Membership Application
Please indicate the position you are applying for: *
Select an option: Firefighter (Active) Reserve Firefighter
First Name *
Last Name *
Full Middle Name *
Home address (No PO Box) *
City *
State *
Select an option: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Email Address
Phone Number *
Are you legally authorized to work in the U.S?
Yes No
Are you at least 18 years of age with a high school diploma or equivalent? *
Select an option: Yes No
Have you previously served with the Tawakoni Fire Department? *
Select an option: Yes No
If you have previously served with the Tawakoni Fire Department, explain the circumstances of your separation (include dates and name of fire chief if possible).
Have you ever served on any other volunteer/paid fire department or EMS company? *
Select an option: Yes No
If you have ever served on any other volunteer/paid department or EMS company, please list each previous membership here including department name, city, state, and start/end dates for each.
Have you ever held a firefighter or EMS certification in any state? *
Select an option: Yes No
If you answered 'YES' above, list any previous or current firefighter or EMS certifications here including certification name, certification number, state, and expiration year.
Have you ever held any public safety certifications which do not pertain to firefighting or EMS? *
Select an option: Yes No
If you answered 'YES' above, list any other public safety certifications.
Please list your general availability (check all that apply). Please be as accurate as possible accounting for work, personal, and family obligations.
Monday morning
Monday afternoon
Monday evening
Tuesday morning
Tuesday afternoon
Tuesday evening
Wednesday morning
Wednesday afternoon
Wednesday evening
Thursday morning
Thursday afternoon
Thursday evening
Friday morning
Friday afternoon
Friday evening
Saturday morning
Saturday afternoon
Saturday evening
Sunday morning
Sunday afternoon
Sunday evening
Monday-Friday any time
Monday-Friday overnight
Friday-Sunday any time
Friday-Sunday overnight
Use the space below for additional comments pertaining to availability.
Are you available for training/meetings on Sundays between 5:00PM and 10:00PM at least two times per month?
Yes No
Membership Application Acknowledgement of Truth and Acceptable Use.
I acknowledge the receipt and understanding of the Tawakoni Fire Department Membership Application Acknowledgement of Truth and Acceptable Use *
Background Packet
Due to the sensitive and personal nature of the services we render, the Tawakoni Fire Department feels it is our responsibility to ensure that the men and women serving our residents are of outstanding morale aptitude, both personally and professionally. As such, please complete this entire section truthfully and accurately as additional information will be obtained by the Tawakoni Fire Department and/or its designees. Any inaccuracies, rather intentional or accidental, will likely lead to the immediate dismissal of your application to this department.
Date of Birth
City, State of Birth
Drivers License Number *
State *
Select an option: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Maiden Name or Any Other Aliases
List all places of residence, starting with the most current, for the past five (5) years below. Make sure to include the full address (including city/state), length of stay, and reason for leaving. *
List all motor vehicle accidents and/or moving violation tickets received in the past ten (10) years. Make sure to include the city/state, month/year, and description of event.
List all criminal charges, despite outcomes, including charges which were later reduced or dismissed by a court or district attorney. Include arrest date and arresting agency/name.
References
Below you will list three (3) personal references, excluding family members. You may only list individuals for which you have a phone number or email address.
Reference 1 Name *
Reference 1 Relationship *
Reference 1 Email and/or Phone Number *
Reference 2 Name *
Reference 2 Relationship *
Reference 2 Email and/or Phone *
Reference 3 Name *
Reference 3 Relationship *
Reference 3 Email and/or Phone *
Background Packet Acknowledgement of Truth and Acceptable Use
I acknowledge receipt and understanding of the Tawakoni Fire Department Background Packet Acknowledgement of Truth and Acceptable Use Notification *