Online Application

Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Position Being Applied For:

If applying for Live-In Member, additional information will be required upon approval.

Are you a citizen of the United States

Yes

Have you ever worked for a fire department?

Yes

If so, when?

Have you ever been convicted of a felony?

If yes, explain?

Education

High School

Start-End

Did you graduate?

College

Start-End

References

Please list 3 professional references.

Reference 1

First Name

Last Name

Relationship

Phone

(###)

###

####

Company

Reference 2

First Name

Last Name

Relationship

Phone

(###)

###

####

Company

Reference 3

First Name

Last Name

Phone

(###)

###

####

Relationship

Company

Previous Employment

Company

Address

Phone

(###)

###

####

Supervisor

Job Title

Responsibilities

Reason for leaving?

Employment Dates

May we contact you previous supervisor for a reference?

Yes

Company

Address

Employer's Phone

(###)

###

####

Supervisor

Job Title

Responsibilities

Reason for leaving?

Employment Dates

From - To

May we contact your previous supervisor for a reference?

Yes

Military Service

Branch

MOS

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. I agree to attend training sessions sponsored by the department. I understand that this application will have to be approved by the Officers and Members of Crystal Fire Department. I will undergo an interview with the Chief or member(s) appointed by him. I understand that drug screening may be required at any time during my membership. I understand that a background check shall be conducted and authorize Crystal Fire to conduct such at their discretion.

Electronic Signature

Today's Date

YYYY