Lewistown Illinois Volunteer Firefighter Application

Lewistown Illinois Volunteer Firefighter Application

Apply to join the Lewistown Volunteer Fire Department as a volunteer firefighter.
Application Date

MonthDayYear
Date
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Date of Birth

MonthDayYear
Date
Occupation
Employer's Name
Employer's Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Work Hours (please specify typical schedule)
School Name (if currently enrolled)

Education Background

Rows	Courses Attended	Days Off	Graduated?	Year
Elementary School
High School
College
Business/Trade
Military

Number of years of experience (please specify area, e.g., firefighting, EMS, or related)
Number of years in current occupation
Other Information: Are there any other factors which you feel make you especially qualified for duties and participation with the Lewistown Volunteer Fire Department?
Do you currently have an active EMS License (none required)
Are you currently an IL. Certified Firefighter (none required)
Have you ever been a member of any other fire department?
If yes, where?
Position held?
What influenced you to apply to the department?
Has membership been discussed with your family?
What are their feelings?
Are you willing to spend time for training and meetings?
Are you willing to respond to departmental calls anytime?
Are you bothered by heights and/or close quarters?
Do you know if you can work with heavy turn-out gear and breathing apparatus?
Are you willing to take a complete physical by a physician?
Do you have any medical problems and/or do you take any medications?
In addition to your present occupation, what prior work experiences have you had?
How often do you consume alcoholic beverages?
Have you ever been arrested?
If yes, please explain in detail.
With this application, provide a copy of your Drivers License

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Reference 1

Full Name Phone Number
Reference 2

Full Name Phone Number
May we contact your references?
Please have one reference write a letter for the deportment.

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Any other remarks to the above questions?
Note: The signing and submission of this application authorizes the Department's Chief Officer and any one he may appoint to conduct a background check on any records with law enforcement officials and the Secretary of State's Office. The Lewistown Volunteer Fire Department does not discriminate in regard to race, color, age, sex, religion, national origin, and physical or mental handicap.

By submitting this application you have not falsely submitted any information.
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