Firefighter Application Form

Firefighter Application Form

Completing an application form is one of the basic step when joining the fire service. If you want to collect full information of the firefighter, this form has all the fields you need. This asks full information of a firefighter from personal information, tracks and records. This will help you evaluate and check the applicant background easily. Form Preview
Richardsville FD Firefighter Application
  • Richardsville Fire Department Firefighter Application

  •  -  - Pick a Date
  • Current Address

  • Previous Address (If less than 5 years at above address)

  • In Case of Emergency, Notify:

  • Present Employer:

  • Previous Fire/Emergency Experience (Most Recent):

  • Additional Fire/Emergency Experience:

  • Current Certifications (FF1, FF2, EMT, CPR, Etc):

  • Education:

  • List Criminal Convictions For the Last 3 Years (Include Dates & Descriptions):

  • List All Traffic Citations or Convictions For The Last 3 Years, Not Including Parking Violations (Include Dates and Descriptions):

  • List All Automobile Accidents For The Last 3 Years (Include Dates and Descriptions):

  • Give name and phone number of three references who are not related to you:

  • I UNDERSTAND THAT AFTER FILLING OUT THIS INITIAL APPLICATION THAT I WILL THEN BE SUBJECT TO A FURTHER APPLICATION PROCESS INCLUDING A CRIMINAL BACKGROUND CHECK.  I FURTHER UNDERSTAND THAT I MAY BE REQUIRED TO PASS A MEDICAL EVALUATION AS A CONDITION OF CONTINUING MEMBERSHIP.

    IN ORDER THAT THE CHIEF OR HIS DESIGNEE MAY BE FULLY INFORMED AS TO MY PERSONAL CHARACTER AND QUALIFICATIONS FOR MEMBERSHIP, I REFER HIM TO MY EMPLOYER, ANY REFERENCES GIVEN, AND ANY OTHER PERSON WHO MAY HAVE INFORMATION CONCERNING ME.  AS THIS INFORMATION IS FURNISHED AT MY EXPRESS REQUEST AND FOR MY BENEFIT, I DO HEREBY RELEASE THE RICHARDSVILLE FIRE DEPARTMENT FROM ANY AND ALL LIABILITY FOR DAMAGE OR OTHER NATURE ON ACCOUNT OF FURNISHING SUCH INFORMATION.  

    I DO AGREE TO THESE CONDITIONS AND I HEREBY CERTIFY THAT ALL STATEMENTS MADE BY ME ON THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

    I UNDERSTAND THAT WILLFULLY WITHHOLDING INFORMATION OR MAKING FALSE STATEMENTS ON THIS APPLICATION WILL BE GROUNDS FOR DENIAL OF THIS APPLICATION OR DISMISSAL FROM THE DEPARTMENT.

    BY CLICKING ON SUBMIT AND ELECTRONICALLY SUBMITTING THIS APPLICATION, I HEREBY CERTIFY THAT I AGREE TO THE ABOVE STATEMENTS.

  • Should be Empty: