Hyalite Rural Fire District Volunteer Application

Hyalite Rural Fire District

Volunteer Application
Please fill out this application to the best of your ability and answer all questions truthfully and with as much detail as necessary.

For any questions that you are unable to provide information for, please simply write "N/A" in the respective space.

Please contact our administrative offices with any questions pertaining to this application.

Hyalite Fire District

4541 South 3rd Road

Bozeman, MT 59715

406-586-3770

recruit@hyalitefire.org

hyalitefire.org

INDIVIDUAL DATA
Date of Application

MonthDayYear
Date
Last Name
First Name
Middle Initial
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Emergency Contact Name
Phone Number
Please enter a valid phone number.
Relationship
Are there currently any criminal charges pending against you?

YesNo
Have you ever been convicted of a misdemeanor or felony?

YesNo
If "yes" to the above question, please explain (all accepted volunteers must complete a criminal background check and a credit history report):
Have you resided in another State?

YesNo
If "yes" to the above question, please list where and from what dates:

ORGANIZATIONS / HOBBIES / INTERESTS
List any hobbies, special areas of interest, and/or other volunteer positions:

RELATED EXPERIENCE
Have you ever volunteered for an emergency response agency before?

YesNo
Agency Name(s):
Agency Location(s) & Phone Number(s):
Agency Supervisor(s) and/or Chief Officer(s):
Please describe past fire and/or EMS training:
Are you an EMT or Paramedic?

YesNo
NREMT Certification #:
Montana State Emergency Care Provider License #:
Please list any additional current fire/EMS/rescue certifications:
Please upload copies of any relevant certifications here:

Cancelof

ADDITIONAL INFORMATION
How did you learn about the Hyalite Fire Department?
Why do you want to be a member of the Hyalite Fire Department?
Do you know anyone who has or is currenlty serving with the Hyalite Fire Department?

YesNo
If "yes" to the above question, please provide the name of person:

PERSONAL CHARACTER REFERENCES
Character Reference 1
Name:
Phone Number:
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation:
Relationship:
Character Reference 2
Name:
Phone Number:
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation:
Relationship:
Character Reference 3
Name:
Phone Number:
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation:
Relationship:

MILITARY SERVICE RECORD
Were you in the Armed Forces?

YesNo
If "yes" to the above question, what branch?
Dates of Duty:
Rank and Status current or at time of discharge:
List any special training obtained:

HEALTH
Have you reviewed the position description for which you are applying?

YesNo
Do you have any conditions (physical or mental) that may affect your performance as volunteer in any way?

YesNo
If "yes" to the above question, please describe:
Are you capable of performing in a reasonable manner the essential functions of the position, with or without a reasonable accommodation?

YesNo

APPLICANT'S STATEMENT

ACKNOWLEDGEMENT - AGREEMENT
I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that misleading, false, incomplete, misrepresented statements will constitute sufficient cause for denying volunteer membership.

I understand that neither the acceptance of this application nor the subsequent entry into any type of relationship with the Hyalite Rural Fire District creates an actual or implied contract of employment. I understand that if I accept
a position it will be on a volunteer basis. This means that the Hyalite Rural Fire Departments or I have the right to terminate the relationship at any time, for any reason, with or without cause.

I authorize the Fire Department to investigate information concerning my education, employment experiences and all other aspects of my background relevant to my proposed volunteer position. I release the Hyalite Rural Fire
District and its members from all liability arising from such investigation. My signature indicates that I have read, understand and agree to all of the above.
Signature

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*Non-Discrimination: The Hyalite Rural Fire District does not discriminate on the basis of age, race, color, national origin, sex, sexual preference, marital status, creed, or political belief, mental or physical handicap or disability, or status as a Vietnam era or disabled veteran in it employment/volunteer policies and practices.
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Hyalite Rural Fire District

INDIVIDUAL DATA

DRIVER INFORMATION

EMPLOYMENT EXPERIENCE

EMPLOYMENT EXPERIENCE 1

EMPLOYMENT EXPERIENCE 2

EMPLOYMENT EXPERIENCE 3

EMPLOYMENT EXPERIENCE 4

EMPLOYMENT EXPERIENCE 5

EDUCATION

ORGANIZATIONS / HOBBIES / INTERESTS

RELATED EXPERIENCE

ADDITIONAL INFORMATION

PERSONAL CHARACTER REFERENCES

Character Reference 1

Character Reference 2

Character Reference 3

MILITARY SERVICE RECORD

HEALTH

APPLICANT'S STATEMENT