Independence Fire District--Citizen Fire Academy Application
First Name *
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Last Name *
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Address Numerics *
Enter only the numbers of your address, ex. 1980
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Address Street *
Enter only the street of your address, ex. DELAWARE CROSSING
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Address City *
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Address State *
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Address ZIP *
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Home Phone *
Please enter your phone number in this format ###-###-####
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Cell Phone *
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Email Address *
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Date of Birth *
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Driver License *
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Occupation *
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Reason for wanting to attend the Citizen Academy *
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Who do you know that is involved in firefighting/EMS? *
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Have you ever been arrested/convicted of a misdemeanor or a felony? If so, when, where, and the charge. *
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How did you hear about the Citizen Fire Academy? *
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Do you authorize the Independence Fire District to run a criminal history check? *
Shirt Size *
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