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?*

YesNo
If yes, provide details.
Social Security # *
Email Address*
Phone Number*
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?*

YesNo
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?*

YesNo
If yes, please describe.
Do you have any joint mobility problems that will limit your duties in an emergency situation?*

YesNo
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*

Clear
Should be Empty:

Lee County Fire Department Application for Volunteer Membership