2. El Dorado Fire Department Volunteer Firefighter Application

4. Name: Last
5. First
6. Middle
8. Address
9. City, State
10. Zip
12. Home Phone
13. Cell Phone
14. Email
16. Date of Birth
17. Place of Birth
19. Driver's License Number
20. State of Issue
21. Social Security Number

23. Circle the appropriate response:

25. Have you ever failed to pass an insurance physical?

    1. Yes
    2. No
27. Have you ever filed for Workmen's Compensation

    1. Yes
    2. No
29. Have you ever been convicted of a felony?

    1. Yes
    2. No
31. If born after 1959, have you registered with the Selective Service?

    1. Yes
    2. No
33. List below all auto accidents/traffic violations received in the last 36 months.
35. Why are you applying to be a volunteer member of the El Dorado Fire Department?
37. Describe your background/experience in the fire, or related, service.
39. Describe your education/training as it relates to the fire service.
41. List the qualities you feel you possess that are necessary to be a successful firefighter.
45. Employee Record (Start with the most recent employer.)
47. 1. Employer Name
48. From/To
50. Address
51. City, State
52. Zip Code
54. Phone
55. Supervisor
57. Reason for Leaving
59. 2. Employer Name
60. From/To
62. Address
63. City, State
64. Zip Code
66. Phone
67. Supervisor
69. Reason for Leaving
71. 3. Employer Name
72. From/To
74. Address
75. City, State
76. Zip Code
78. Phone
79. Supervisor
81. Reason for Leaving
85. Personal References:

    (List two persons you have known for the last 5 years - who you are not related to)

87. Name
88. Phone
90. Address
91. Occupation
93. Name
94. Phone
96. Address
97. Occupation
101. Person to Contact in Case of an Emergency:
103. Name
104. Phone Number(s)
105. Relationship
107. Address
108. City, State
109. Zip Code

113. Agreement

115. I certify that the answers given herein are true and complete to the best of my knowledge.

     I authorize the El Dorado Fire Department to investigate all statements contained in this application as may be necessary in arriving at an acceptance decision.

     In the event of acceptance, I understand that false or misleading information given in the application process may result in discharge. I also understand that I am required to abide by all rules, regulations and Standard Operating Guidelines of the El Dorado Fire Department, including the Non-Tobacco Use Policy.

117. Signature of Applicant
118. Date

122. No Tobacco Use Policy

124. All members of the El Dorado Fire Department are prohibited from using smoking tobacco, in any form, either on-duty or off-duty.  And chewing tobacco on-duty or on city property 

     An employee who violates this policy shall be subject to termination.

     I have read and understand the preceding ‘Tobacco Use Policy’ of the El Dorado Fire Department and agree to its terms.

126. Signature of Applicant
127. Date
131. For Office Use Only

133. Date Received:                                                                                By:                                                          

      

     Date of Background Check:                                                                                         Completed By:                                                         

     Interview Scheduled For:                                                                                                                                                       Interview Conducted On:                                                                                                                                                                                                    Board Recommendation                                                                                                                                                                       

     Strength & Agility Taken:___________________________________________________________________________________

     Applicant  not  accepted.                              

     Reason:                                                                                                                                                                                                                                                                                                                                                                                                

      

     
     

      

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135. 1. Receive an email copy of this form.
136. Email address

     This field is not part of the form submission.

137. Submit

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