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Application for Review
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General Information
I am Interested in Becoming A WVFD:
(Required)
Please Choose...
Firefighter
EMS (EMT/Ambulance Driver)
Administrative
Not Sure
Prefered Station
(Required)
Please Choose...
Fire Station 3 - 3245 Old Washington Road
EMS Station 3 - 1069 St Ignatius Drive
Fire/EMS Station 12 - 7000 Saint Florian Drive
Don't Know/ Place Me Where I'm Most Needed
Applicant Name
(Required)
First
Last
Applicant Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Applicant Phone
(Required)
Applicant Email
(Required)
Are You a Citizen of the United States?
(Required)
Yes
No
If no, are you authorized to work in the U.S.?
(Required)
Yes
No
Have you Ever Been Convicted of a Felony?
(Required)
Yes
No
If Yes, Please Explain Fully
(Required)
Education
Are You Still Attending High School?
(Required)
Yes
No
Name of High School
(Required)
Did You Attend College/Trade School?
(Required)
Yes
No
Name of College/Trade School Attended
(Required)
Date Attended From
(Required)
MM slash DD slash YYYY
Date Attended To
(Required)
MM slash DD slash YYYY
Did You Graduate?
(Required)
Yes
No
Degree Received
(Required)
References
Please list two personal references utilizing the fields below.
Reference #1 Name
(Required)
First
Last
Reference #1 Phone
(Required)
Reference #1 Email
(Required)
Reference #2 Name
(Required)
First
Last
Reference #2 Phone
(Required)
Reference #2 Email
(Required)
Previous Employment
Please document the last 5 years of employment history in the spaces provided below.
Company
(Required)
Phone
(Required)
Job Title
(Required)
Supervisor
(Required)
First
Last
Responsibilities
(Required)
Employment Start Date
(Required)
MM slash DD slash YYYY
Employment End Date
(Required)
MM slash DD slash YYYY
Reason for Leaving
May we Contact Your Previous Supervisor for a Reference?
(Required)
Yes
No
Did The Above Employment Information Cover Your Last 5 Years of Employment?
(Required)
Yes
No
I have less than 5 years of employment history
Company
(Required)
Phone
(Required)
Job Title
(Required)
Supervisor
(Required)
First
Last
Responsibilities
(Required)
Employment Start Date
(Required)
MM slash DD slash YYYY
Employment End Date
(Required)
MM slash DD slash YYYY
Reason for Leaving
May we Contact Your Previous Supervisor for a Reference?
(Required)
Yes
No
Do you have any previous Fire/EMS Experience?
(Required)
Yes
No
Have you Previously Volunteered for This Department?
(Required)
Yes
No
If Yes, When Were You A Volunteer?
(Required)
Fire/EMS Department Name
(Required)
Fire/EMS Department Phone
(Required)
Fire/EMS Department Job Title
(Required)
Fire/EMS Department Supervisor
(Required)
First
Last
Fire/EMS Department Responsibilities
(Required)
Member From
(Required)
MM slash DD slash YYYY
Member To
(Required)
MM slash DD slash YYYY
Reason for Leaving
(Required)
May We Contact Your Previous Fire/EMS Department Supervisor for a Reference
(Required)
Yes
No
Emergency Contact Information
Emergency Contact Name
(Required)
First
Last
Emergency Contact Primary Phone
(Required)
Emergency Contact Secondary Phone
(Required)
Emergency Contact Address
(Required)
Street Address
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Relationship to Emergency Contact
(Required)
Disclaimer & Signature
Application Disclaimer
(Required)
I agree to the application policy.
I certify that my answers are true and complete to the best of my knowledge and that I am over 18 years
of age and that I will attend required amount of drills, business meetings and other duties as assigned by the
department. I will obey my superior officers to the best of my ability. I will be responsible for any departmental
property that I am issued if at any time, I decided to resign or go inactive or change divisions, that I will return all
property to my chief officer.
I will attest to the fact that the answers I have provided are true to the best of my knowledge and hereby
authorize the Waldorf Volunteer Fire Department, Inc. to investigate their accuracy as appropriate. I further
understand that if any part application is found to be misleading or untruthful, that I will be dismissed from the
department without appeal.
Applicant Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Guardian Signature
Guardian Signature is only needed for applicants under 18 years of age
Date
MM slash DD slash YYYY
Δ
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