Volunteer Membership Application Apply Online

Date (required)

First Name (required)

Last Name (required)

Additional name(s) which you have and/or you have been known as

Date of Birth (required)

Address (required)

City, State, Zip (required)

Phone (required)

Additional Phone

Email (required)

Have you reviewed the requirements for becoming a probationary volunteer member of EFPD? (required)

YES

Do you reside (required)

In District

Out of District

U.S. Citizen (required)

YES

Do you have a valid driver's license (required)

YES

Do you have a reliable method of transportation to the fire station? (required)

YES

APPLICANT'S EMPLOYER

Current Employer (required)

Supervisor (required)

Address (required)

City, State, Zip (required)

Phone (required)

APPLICANT'S EDUCATION

Highest grade/level of education completed (required)

Military Service (Which Branch)

Dates of Service

Type of Discharge

Honorable

Dishonorable

Retired

Have you ever completed any fire and/or EMS training courses? (required)

YES

If yes, please list course(s) completed and date(s) of completion

Do you have CPR certification(s)? (required)

YES

If yes, give expiration date(s)

APPLICANT'S HISTORY

Have you ever been charged or convicted of arson? (required)

YES

Have you ever been convicted of, or pled guilty to a felony? (required)

YES

If yes, state nature of conviction

Date of conviction

Age when convicted

Do you have any pending criminal charges? (required)

YES

Have you previously applied to be a volunteer member of Elbert Fire Protection District? (required)

YES

If yes, please give an approximation date of when?

Have you ever applied to, been a member with and/or been employed with any other fire department(s) or ambulance company?

YES

If yes, please list department(s) and location(s)

LIST 3-CHARACTER REFERENCES WE MAY CONTACT

Full Name (required)

Address (required)

City, State, Zip (required)

Phone (required)

Relationship to you (required)

Full Name (required)

Address (required)

City, State, Zip (required)

Phone (required)

Relationship to you (required)

Full Name (required)

Address (required)

City, State, Zip (required)

Phone (required)

Relationship to you (required)

ESSAY QUESTIONS

What motivated you to apply as a volunteer member with Elbert Fire Protection District? (required)

What experience(s), skill(s), and/or education do you have that can contribute to Elbert Fire Protection District? (required)

What do you hope to gain from becoming a volunteer member at Elbert Fire Protection District? (required)

Copies of the following documents MUST be submitted with this application

• High School diploma or GED • Military Discharge DD-214 (If Applicable) • Birth Certificate • Copy of Driving Record • Driver’s License (Enlarged and Readable) • Current Fire/EMS Related Certifications (If Applicable) (required)

AUTHORIZATION TO RELEASE INFORMATION

As an applicant for a volunteer membership position with the Elbert Fire Protection District, I am required to furnish information concerning my character, work habits, moral, physical, educational and mental qualifications, including any and all criminal history. In this regard, I authorize Elbert Fire Protection District to make any and all appropriate inquiries, verifications and investigation of all statements contained in this application as may be necessary regarding the pre-mentioned qualifications. Moreover, I authorize those people or organizations selected by Elbert Fire Protection District to release any and all information of a confidential or privileged nature. I hereby release you, and your organization, and all concerned from any liability or damage which may result from furnishing the information requested in connection therewith.

I understand that omission, falsification, or misleading information in this application or other documents submitted in support of this application may result in rejection of this application, removal from an eligibility list, or release of duties as a volunteer member from Elbert Fire Protection District whenever it is discovered. I certify that the information I have provided is true and complete to the best of my knowledge.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

AUTHORIZATION TO ACQUIRE BACKGROUND CHECK

I, hereby give permission to Elbert Fire Protection District to acquire a background check.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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