Employment/Membership Application

    Applicant Information

    First Name
    Last
    M.I.
    Street Address
    Apartment/Unit #
    City
    State
    ZIP
    Phone
    E-Mail Address
    Cell Phone
    Social Security No.
    Date of Birth
    Marital Status
    Spouse's Name
    TDL
    Type
    Exp
    Date Available to Start
    Have you ever been refused admittance to or been discharged from any Fire or EMS Service?
    If yes, explain
    Have you ever been arrested?
    If yes, explain
    Emergency Contact
    Phone
    Relationship

    Education

    High School
    City,State
    Did you Graduate?
    Bilingual
    Languages
    College
    City,State
    Certification
    Cert #
    EXP
    Certification
    Cert #
    EXP
    Upload File Here (please upload only .jpg or .pdf)

    References

    Full Name
    Relationship
    Company
    Phone
    Address
    Full Name
    Relationship
    Company
    Phone
    Address
    Full Name
    Relationship
    Company
    Phone
    Address

    Previous Employment

    Department
    Phone
    Address
    Years with Department
    Responsibilities
    Employment From
    Employment To
    Reason for Leaving
    May we contact your previous supervisor for a reference?
     
    Department
    Phone
    Address
    Years with Department
    Responsibilities
    Employment From
    Employment To
    Reason for Leaving
    May we contact your previous supervisor for a reference?
     
    Department
    Phone
    Address
    Years with Department
    Responsibilities
    Employment From
    Employment To
    Reason for Leaving
    May we contact your previous supervisor for a reference?
     

    Military Service

    Branch
    Service From
    Service To
    Rank at Discharge
    Type of Discharge
    If other than honorable, explain

    Disclaimer and Signature

    I, the undersigned, certify the foregoing information to the true and correct to the best of my knowledge and belief and agree that any false statements are ground for my immediate dismissal. I further agree to bide by the By-Laws of the Westlake Volunteer Fire Department and follow all rules, regulations, policies, and procedures. It is also understood that all information in this application will be investigated.
    Signature
    Date