Required fields are marked with asterisks (*)

Prescott Fire Department

Volunteer Firefighter Application

First and Last Name

Telephone Number

Current address

E-mail Address

What days and times are you available to respond to emergency calls?

250/250 remaining

Do you have previous firefighting experience?

Yes

If you answered yes, please provide a location.

Please provide the name of your present employer.

Please provide the name of your previous employer.

Please list other relevant skills/training/qualifications.

250/250 remaining

References (No Family Members)

Name:

Phone Number

Address:

Name

Phone Number

Address:

Do you know any active members of the Prescott Fire Department? If so, please list their names.

250/250 remaining

Please describe why you would like of become a member of the Prescott Fire Department.

250/250 remaining

I hereby certify that the information set forth and attached is true and complete, and I understand that ommissions or false statements will be considered sufficient cause for rejection of my application, or discharge if my application has been accepted.

Please sign.

Clear

Please enter the date

Personal information contained on this form is collected pursuant to the Freedom of Information and Protection of Privacy Act and will be used for the purpose of processing the application. Questions about this collection should be directed to the Town Clerk at (613)925-2812.