Crescent Twp VFD Application

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This is an application to become a firefighter in the Crescent Township Volunteer Fire Department, There is also a $20.00 Application Fee.

Name *

First and last name

Address *

Email *

Mobile Phone Number *

Home Phone Number

Date of Birth *

YYYY

Social Security Number

Driver's License Number *

Marital Status *

Married

Single

Divorced

Other:

Required

Sex *

Male

Female

Race *

Asian

Black

American Indian

White

Unknown

In Case of Emergency Notify (provide Name, Phone and relationship)

Which position(s) are you interested in? *

Firefighter

Support Member

Junior Firefighter (under 18 years or age)

Required

Do you have any illnesses that may interfere with performance of duties? *

Yes

Required

Have you ever been convicted on a crime? *

Yes

Required

Are you Bondable?

Yes

Not Sure

Do you have firefighter experience? *

Essentials Only

Firefighter I

Firefighter II

None

Other:

If you have previous experience, where is it from?

Current Employer (name, address, duties)

Electronic Signature *

By E-signing this application you acknowledge that the information contained here is true and accurate to the best of your ability.

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