Volunteer Firefighter ApplicationApplicant InformationLast Name (required)First Name (required)Middle NameAddress (required)City (required)Zip Code (required)Email (required)Phone Number (required)Are you legally authorized to work in the U.S? (required)YesNoAre you 18 years of age? (required)YesNoDo you have a Firefighter I certification? (required)YesNoIf yes, what is the date of the certification?Do you have a current EMT certification? (required)YesNoIf yes, what is the date of the certification?Have you applied here before?YesNoAvailabilityWhat hours are you available to respond to emergency calls? (required)Can you be available Monday evenings, 6:00 p.m. - 9:00 p.m. for training drills? (required)YesNoCan you be available on occasional Saturdays, 8:00 am - 12:00 p.m. (required)YesNoDriving Record CheckDo you have a valid driver's license? (required)YesNoEducation and TrainingHigh School (required)Did you graduate? (required)YesNoCollege/Trade SchoolSubject/MajorWork HistoryPresent Employer (required)Supervisor's Name (required)Address (required)Phone Number (required)Job Title (required)Dates Employed (required)Working Hours (required)May we contact Employer? (required)YesNoSpecific Duties (required)Previous EmployerSupervisor's NameAddressPhone NumberJob TitleDates EmployedWorking HoursMay we contact Employer?YesNoSpecific DutiesPrevious EmployerSupervisor's NameAddressPhone NumberJob TitleDates EmployedWorking HoursMay we contact Employer?YesNoSpecific DutiesPrevious EmployerSupervisor's NameAddressPhone NumberJob TitleDates EmployedWorking HoursMay we contact Employer?YesNoSpecific DutiesMilitary Service (if applicable)Branch of ServiceDuty StatusActiveVeteranReseveReferences (Please list 3, not related to you)Name (required)Email (required)Phone Number (required)Employer (required)Name (required)Email (required)Phone Number (required)Employer (required)Name (required)Email (required)Phone Number (required)Employer (required)There was a problem saving your submission. Please try again later.Please wait while your submission is being saved...Submitting...SubmitThank you, your submission has been received.
