Fillable CITY OF PASADENA fire department reserve fire inspector

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CITY OF PASADENA fire department reserve fire inspector

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CITY OF PASADENA
fire department
reserve fire inspector APPLICATION
Name:_______________________________________________________________________
Address: ______________________________________________________________________________
City/State/Zip: ________________________________________________________________________
Daytime Phone: ( ) ________________________ Evening Phone: ( ) _________________
Personal Information: I am 18 or older: _____Yes _____ No
Date of Birth (month & date only if over 18. If under 18 provide birth year also):_________________________________
Emergency Contact: (Name and relationship): ___________________________________________________
__________________________________________________ Phone: ( ) ___________________________
Health Care Information if applicable: (provider, number facility):____________________________________
_________________________________________________________________________________________
Do you have a family member employed by the City or participating in the program you are volunteering for?
_____No _____Yes Name(s)________________________________________________________________
Education : (check all that apply): _____High School Graduate _____ Undergraduate Degree ____
___ Graduate Degree
Employer name or current school attending:___________________________________________________
Occupation (and/or previous volunteer experience):______________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Please list information you consider pertinent to your interest in volunteering; including professional
affiliations, community organizations, school honors, skills, strengths, training or/experience.:
_______________________________________________________________________________________
_______________________________________________________________________________________
Are you bilingual: ____________ What language: _____________________________________________
Please complete and email the application to Deputy Fire Marshal, Wendell Eaton at reservefireinspector@cityofpasadena.net
215 N. Marengo Ave. Suite 195
Pasadena CA 91101
References: We reserve the right to check references on all potential volunteers. Please list three people other
than relatives who would be willing to serve as personal references and have known you for at least one year.
Name_____________________________________________Daytime Phone__________________________
Address_____________________________________City________________State________Zip____________
Name_____________________________________________Daytime Phone__________________________
Address_____________________________________City________________State________Zip____________
Name_____________________________________________Daytime Phone__________________________
Address_____________________________________City________________State________Zip____________
General Information: Affirmative responses to the following questions will not automatically exclude you from
volunteering.
Have you ever been discharged or resigned under the threat of being terminated? _____Yes______No
If yes, please explain________________________________________________________________________
Have you ever been convicted of an offense in an adult court? _____Yes _____No
If yes, please explain________________________________________________________________________
If volunteer is under 18 years of age, a parent or guardian must consent to an applicant working as a volunteer.
I hereby consent to my child’s participation in the City of Pasadena volunteer program.
____________________________________________________________
Name of Parent/Guardian (Please Print)
____________________________________________________________ _____________________
Signature of Parent/Guardian Date
STATEMENT OF AUTHENTICITY
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize
investigation of all statements contained and information requested in this volunteer application as may be
necessary to arrive at a decision. I hereby release and agree to hold harmless from liability the City of
Pasadena, employees and volunteers thereof, or any person or organization that may provide such information.
____________________________________________________________ _____________________
Applicant Signature Date
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CITY OF PASADENA fire department reserve fire inspector

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Completed 13 January 2021

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