Helena Vol.                     Fire Dept.          
                     Do you have what it takes?
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Name                                    *
First and last name                                                                            Date of Application:
What is your current age and DOB? *
Address *
Email *
Phone number *
What is your current occupation? Are you full-time or part-time? *
Which position(s) are you interested in? *
Required
Do you have a current NYS Driver's License *
What is your Driver's License number? *
Do you have any qualifications or training that may apply to being a firefighter?  *
Do you have any physical disabilities that may prevent you from doing the tasks required of a firefighter? *
A background check is required for membership. Do you have an issue with submitting to a background check? *
Social Security Number *
Please list 3 references (with contact info) *
Do you have any previous DWI/DWAI charges? *
Do you have any past felony convictions? *
If you answered yes to the previous question, please explain below. *
Please provide the name, phone number, and your relationship of an emergency contact. *
Signature:  *
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