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St Paul Blvd Volunteer Firefighter Application

Date of application:    __\___\___              

Full Name: __________________________________________________________

Present Address: _____________________________________________________

Length of residence:     _______ Years   ______ Months

Home Phone Number: ______________ Cell Phone Number: ________________

E-MAIL Address: ____________________________________________________

Social Security Number:         ________ - _______ - _________

Date of Birth:        _____/_____/_____               Age:    ________

Marital Status:  Single \ Married      Spouse's Name: _______________________ 

Are you a citizen of the U.S.?  YES / NO

Present Occupation: __________________________________________________

Name of Employer: ___________________________________________________

Please list some personal references (non-relatives) with addresses, and phone numbers that we can contact:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Are you now or have you ever been a member of any other Fire or EMS Association? If yes, please list dates and location: ____________________________________________________________________

____________________________________________________________________

Do you have any previous fire or EMS service training?  YES / NO

____________________________________________________________________

____________________________________________________________________

Driver’s License Identification # _________________________ State: _________

Do you have a vehicle available for your use?  YES / NO

Do you have any physical inabilities?  YES / NO 

If yes, please describe: ________________________________________________

Are you able to attend Thursday Evening drills and First Monday of the Month meetings?   YES / NO

Do you have any police or military convictions?  YES / NO

If yes, please list: _____________________________________________________

I, ___________________________, hereby authorize the St. Paul Boulevard Fire Association to perform a records check with a police agency to receive information as part of my application for membership in the St. Paul Boulevard Fire Association.     

Within thirty days of the receipt of your application, an informal interview will be held. You will be notified by phone as to the date and time. Acceptance of this application is subject to approval by the membership of this Association.

Appointment to active status for Fire Service requires successful completion of a physical and acceptance by the Fire District Commissioners.

Signed ________________________________________________ Date:  __\__\__



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