Volunteer Firefighter Application
EASTSIDE FIRE AND RESCUE
175 Newport Way N.W.
Issaquah, WA 98027 425 313-3247
Once completed, mail your application with drivers abstract and two copies
of social security card and drivers license to:
JFallstrom@ESF-R.ORG
Name _________________________________________________________________________
Last, First, Middle initial
Resident Address _______________________________________________________________
______________________________________________________________________________
City, State, Zip
Mailing address ________________________________________________________________
if different_____________________________________________________________________
City, State, Zip
Email address_____________________________________
Phone (Day) ___________________________ ( Evening) ____________________________
WA Driver's License # _________________________________ SSN #___________________
I acknowledge that the above information to be true and authorize Eastside Fire
and Rescue to obtain information on my Washington State Driving Record for the
purpose of review.
Signature of Applicant __________________________________ Date ________________
Why would you like to be a reserve firefighter __ or EMS responder __ check one
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
List any firefighting/EMT or First Responder experience. (attach copies of any
certifications)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
DEPARTMENT USE ONLY
Letter sent: INT D/L Check OK NA ____________
Sta:____ Test: Written _____ Phy _____ Oral _____ FF/EMS__ EMS only:__