Volunteer Firefighter Membership Application Form

Name*

First NameMiddle NameLast NameSuffix

Residence Address*

Street Address

Street Address Line 2

CityState

Zip Code

Primary / Cell Phone Number*

Home/Work Phone

Email*

Confirmation Emailexample@example.com

Social Media Handles (You are required to list ALL of your social media handles. Ex: https://www.facebook.com/profile.php?id=100090441139593, etc.) *

Let us know your social media handles if you are on Facebook, Instagram, TikTok, etc. If you are not on social media, please enter NONE.

Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

Driver's License #:*

State Driver's License Image*

Browse Files

You must upload a clear image of your valid state driver's license.

Are you a citizen of the United States?*

Are you legally entitled to work in the United States?*

Are you 18 years of age or older?*

Have you ever been convicted of a felony?*

Have you ever been arrested by any law enforcement agency?*

Have you ever been convicted of a DUI or DWI?*

If you selected YES to a felony conviction, DUI or DWI conviction, you must list date of conviction, court, and detailed explanation. Otherwise leave blank.

Do you understand that applicants will be required to have the information provided in this application investigated through criminal background checks, personal and employment references, and other methods as deemed appropriate?*

Have you ever volunteered with the GRAY VOLUNTEER FIRE DEPARTMENT in the past?*

If you have volunteered with us in the past, list the dates and position.

Additional Comments

Please select your availability for the given days and time phases*

If accepted by the Fire Department, you will be required to attend regular monthly meetings (approximately 9-11 a.m. on the Saturday following the first Tuesday of the month). Can you meet this requirement? *

Do you understand that in order to be available for emergency call-outs, you must be able to arrive at the fire station promptly and have abstained from alcohol and drugs for the previous 12 hours?*

Are you willing and able to participate in the required training programs which may be offered in the evenings and on weekends?*

High School Attended*

College Attended

Other Vocational Training School

Attach high school transcript here.*

Browse Files

Please block out Social Security number before uploading.

Attach college or trade school transcript here.

Browse Files

Please block out Social Security number before uploading.

Please indicate if you have any of the following skills or training*

Please explain how previous schooling, training, volunteering, or work experience could help you in your role as a firefighter:*

0/250

Previous Volunteer Experience - Explain:

Previous Volunteer Firefighting Experience – Explain:

Please provide a short statement as to why you are joining the Gray Volunteer Fire Department:*

0/250

Current Employer*

Previous Employer*

Previous Employer

Reference #1*

Reference #2*

Reference #3*

Firefighters and first responders must meet stringent physical and mental health requirements including strength, endurance, agility, and the ability to lift heavy objects, alongside mental health standards that assess your ability to handle high-stress situations, traumatic experiences, and make quick decisions under pressure.

NFPA 1582 sets physical and mental health standards for fitness for duty for firefighters. The medical requirements in this standard were based on in-depth consideration of essential structural fire-fighting functions. These essential functions are what members are expected to perform at emergency incidents and are derived from the performance objectives stated in NFPA 1001, Standard for Fire Fighter Professional Qualifications.

Essential functions are performed in and affected by the following environmental factors:

(1) Operating both as a member of a team and independently at incidents of uncertain duration

(2) Spending extensive time outside exposed to the elements

(3) Tolerating extreme fluctuations in temperature while performing duties; fire fighters are required to perform physically demanding work in hot (up to 400°F), humid (up to 100 percent) atmospheres while wearing equipment that significantly impairs body-cooling mechanisms

(4) Experiencing frequent transition from hot to cold and from humid to dry atmospheres

(5) Working in wet, icy, or muddy areas

(6) Performing a variety of tasks on slippery, hazardous surfaces such as on rooftops or from ladders

(7) Working in areas where sustaining traumatic or thermal injuries is possible

(8) Facing exposure to carcinogenic dusts such as asbestos, toxic substances such as hydrogen cyanide, acids, carbon monoxide, or organic solvents, either through inhalation or skin contact

(9) Facing exposure to infectious agents such as Hepatitis B or HIV

(10) Wearing personal protective equipment that weighs approximately 50 lb. while performing fire-fighting tasks

(11) Performing physically demanding work while wearing positive-pressure breathing equipment with 1.5 in. of water column resistance to exhalation at a flow of 40 L/min

(12) Performing complex tasks during life-threatening emergencies

(13) Working for long periods of time, requiring sustained physical activity and intense concentration

(14) Facing life-or-death decisions during emergency conditions

(15) Being exposed to grotesque sights and smells associated with major trauma and burn victims

(16) Making rapid transitions from rest to near-maximal exertion without warm-up periods

(17) Operating in environments of high noise, poor visibility, limited mobility; at heights; and in enclosed or confined spaces

(18) Using manual and power tools in the performance of duties

(19) Relying on senses of sight, hearing, smell, and touch to help determine the nature of the emergency, to maintain personal safety, and to make critical decisions in a confused, chaotic, and potentially life-threatening environment throughout the duration of the operation

Have you ever been treated with an organ transplant, prosthetic device (e.g. artificial hip), or an implanted pump (e.g. for insulin) or electrical device (e.g. cardiac defibrillator)?*

YESNOPrefer not to answer

Have you had or have you been advised to have an operation?*

YESNOPrefer not to answer

Have you ever been a patient in any type of hospital?*

YESNOPrefer not to answer

Have you consulted or been treated by clinics, physicians, healers, or other practitionerswithin the past year for other minor illnesses?*

YESNOPrefer not to answer

Have you been rejected for military service because of physical, mental, or other reasons?*

YESNOPrefer not to answer

Have you ever been treated for a mental or emotional condition?*

YESNOPrefer not to answer

Have you ever been diagnosed with or treated for alcoholism or alcohol dependence?*

YESNOPrefer not to answer

Have you ever been diagnosed as being dependent on illegal drugs, or treated for drug abuse?*

YESNOPrefer not to answer

Will you consent to submit to random and unannounced drug and alcohol testing?*

YESNOPrefer not to answer

Will you consent to submit to a polygraph or CVSA (Computer Voice Stress Analysis)?*

YESNOPrefer not to answer

REQUIRED - Take Photo of Applicant now for Identity Verification*

Today's Date*

Date

Signature*

Gray Volunteer Fire Department

Personal Information

Basic Requirements

Availability

Education

Skills and Experience

Employment History

References

Health & Fitness

Voluntary Medical Assessment

Disclosure and Agreement