Volunteer Firefighter Application Form
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Home/Work Phone
*
-
Area Code
Phone Number
Residence Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Basic Requirements
Are you legally entitled to work in the United States?
*
Are you 18 years of age or older?
*
Do you possess a valid Driver’s License and a good driving record?
*
Do you understand that applicants will be required to provide a copy of your Driver’s License and have a Criminal Record Check completed?
*
If accepted by the Fire Department, you will be required to attend regular weekly Tuesday night training and monthly meetings (approximately 7:00PM to 9:00PM). Can you meet this requirement?
*
Are you willing and able to retain and wear an emergency pager and respond to emergencies?
*
Are you willing and able to participate in the occasional weekend and evening training programs?
*
Skills and Experience
What Position Within Our Department Is Your Ultimate Goal
*
Interior Firefighter
Exterior Firefighter
Fire Scene Support
First Responder (EMT)
Social Member
Please indicate if you have any of the following skills or training
*
CPR - Cardiopulmonary resuscitation
Certified Trade - mechanic, electrician
Fire Safety Systems - alarms, extinguishers
Rescue procedure - lifeguard, auto extrication
First Aid
Knowledge of breathing apparatus - scuba diving, etc
PAD/Defibrillation Training
Occupational Health & Safety
Other
Please indicate if you have any of the following skills or training
CPR - Cardiopulmonary resuscitation
Certified Trade - mechanic, electrician
Fire Safety Systems - alarms, extinguishers
Rescue procedure - lifeguard, auto extrication
First Aid
Knowledge of breathing apparatus - scuba diving, etc
PAD/Defibrillation Training
AED Training
Occupational Health & Safety
Other
Tell Us About Yourself:
Why Do You Want To Join Our Department - Explain:
Previous Emergency Volunteer Experience - Explain:
Previous Firefighter Experience – Explain:
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: