Firefighter and / or EMS Application
Personal Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Residence Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Basic Requirements
Are you 18 years of age or older?
*
Do you possess a valid Driver’s License?
*
Have you been convicted of a felony or DWI?
*
Do you understand that applicants will be required to submit to a Criminal Record Check?
*
Do you believe you are free of medical conditions that may preclude your participation as a volunteer firefighter?
*
Do you understand that volunteer firefighters are expected to be in good physical condition, and do you feel you are physically able to participate in a physical fitness related test as part of the selection process? *unless applying for EMS ONLY.*
*
Additional Comments
Availability
If accepted by the Fire Department, you will be required to attend monthly meetings every first and third Monday night (approximately 6:00PM to 8:00PM) to the best of your ability.
*
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 8 hours?
*
Are you willing and able to retain and wear an emergency pager and respond to emergencies?
*
Skills and Experience
Please indicate if you have any of the following skills or training
*
CPR - Cardiopulmonary resuscitation
Certified Trade - mechanic, electrician, etc.
Hazmat Awareness and / or Operations
Wildland Firefighting
First responder, EMR, EMT, Paramedic
Knowledge of breathing apparatus - scuba diving, etc
AED/Defibrillation Training
Other
Current occupation:
Previous Firefighter Experience – Explain:
References
Please add two.
Terms and Conditions
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
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