Lee County Fire Department Volunteer Membership Application

Lee County Fire Department Application for Volunteer Membership

Please complete the form below to apply for a position with us.
Applicant Information
Full Name

First NameMiddle NameLast Name
Date of Birth

DayMonthYear
Current Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Driver's License #
License State Issued
License Class
Do you have any driving violations or Collisions in the past five years?
If yes, provide details.
Social Security #
Email Address
Phone Number
Format: (000) 000-0000.
Applying for Position
Have you ever worked or volunteer with Lee County Fire/Rescue?
If yes, when?
Are a citizen of the US?
If no, are you authorized to work in the US?
Have you ever been convicted of a crime?
If yes, explain:
List availability hours including morning, afternoon, evening, and nights.

Additional Skills/Qualifications
List additional skills and qualifications (e.g CPR, foreign language, other education/training):
Disclaimer and Signature
Do you realize that as a member you will be required to give freely your time to attend incidents, training and other events?
Do you have a fear of heights, confined spaces, water, or any other fears or discomfort regarding possible response to scenes which involve emergency operations?
If yes, please describe.
Do you have any joint mobility problems that will limit your duties in an emergency situation?
If yes, please describe.
The Lee County Fire Department is an equal opprtunity agency. Discrimination based on gender, religion, race or nationality is stictly prohibitted.

I certify that my answere are true and complete to the best of my knowledge.

If this application lead to membership with the department, I understand that false or misleading information in my application or interview may result in my release.
Signature
Should be Empty:

Lee County Fire Department Application for Volunteer Membership