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Volunteer Firefighter Application

All applicants must live within the established boundaries of the fire district. Applicants must be able to provide proof of residency. If you do not live within the district boundaries, your application will be rejected.

Do you currently live within our fire district? (If you do not currently live within our fire district, you are not eligible to apply. Please exit this application).

Yes

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Birthday

Month

Day

Year

Upon acceptance to the fire department, you will be required to provide your Social Security Number, and a copy of a valid Driver's License or State ID.

I agree

Membership Type

We have 3 different membership categories. If you are unsure of what option to choose, please choose "Not Sure" and we will cover this at a later time.

Firefighter members are consider to be full members of the fire department, and are able to function as front-line firefighters and medical personnel.

Driver/Engineer members are limited to driving emergency vehicles to a scene and operating fire engines during a fire.

High School members are for any high school student interested in the fire service industry. You must be at least 16 years old and must have successfully completed their Sophomore year. There are several restrictions for this position. (Parent / Legal Guardian approval required)

Fire / EMS Experience

Education

Please tell us about your education, including any degrees or trade-school programs.

Are you currently employed?

Full-time

Part-time

Not Currently Employed

Other

Please tell us about your current or most recent job.

Health & Medical

Please answer all questions as honestly as possible. Please note that the information you provide does not automatically disqualify you.

Height

Weight

If you checked any boxes for the previous question, please explain.

Any allergies?

Please Provide 2 Personal References

Emergency Contact

All of the information contained in this application is true and correct to the best of my knowledge, and I authorize investigations of all statements contained in this application. I would be willing to submit to an annual physical examination if requested by the fire protection district. I understand and agree that I may be subject to a random drug/alcohol test at any time while serving as a member. I promise that upon termination of my status as a member, to return any articles or properties

Signature - PLEASE TYPE YOUR COMPLETE LEGAL NAME*

By typing your name, you are signing this Application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this Application. By typing your name, you consent to be legally bound by this Application's terms, conditions, and/or disclaimers.

PLEASE TYPE YOUR COMPLETE LEGAL NAME