Rising Star Volunteer Fire Department
P.O. Box 547
Rising Star TX 76471
Membership Application
Date__________________________
Full Name____________________________________________________________
Address______________________________________________________________
City__________________ Zip Code ______________________
Are you at least 19 years old? ________________ SS# ____________________
Employer ____________________________________________________________
Do you have a valid Driver’s License? _____________
DL# __________________ Class ______________ Expires______________
Discuss your reason and interest for joining the Rising Star Volunteer Fire Department
______________________________________________________________________
______________________________________________________________________
List any medical conditions that would prevent you from filling the physically demanding position you are applying for
_______________________________________________________________________
Will you be able to attend training sessions? ____________________________________
What time of day will you best be able to respond to emergency calls? ________________
Do you have any felony convictions or DWI violations? _____________________________
Has your driver’s license been suspended or revoked in the last 7 years? _______________
Do we have your permission to run a background check?________________
Are you willing to take a drug test?_________________
Emergency Contact: ___________________________________________
Relationship __________________ Phone ________________________
References:
Name __________________________________ Phone ___________________
Name___________________________________ Phone____________________
Name___________________________________Phone_____________________
All information provided with this application is true and correct to the best of my knowledge. I understand that any false information or omission of fact shall be just cause for denial of membership and/or dismissal of membership in the Rising Star Volunteer Fire Department. I also understand that firefighting is a dangerous profession and could result in severe bodily injury including death. I also understand that I will be exposed to loud noises, long working hours, high stress and unpredictable work environments. I also understand that I will be expected to do my part and make as many calls as possible. The equipment I will be provided is on loan and under my care at all times. If membership is terminated and I do not return the equipment, the Department will take all actions necessary to recover it. I also understand that if the equipment is destroyed due to my negligence I will be expected to pay for the equipment at replacement cost.
Signed_________________________________ Date_______________________
Print___________________________________
The information provided in this application will be for Department use only.
Received by_______________________________ Date _______________________