JOIN WHITING FIRE & RESCUE

Application to serve

Apply for fire, ambulance/rescue, or both. Please complete this interest application, and a department representative can follow up with you.

Dual volunteer membership application

Fields marked * are required. Do not include Social Security or driver's license numbers.

Applicant details

First name *

Last name *

Date of birth *

Street mailing address *

City *

State *

ZIP *

Phone number *

Phone type *

Email address *

I am interested in * (choose one or both)FireAmbulance/Rescue

Relevant training or experienceNo prior experience is required to express interest.

Your general availability *

Why would you like to join? *

Training and previous agencies

Certifications, licenses, training, and expiration datesList certifications, licenses, and training with expiration dates if applicable (for example, CPR, EMT, Mandatory Reporter, RN, or Fire Fighter 1). If expired, give the expiration date.

Previous agency / department experience, if applicable:

Agency / department 1

Agency / department

Years served

Phone number

Contact name

Agency / department 2

Agency / department

Years served

Phone number

Contact name

Employment

If you have worked for your present employer less than five years, include your previous employer.

Current employer

Employer

Years employed

Position

Normal work hours

Employer address

Employer phone number

Contact name

Previous employer

Years employed

Position

Reason for leaving

Previous employer phone

Contact name

Additional information

Is your driver's license current? *

Driver's license issuing state

Driver's license class

Driver's license expiration date

Criminal / driving record explanation (if applicable)Do not include driver's license numbers or Social Security numbers.

How do you feel you could serve as an asset to our organization? *

References

Provide three people we may contact. Please ask them before listing their contact information. A name, phone number, and relationship are required for each; email is optional.

Reference 1

Full name *

Phone number *

Relationship *

Email (optional)

Reference 2

Full name *

Phone number *

Relationship *

Email (optional)

Reference 3

Full name *

Phone number *

Relationship *

Email (optional)

Signature

I certify that the answers given in this application are true and complete to the best of my knowledge. I give Whiting Fire & Rescue permission to contact the references listed here. I understand that knowingly false or misleading information may result in my discharge if accepted for membership. I agree to abide by the Whiting Fire & Rescue Department By-Laws.

Type your full name as your signature *

Date signed *

Your answers are used to review your interest in Whiting Fire & Rescue. If you need help with the form, message the department on Facebook.