Volunteer Firefighter - Membership Application

Applicant Information

Name*

First Name Middle Name Last Name

Gender:*

Male

Female

Date of Birth:*

Social Security #*

Driver's License Number:

Driver's License State:

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Are you a U.S. citizen?*

Yes

Are you authorized to work in the U.S.?*

Yes

Have you ever worked for this department?*

Yes

When did you work this department and in what position/capacity?*

Yes

Have you ever been criminally convicted in a court of law?*

Yes

Please explain your conviction(s):

Emergency Contact Information

Emergency Contact Full Name:*

Emergency Contact Phone Number:*

Emergency Contact Address

Street Address Address Line 2 City State ZIP Code

Education Information

Do you have a high school diploma or GED?*

High School Diploma

GED

Neither

Name and Location of high school:*

Name and Location where you obtained your GED:*

Have you completed any college or university course work?*

Yes

Please list all college coursework and/or degrees completed:

Name of College/University	Major	Type of Degree	Actions

There are no Schools.

Maximum number of schools reached.

Do you have any specialized training, certificates and/or have attended any trade schools?*

Yes

List any specialized training, certificates and/or trade schools:*

Please include school names and addresses.

Employment History

Begin with your present or most recent employer. List the 3 most recent jobs, paid or volunteer. To add a new position to the list, click "Add Job".

Employment

Position Title	Name of Employer	Start Date (Month and Year)	Actions

There are no JObs.

Maximum number of jobs reached.

Have you ever been terminated, discharged, or resigned in lieu of termination due to misconduct or unsatisfactory service?*

Yes

Please name the employer, explain the circumstances, and date (Mo/Yr).*

References

Please add up to 3 professional references.

References

Name	Actions

There are no References.

Maximum number of references reached.

Military Service

Branch:

Rank:

From Date:

To Date:

Discharge Type:

If other than honorable, please explain:

Why do you want to join the fire department and did you choose White Cross VFD as your choice?

Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview will result in my release.

Full Name*

Signature*

Your Name
Your Name
Your Name

Today's Date*

This institution is an equal opportunity provider and employer. Discrimination is prohibited by Federal Law. To file a complaint of discrimination write USDA, Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC 20250-9410 or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay).

The Annual Meeting for the White Cross Vol. Fire Dept. Will be held September 3rd, 2026 at 7pm. Click here for more info

Volunteer Firefighter – Membership Application

Applicant Information

Emergency Contact Information

Education Information

Employment History

References

Military Service

Signature

White Cross Fire Department

Links

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