APPLICATION FOR MEMBERSHIP
How long have you lived at your present address?
How long did you live at your previous address?
Have you ever been convicted of a felony or misdemeanor?
Do you have a high school diploma or equivalency diploma (GED)?
Did you attend any educational institution post high school?
Are you a veteran of the US Military?
Previous Employment Duties
Do you have any previous fire department or emergency service experience?
EMS Certification Number (If Applicable)
Initial Certification Date
Certification Expiration Date
Do you have, or have you ever had, any of the following conditions: heart conditions, diabetes, high blood pressure, epilepsy or seizures in general, back injury, a job related injury, permanent disability?
Do you agree to have a physical exam performed by a licensed physician at no cost to you?
Are you currently receiving workers compensation due to a workplace injury?
How would you describe your current health?
List four (4) references that are not employers or relatives
List any machinery that you are qualified to operate
Why do you want to join the Elberta Volunteer Fire Department?
Use the Upload File button below to send a picture of your drivers license
Upload supported file (Max 15MB)
Information provided in this application will be used to perform a preliminary background and criminal history check.
Thank you for your interest. Your application has been submitted! You will be contacted within the next few days.