Volunteer Firefighter Application Form

Full Legal Name

First NameLast Name

Social Security Number* Driver's License State of Issue Driver's License Number

Phone Number

Area CodePhone Number

Home/Work Phone

Area CodePhone Number

Email

example@example.com

Residence Address

Street Address

CityState / Province

Postal / Zip Code

Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you legally entitled to work in the United States?

Have you ever been convicted of a Felony?

Have you ever been charged with a traffic offense (ticket)

Please select your availability for the given days and time phases

Special Skills:

Reference #1

Current Employer

I solemnly declare and affirm that all answer and statements in this application are wholly true, full and correct in every particular and detail and I further authorize the City of Livingston, its agents, and the Livingston Fire Department to investigate and verify all statements listed above. I agree to abide by and comply with all laws of the State of Alabama and the City of Livingston, as well as the rules and regulations, working conditions, and policies established by the Livingston Fire Department.

I understand that misrepresentation as to preexisting physical or mental conditions may void my workers’ compensation benefits. I also understand that if I suffer an on-the-job injury, I may be required to submit to a drug or alcohol test. Failure to submit to a test, or a positive result, may be reason for denial of workman’s compensation and can be released from the Livingston Fire Department Volunteer Roster.

Date

Signature

Volunteer Firefighter Application Form

Personal Information

Current Certifications

References

Terms and Conditions