 Cerro Gordo/Swift, D5 Mt. Hermon/Cravens, D6 Walkertown/Olivet, D7 Pyburn/Nixon, D8 Burnt Church/Gillis Mills, D9 Olive Hill/Harbert Hills, D11 Walnut Grove, D14 Bruton Branch
T-Shirt Size*
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Sex*
SSN*
Address*
City*
State*
Zip*
Phone Number (CELL /MOBILE ONLY!)*
Phone Number (HOME)
Email (That you check regularly.)*
example@example.com
Marital Status*
Drivers License*
Type*
Endorsements
Upload a photo of your Driver's License: If you have issues with the uploader please email a clear photo copy to jessica@hardincountyfire.com
Emergency Contact Information
Emergency Contact #1: First & Last Name*
Phone*
Relation*
Emergency Contact #2: First & Last Name
Phone
Relation
Education Information
High School Graduate*

YesNo
GED Graduate

YesNo
Other
College or Universities Attended most recently
Graduated College*

YesNo
Year
Degrees/Certifications Obtained

VFIS BENEFICIARY DESIGNATION FORM

A Division of Glatfelter Insurance Group183 Leader Heights Road P.O. Box 2726 York, PA 17405 (800) 233-1957 or (717) 741-0911 www.vfis.com
WHAT IS THIS?
The Hardin County Fire Department provides a free VFIS Beneficiary Insurance to all Hardin County firefighters. This insurance will provide a one-time stipend in the event that you are involved in a line of duty death. This form must be filled out in completion in order to receive this benefit. While we hope we never have to use these, they are an important part of your personnel record. Please be sure to update any time you have a MAJOR LIFE CHANGE otherwise whomever is listed on this form will be awarded the stipend.

HOW TO FILL THIS FORM OUT:
All information is required. None can be skipped.
There are two class sections of beneficiaries, the Primary (gets it first) and Contingent (gets it if the primary is no longer living). Each class section should eqal to a toal of 100% no matter how many ways it is divided. If you have multiple beneficiaries please divide evenly to equal a total of 100% in that class section. EXAMPLE OF MULTIPLE: Primary Class: Grace Hays Jones 50%, Mary Jones Ford 25%, and William Roger Jones 25% - these combined make a total of 100%.

CLICK THE TITLES BELOW TO FILL OUT EACH SECTION.

This form may be used for multiple policies when designating the same beneficiary. Use a separate form when designating different beneficiaries for each Policy.

Your Personal Information
Name*

First NameLast Name
MI
Date of Birth*

MonthDayYear
Date
Date of Membership*

MonthDayYear
Date
SSN*

PRIMARY BENEFICIARY CLASS
I hereby designate the following beneficiary(ies) to receive any death benefit proceeds payable under the policies checked above. If this form represents a change of beneficiary, the present beneficiary designation(s) are terminated and the following designation(s) made:
Primary Beneficiary #1*

First NameLast Name
Relationship to Insured*
Primary Beneficiary #1 Date of Birth*

MonthDayYear
Date
Primary Beneficiary #1 Percentage *
There are two classes, Primary (gets it first) and Contingent (gets it if the primary is no longer living). If you have multiple beneficiaries please divide evenly to equal a total of 100% in the class. EXAMPLE OF MULTIPLE: Primary Class Grace Hays Jones 50%, Mary Jones Ford 25%, and William Roger Jones 25% - these combined make a total of 100%.
Primary Beneficiary #2 Name

First NameLast Name
Relationship to Insured
Primary Beneficiary #2 Date of Birth

MonthDayYear
Date
Primary Beneficiary #2 Percentage
Primary Beneficiary #3 Name
Primary Beneficiary #3 Relationship to Insured
Primary Beneficiary #3 Date of Birth

MonthDayYear
Primary Beneficiary #3 Percentage

CONTINGENT BENEFICIARY CLASS
I hereby designate the following beneficiary(ies) to receive any death benefit proceeds payable under the policies checked above. If this form represents a change of beneficiary, the present beneficiary designation(s) are terminated and the following designation(s) made:
Contingent Beneficiary #1 Name*
There are two classes, Primary (gets it first) and Contingent (gets it if the primary is no longer living). If you have multiple beneficiaries please divide evenly to equal a total of 100% in the class. EXAMPLE OF MULTIPLE: Primary Class Grace Hays Jones 50%, Mary Jones Ford 25%, and William Roger Jones 25% - these combined make a total of 100%.
Contingent Beneficiary #1 Relationship to Insured *
Contingent Beneficiary #1 Date of Birth *

MonthDayYear
Date
Contingent Beneficiary #1 Percentage*
Contingent Beneficiary #2 Name
Contingent Beneficiary #2 Relationship to Insured
Contingent Beneficiary #2 Date of Birth

MonthDayYear
Date
Contingent Beneficiary #2 Percentage
Contingent Beneficiary #3 Name
Contingent Beneficiary #3 Relationship to Insured
Contingent Beneficiary #3 Date of Birth

MonthDayYear
Date
Contingent Beneficiary #3 Percentage

Sign and Date Your Beneficiary Form
Insured's Signature*

Clear
Today's Date*

MonthDayYear
Date

Acknowledgement & Signature Page
I certify that all information is correct and complete to the best of my knowledge. I understand that falsification of any information may be grounds for denial of membership. I understand that the information provided on this application will be used to do a local, state, and/or national background check. In addition to the background check, a driver's license validity check and driving history record will be performed. I understand that the references I have listed may be contacted by the department. I understand by signing and dating below that I give permission for the department to access these records on my behalf and contact my listed references. This information is for Hardin County Fire Department use only.
Applicant Full Name
Today's Date

MonthDayYear
Date
Applicant Signature

Clear
Should be Empty:

Hardin County Fire Department Volunteer Application (age 18+)

Demographic Information

HCFD Volunteer Application for Ages 18+

Emergency Contact Information

Education Information

Military Service Information (if applicable)

Employment History

References (Work and Family)

Prior or Current First Responder Information

Criminal, Drug, and Alcohol History

VFIS BENEFICIARY DESIGNATION FORM

Acknowledgement & Signature Page