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 NO Do you reside (required) In District Out of District U.S. Citizen (required) YES NO Do you have a valid driver's license (required) YES NO Do you have a reliable method of transportation to the fire station? (required) YES NO APPLICANT'S EMPLOYER Current Employer (required) Supervisor (required) Address (required) City, State, Zip (required) Phone (required) Email 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 NO If yes, please list course(s) completed and date(s) of completion Do you have CPR certification(s)? (required) YES NO If yes, give expiration date(s) APPLICANT'S HISTORY Have you ever been charged or convicted of arson? (required) YES NO Have you ever been convicted of, or pled guilty to a felony? (required) YES NO If yes, state nature of conviction Date of conviction Age when convicted Do you have any pending criminal charges? (required) YES NO Have you previously applied to be a volunteer member of Elbert Fire Protection District? (required) YES NO 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 NO 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) Email Relationship to you (required) Full Name (required) Address (required) City, State, Zip (required) Phone (required) Email Relationship to you (required) Full Name (required) Address (required) City, State, Zip (required) Phone (required) Email 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 There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
