Eastside Fire & Rescue

Volunteer Application
 
 

Applicant Information

 

Full Name:

 

 

 

Date:

 

 

                       Last

First

M.I.

 

Address:

 

 

 

                       Street Address

Apartment/Unit #

 

 

 

 

 

 

 

City

State

ZIP Code

 

Phone:

(         )

E-mail Address:

 

 

Date Available:

 

Social Security No.:

 

WA Driver’s License:

 

 

Position Applied for:

  Volunteer EMT       Volunteer Firefighter

 

Are you a citizen of the United States?

YES

NO

If no, are you authorized to work in the U.S.?

YES

NO

 

Have you ever been convicted of a felony?

YES

NO

Has your driver’s license ever been suspended or revoked?

YES

NO

If yes, explain:

 

 

Do you currently live within the EFR service area (Cities of Carnation, Issaquah, North Bend, Sammamish; or King County Fire Districts 10/38)?

YES

NO

If no, are you willing to move into the service area by the beginning of training?

YES

NO

Have you completed any training as an Emergency Medical Technician?

YES

NO

Have you completed any fire training?

YES

NO

If yes, explain:

 

Important: Please attach copies of any training/certifications you have achieved to this application.

 

 

 

Education

 

High School:

 

Address:

 

 

From:

 

To:

 

Did you graduate?

YES

NO

Degree:

 

 

College:

 

Address:

 

 

From:

 

To:

 

Did you graduate?

YES

NO

Degree:

 

 

Other:

 

Address:

 

 

From:

 

To:

 

Did you graduate?

YES

NO

Degree:

 

 

 

 

Personal Reference

 

Please list a personal reference who is not a family member.

 

Full Name:

 

Relationship:

 

 

Company:

 

Phone:

(         )

 

Address:

 

 

 

 

Current/Previous Employment

 

Company:

 

Phone:

(         )

 

Address:

 

Supervisor:

 

 

Job Title:

 

 

From:

 

                          To:

 

Reason for Leaving:

 

 

May we contact your previous supervisor for a reference?

YES

NO

 

 

Company:

 

Phone:

(         )

 

Address:

 

Supervisor:

 

 

Job Title:

 

 

From:

 

                          To:

 

Reason for Leaving:

 

 

May we contact your previous supervisor for a reference?

YES

NO

 

 

 

 

Military Service

 

Branch:

                                                                  

From:

 

To:

 

Rank at Discharge:

 

Type of Discharge:

 

 

If other than honorable, explain:

 

 

 

 

Disclaimer and Signature

 

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature:

 

Date:

 

Department Use Only