SUNSET HARBOR ZION HILL VOL. FIRE DEPT.
APPLICATION
Please Print
Name in Full: __________________________________________________________________
FIRST MIDDLE LAST
Mailing Address: _______________________________________________________________
Street or Box City State Zip
How Long: _____ Yr. Telephone number:______________ Age:___ Birth Date:__________
Previous Address: _______________________________________________________________
Street or Box City State Zip
How Long:______ Yr._____ Social Security #_________________ Sex: M [ ] F[ ]
Email Address__________________________________________________________________
Driver’s License Number, Class and State __________________________________________
Marital Status: Single [ ] Married [ ] Divorced [ ] Separated [ ]
Emergency Contact:_____________________________________________________________
FIRST MIDDLE LAST
Present Address:________________________________________________________________
Street or Box City State Zip
Relationship with emergency contact:_______________________________________________
Emergency Contact Phone:_______________________________________________________
Emergency Contact Address:_____________________________________________________
Emergency Contact Email:_______________________________________________________
Any Previous Fire Fighting Experience: Yes [ ] No [ ] How Long __________ Yrs.
If Yes:_____________________________________ _______________________
Fire Department Name Rank
Present Address of Last Department: ______________________________________________
Address City State
Reference Last Department: ________________________ ________________________
Name of Reference Telephone
Two Non-Relative 1._______________________________________________________
Personal References: Name Telephone
2.______________________________________________________
Name Telephone
Military Experience: Yes [ ] No [ ] Type of Discharge: _________________________
Do You Have a Criminal Record: Yes [ ] No [ ] Charge: __________________________
SUNSET HARBOR ZION HILL VOL. FIRE DEPT.
APPLICATION
Can You Answer Day Time Calls: Yes [ ] No [ ] Sometimes [ ]
Present Employer: ______________________________________________________________
Length of Employment: ______ Yr. or Month Telephone # ______________________
Physical Condition: Good [ ] Fair [ ] Poor [ ]
Comments: ____________________________________________________________________
Applying For: ( ) Volunteer ( ) Part Time Employment ( ) Full Time Employment
Briefly explain why you want to be considered for
membership::____________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
YOUR SIGNATURE GIVES THE SUNSET HARBOR AND ZION HILL
VOLUNTEER FIRE DEPARTMENT PERMISSION TO CHECK REFERENCES
Applicant’s Signature: ____________________________ Date: _______________________
APPLICANT DO NOT WRITE BELOW THIS LINE, FIRE DEPT. USE ONLY
Interviews: Date Favorable
1.________________________________/_______________ Yes [ ] No [ ]
2.________________________________/_______________ Yes [ ] No [ ]
3. ________________________________/_______________ Yes [ ] No [ ]
Comments: ___________________________________________________________________
Applicant Provides At His / Her Expense: 1- Copy of most recent physical examination
Department Provides At Our Expense: 1- Drug Screen 2- Basic physical exam if no
physical taken in past year
