Membership Application

Interested in Joining the Township Fire Department?

Please complete the short form below:

Company

This field is for validation purposes and should be left unchanged.

Position Applied For

Check all that apply.

Application for Position Of(Required)

Check all that apply.

Emergicare

Probationary Firefighter (18 years of age or older)

Student Firefighter (16 to 18 years of age)

Personal Information

Full Name(Required)

First Middle Last

Present Address(Required)

Street Address Address Line 2 City State ZIP Code

Email Address(Required)

Home Phone

Cell Phone

Do you have a valid driver's license?(Required)

Yes

If yes, driver's license number and state

How did you find out about Township Fire Department (TFD)?

Have you filed an application with TFD in the past?(Required)

Yes

If yes, list dates of previous applications

Have you been a member of TFD in the past?(Required)

Yes

If yes, list dates of previous membership

Are you legally eligible for employment in this country?(Required)

Proof of U.S. citizenship or immigration status may be required.

Yes

Have you been convicted of a crime within the past seven years?(Required)

Yes

If yes, please explain conviction

Education and Training

Name and location of high school attended

If you did not complete high school, do you have a GED equivalency?

Yes

N/A - Completed high school

Training Beyond High School

College, University, or other schools attended. List up to two institutions.

School 1 - Name and Location

School 1 - Dates Attended (From)

School 1 - Dates Attended (To)

School 1 - Credits Earned

School 1 - Major Field

School 1 - GPA

School 1 - Degree Earned

School 2 - Name and Location

School 2 - Dates Attended (From)

School 2 - Dates Attended (To)

School 2 - Credits Earned

School 2 - Major Field

School 2 - GPA

School 2 - Degree Earned

Additional Education or Training

Describe any education or training not covered above, including correspondence courses, service schools, in-service training, volunteer work, and relevant licenses or certificates.

Organizations, Honors and Awards

List any organizations to which you belong or have belonged, and any honors or awards you have received that are relevant to the position(s) for which you are applying.

Work Experience

Provide a complete description of your past work experience. Start with your most recent job. Include service in the Armed Forces. Indicate any changes in job title under the same employer as a separate position.

Employer 1 - Name

Employer 1 - Kind of Business

Employer 1 - Location (City and State)

Employer 1 - Your Title

Employer 1 - Reason for Leaving

Employer 1 - Dates Employed (From)

Employer 1 - Dates Employed (To)

Employer 1 - Job Duties

Employer 2 - Name

Employer 2 - Kind of Business

Employer 2 - Location (City and State)

Employer 2 - Your Title

Employer 2 - Reason for Leaving

Employer 2 - Dates Employed (From)

Employer 2 - Dates Employed (To)

Employer 2 - Job Duties

Employer 3 - Name

Employer 3 - Kind of Business

Employer 3 - Location (City and State)

Employer 3 - Your Title

Employer 3 - Reason for Leaving

Employer 3 - Dates Employed (From)

Employer 3 - Dates Employed (To)

Employer 3 - Job Duties

May we communicate with your present/past employer?(Required)

Yes

Do you have any limitations that would not allow you to perform in the position(s) for which you are applying?(Required)

Yes

If yes, please explain limitations

References

Please do not include employers or relatives.

Reference 1 - Name

Reference 1 - Address

Reference 1 - Phone

Reference 2 - Name

Reference 2 - Address

Reference 2 - Phone

Reference 3 - Name

Reference 3 - Address

Reference 3 - Phone

Electronic Signature — Type your full name to sign this application(Required)

By typing your name above, you are electronically signing this application and agreeing to all terms stated above.

Date of Application(Required)

Student Firefighter - Parent or Guardian

Complete this section only if applying for the Student Firefighter position. A parent or legal guardian signature is required, indicating they have read and understood the articles of this application and the role of the Student Firefighter as outlined in TFD's job description, and give their permission for the applicant to become a member of TFD.

Parent/Guardian Name (Student Firefighter applicants only)

Burning Permits

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