West I-10 Fire Department
Application for
Volunteer Firefighter

 

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Applying for:      Firefighter          Reserve Member

Name:
Last: First: Middle:
Phone Numbers:
Home:       Cell:    
Email Address:
Home Address:
Street:  City:   State:   Zip:
How Long have you been at your present address:  Years    Months
Previous Address:
Street:  City:   State:   Zip:
How Long have you been at your previous address:  Years    Months
Are you between 18 and 70 years old?     Yes        No       Date of Birth (mm/dd/yy):



Employment History

Provide information on present employer and last two employers:

Business Name

Address

Phone Number
Contact Person

Month/Year
(mm/yy)
 
 From:
To:   
 
 From:
To:   
 
 From:
To:   



Personal Information
Formal education (check one):  High School:     GED:  
College and/or trade School:      Year Completed:
Fire Service Experience:
Emergency Medical Experience: 
Certified EMT:  Yes    No      If yes:  Level   Exp. Date (mm/yy)
Military Service: Yes    No    If yes:  Branch Type of Discharge:
Do you have a valid Texas drivers license?  Yes    No    If yes license #:
Have you ever been convicted for anything other than minor traffic violation?  Yes    No   
   If yes, Please explain:
The fire service places great physical demand and requires you to carry, lift, climb, crawl, stoop and bend.  Do you have any physical limitations that would prevent you from performing these duties?  Yes    No   
    If yes, Please explain:


References

Please provide the names of three references other than relatives:

Name

Address

Phone Number

Relationship
 
  
  
 


Please Explain why you want to become a firefighter?

By submitting this application you hereby certify that this application contains no misrepresentations or falsifications and that the information given is true and complete to the best of your knowledge and belief.  You understand that misrepresentation or omission of facts called for in this application is cause for cancellation of the application and/or dismissal. 

Furthermore, by submitting this application you are authorizing the West I-10 Fire Department to make any necessary and appropriate investigations to verify the information contained herein.

Entering your name in the following text box signifies that you have read, understand and consent to the above statement.