| Name:
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| Sex:
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| Race:
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| Date of Birth:
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| Phone:
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Address:
Street Address, City, Zip
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| Social Security :
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| Email Address:
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| Marital Status:
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Spouse Name:
(If applicable)
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Children's Name:
(If applicable)
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| Do you have a valid NC drivers’ license?:
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| NCDL#:
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| License Class:
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| High School Diploma?:
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| GED?:
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| Attending School:
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| Employer:
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| Full Time or Part Time:
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| Employer Address:
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| Work Hours:
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| Supervisor’s Name:
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| Insurance Carrier:
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| Policy Number:
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| Personal Physician:
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| Hospital Preference:
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| Date of last physical:
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| Have you ever been convicted of any crimes, including driving citations?:
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| If yes, please list each conviction and citation including dates:
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| Do you agree to let the West Iredell Fire Department perform a Criminal Background check and obtain a Drivers’ History Report at any time during your membership with the West Iredell Fire Department?:
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| Do you agree to submit to a drug test at any time during your membership?:
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| Do you agree to complete a minimum of 36 training hours per year:
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| Do you agree to abide by the SOG’s of West Iredell Fire Department?:
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| Have you ever been a member of a fire department or rescue squad?:
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| If yes, what is the name of that organization?:
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| Reason you are no longer a member of that organization?:
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| Where you recommended for membership by a current member or employee of West Iredell Fire Department?:
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| If yes please state whom:
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| Please list three personal references (Non-related) |
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Reference #1:
Name, Phone Number, Relationship
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Reference #2:
Name, Phone Number, Relationship
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Reference #3:
Name, Phone Number, Relationship
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| Acknowledgment |
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| Digital Signture:
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By typing my digital signature to this application, I have stated that all information provided on this application is true and current. I understand that falsifying information on this application may be grounds for termination of this application and employment.
All applicants will be reviewed by the Chief and command staff. An interview will be offered depending on whether or not there are any current openings within the department. If we decide to turn your application down you will be contacted by letter explaining the reason for decline. Thank you for your interest in joining West Iredell Volunteer Fire Department.
Upon completion of this application you will be directed to an application agreement, please print this out and return it to the West Iredell Fire Department.
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