Junior Application - Sykesville Freedom District Fire

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Sykesville Freedom District Fire Department

Junior Application

Sykesville-Freedom District Fire Department
Junior Firefighter Program

Indicates Required Field

PERSONAL

Membership Type:

Name:

E-mail Address:

Address:

How long have you lived at this address?:

Home Phone:

Business Phone:

Sex:

Where are you currently employed?:

If you were in the Armed Forces, when were you discharged? Month/Year:

Are you under 16 years of age?:

Date of Birth:

Have you ever been convicted of a traffic violation, misdemeanor, or a felony?:

If Yes, indicate the date and nature of the charge, police agency, court and disposition.:

EXPERIENCE

Have you ever filed an application with Sykesville Freedom District Fire Department?:

If so, when?:

Have you ever been denied membership to a fire and/or rescue squad?:

If so, please give details.:

Have you ever been discharged for misconduct or unsatisfactory service or asked to resign from a fire and/or rescue department?:

If you have been discharged please give details.:

List any firefighting and/or emergency medical certifications that are current. Please provide copies of certifications:

Upload Certifications:

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EDUCATION

Middle or High School attended:

REFERENCES

Reference #1:

Reference #2:

Reference #3:

EMERGENCY CONTACT

Contact Name:

Contact Relationship:

Contact Address:

Contact Phone Number:

ACKNOWLEDGEMENT

Electronic Signature:

How did you hear about us?:

By signing above, I signify that I have applied for the membership to the Sykesville Freedom District Fire Department; that I have answered all questions truthfully and to the best of my knowledge; and that I fully understand that any intentional false statement may be grounds for dismissal from the department. Furthermore, I hereby grant to Sykesville Freedom District Fire Department permission to contact my employer, references, and any other persons or agencies who may have knowledge of me, my skills and my experience as may be deemed necessary.

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