Firefighter Application

Name
First Middle Last
Date of Application
MM slash DD slash YYYY
Address
Note: If you use a PO Box, please also list physical address to show Tooele City residency.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Home or Primary Telephone Number
Cell Phone
Work or Day-time Number
STATEMENT OF INTEREST
Please explain why you want to become a member of the Tooele City Volunteer Fire Department
AVAILABILITY
Will your employer allow you to attend fires while on the job?
- Yes
- No
- Not Sure
(If yes, a letter of authorization from your employer will be required for all potential candidates.)
Present Employer & Address
Present Position/Title
Work Hours
Supervisor
Supervisor’s Phone Number
Are You Available to Respond to Day Time Fires?
- Yes
- No
- Some
Daytime fires Explanation
(Explain any limitations)
Are You Available to Respond to Evening or Night Time Fires?
- Yes
- No
- Some
Nighttime fires Explanation
(Explain any limitations)
BACKGROUND
Criminal Information (Criminal convictions will not necessarily disqualify an individual from consideration. Please be aware that each selected applicant must successfully pass a comprehensive public safety background investigation which will include completing a comprehensive background questionnaire.)
In the last 10 years, have you been convicted of any crime, other than minor traffic offenses? Note: Alcohol related offenses are not considered minor traffic offenses and must be disclosed. If yes, give dates, charges, and penalty for each offense. Attach a separate sheet if necessary.
- Yes
- No
Additional Information
Driver’s License (Driving record will not necessarily disqualify an individual from consideration; however, Tooele City standards for driver insurability may limit your ability to drive.)
Do you have a valid Utah Driver’s License?
- Yes
- No
Additional Information
Have you ever had your driver’s license revoked or suspended? If yes, please explain why.
- Yes
- No
Additional Information
Have you had any traffic-related violations or at-fault accidents within the past 5 years? If yes, please explain.
- Yes
- No
Additional Information
Future Reporting
If in the future you are arrested for, involved in proceedings related to, or convicted of any criminal offense will you report it immediately (generally within 24 hours of offense) to the officers of this department?
- Yes
- No
Additional Information
QUALIFICATIONS
Do you have any military service? If yes, list branch, date of entry, years of service, and type of discharge.
- Yes
- No
Additional Information
Do you have any prior experience as a firefighter, either paid or volunteer? If yes, list department, dates, and reason for leaving.
- Yes
- No
Additional Information
Education/Certifications
Do you have a high school diploma or equivalent?
- Yes
- No
List any trade school, college education, certifications or specialized training. Attach a separate sheet if necessary.
Additional Information
List any other interests, qualifications, training, experience, skills, or attributes you feel may contribute to your success as a fire fighter.
List any other volunteer or civic organizations you belong to that would relate to your ability to perform the duties of a volunteer firefighter.
To help us determine your commitment to volunteer services, please provide an estimate of the number of hours you have donated to any civic, charitable, or non-profit cause during the past two years.
CERTIFICATION OF APPLICANT & AUTHORIZATION TO VERIFY INFORMATION
- I certify that the information contained in this application and in any other documents supplied by me in connection with this application is correct and complete to the best of my knowledge and belief. I have not withheld anything that would, if disclosed, affect the application unfavorably. I understand that misrepresentation, falsification, or omission of information may be sufficient cause for the rejection of this application and/or dismissal from the volunteer position.
- I give Tooele City Corporation, the Tooele City Fire Department, or any of agents thereof, the right to verify any and all information on this application for accuracy. I grant permission to Tooele City Corporation to conduct a background investigation as deemed necessary for the volunteer services I will be performing. I further release all references, previous employers, and schools from damages resulting from furnishing such information.
- I understand and agree that Tooele City Corporation and the Tooele City Fire Department reserves the right to modify by-laws, guidelines, policies, procedures, or any other operational guidelines as necessary and at their sole discretion. There is no contract between us.
Applicant’s Signature
Date Signed
MM slash DD slash YYYY
REFERENCES
In order for your application to be considered, provide two references that are First Class Firefighters from this or any other fire department.
Name
Fire Department
Phone Number(s)
Name
Fire Department
Phone Number(s)
DEPARTMENT SPONSOR
In order for your application to be considered, you must have one current Tooele City Volunteer Firefighter review your application and sign as a sponsor. Our sponsors do more than just sign your application. If selected, your sponsor will help ensure your success as you train for a demanding yet rewarding volunteer commitment! A current volunteer roster is available on the website. If you are new to our community or don’t know a qualifying volunteer, we still want to hear from you. Please contact our department to find out how you can get involved.
Name of Tooele City Fire Department Sponsor
Signature
Date
MM slash DD slash YYYY
FOR DEPARTMENT USE ONLY – Considered On:
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Phone
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STATEMENT OF INTEREST

AVAILABILITY

BACKGROUND

QUALIFICATIONS

CERTIFICATION OF APPLICANT & AUTHORIZATION TO VERIFY INFORMATION

REFERENCES

DEPARTMENT SPONSOR