Volunteer Application – Colusa Firefighters Association

Position Applied for:

Volunteer Firefighting Volunteer Non-Firefighting

Name

Address

Phone

How long have you lived in Colusa?

Health

Excellent Good Fair Poor

Marital Status

Single Married Separated Divorced

BRANCH OF MILITARY (If Applicable)

Dates of Service:

Type of Discharge

Honorable General Dishonorable

Are you a member of the National Guard or Reserve?

Yes No

Name and Address of High School

Date Graduated:

Technical School Attended and Dates

College or Universities Attended

Present Employer

Address

Occupation

Immediate Supervisor and Contact Info

May we contact this Employer?

Yes No

Previous Employer

Address

Occupation

Immediate Supervisor and Contact Info

May we contact this Employer?

Yes No

1) Name

Phone Number

2) Name

Phone Number

3) Name

Phone Number

Have you ever been a member of a Fire Department, Rescue Squad, or any other similar organization?

Yes No

Name and Address of Organization

Dates of Service

Position Held

Reason for Leaving

List all related training you have completed

In a brief paragraph, state why you wish to join the Colusa Fire Department. What the Department can gain from your membership. What do you expect to gain from your membership.

Have you ever been dismissed from any position?

Yes No

If yes, Explain

Have you ever been forced to resign from any position?

Yes No

If yes, Explain

Have you ever been arrested, summoned into court as a defendant or indicted, convicted, fined, imprisoned, or placed on probation, or has any case been filed against you?

Yes No

If yes, Explain

In the event of my Membership by the Colusa Fire Department, I agree to abide by all present and subsequently issued rules of the Fire Department. authorize all schools which attended and all previous employers to furnish to the Colusa Fire Department my record, reason for leaving, and all information they may have concerning me. I hereby release them and the Colusa Fire Department from all liability for any damage whatsoever arising therefrom. I also authorize investigation of all statements in this application. I understand that, in the event of my membership by the Fire Department, any misrepresentation or failure to give material information shall constitute misconduct and just cause for my dismissal as a volunteer member of the Colusa Fire Department.

Date

By typing your full name, you agree to the terms above