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Volunteer Firefighter Application Form
Name
*
Indicates required field
Last
*
First
*
Middle Initial
*
Contact Information
Email
*
Primary Phone
*
best number to reach you (cell)
Phone Number
*
Secondary number (landline/work)
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Education History
Education Completed
*
High School
College
University
Education Details (optional)
*
You can provide any details on course/schools here if desired.
Addtional Courses/Training
*
Please list any applicable training or courses you may have completed (First Aid, confined space, leadership, etc)
Additional Skills/Experience
*
Employment Information
Present Employer
*
Work Location
*
Line 1
Line 2
City
State
Zip Code
Country
Employer's Phone Number
*
Employed since
*
how long have you been with this employer?
Occupation/Job Title
*
Job Duties/Role description
*
give us some information on the type of work you do day to day
Shift Work?
*
Yes
No
Work Schedule Information
*
what hours/shifts do you usually work?
Do you have your Employer's permission to respond to calls during work hours?
*
Yes
No
Drivers License Information
Do you have a driver's license?
*
Yes
No
License Class
*
Class 5 (Passenger Vehicle)
Class 4 (Taxi, ambulance or small bus)
Class 3 (Trucks over 14,000 kg)
Class 1 (Tractor Trailer)
Do you have regular access to a reliable vehicle?
*
Yes
No
Attachments
You may attach up to 3 documents to support your application (Resume, cover letter, certificates, etc)
File 1
*
Max file size: 20MB
File 2
*
Max file size: 20MB
File 3
*
Max file size: 20MB
Consent
Please check each box below to indicate you consent to the following conditions of application (ALL are required)
I, the applicant hereby certify or consent to
*
I am at least 19 years of age
Drivers abstract
Criminal Record check
I am presently and shall remain a resident of the Cross Roads Fire District
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Privacy Policy
I accept the privacy policy
*
Yes
No
I consent to being contacted by CRFD representatives
*
Yes
No
Submit Application
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