Volunteer With Us

Personal Information

Name

Address

City

State

Zip Code

Email Address

Contact Phone

Cell Phone

Employment

Name of Employer

Address

Phone

Have you ever been convicted of a felony or misdemeanor?

Yes
No

If Yes, Please Explain. Number of convictions, nature of offense, how recent?

Do you have a valid driver's license?

Yes
No

State

License#

Expiration Date

Have you ever been convicted of driving impaired in the past five years?

Yes
No

If Yes, please explain.

Have you had any moving violations during the past three years?

Yes
No

If Yes, please explain.

Do you have any physical conditions that may limit your ability to perform firefighter duties?

Yes
No

If Yes, please explain.

How did you hear about Rapid Valley Fire Department?

newspaper
radio
website
Rapid Valley member
other

Experience

Do you have any structure firefighting experience?

Yes
No

Certified?

Yes
No

What Agency?

Do you have any wildland firefighting experience?

Yes
No

Certified?

Yes
No

What Agency?

Do you have any medical experience?

Yes
No

EMT?

Yes
No

What Level?

I certify that all statements made herein are true and correct to the best of my knowledge. I authorize investigation of all statements herein recorded

Yes
No

Date

Please leave your additional comments here. Thank you for your application!