Charlton County Fire Rescue
Volunteer Firefighter Application
APPLICANT
INFORMATION
Full
Name:
Date:
Last First M.I.
Address:
Street Address Apartment/Unit #
City State ZIP Code
Phone: E-mail Address:
Date Available: Social Security No.:
Position Applied for:
VOLUNTEER FIREFIGHTER
Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO
Have you ever worked for this company? YES NO If yes, when?
High School: Address:
From: To: Did you graduate?
YES NO Degree:
College: Address:
From: To: Did you graduate?
YES NO Degree:
Other: Address:
From: To: Did you graduate? YES NO Degree:
REFERENCES
Please list three professional references.
Full Name: Relationship:
Company: Phone:
Address:
Full Name: Relationship:
Company: Phone:
Address:
Full Name: Relationship:
Company: Phone:
Address:
EDUCATION
CCFR 20.5 (2/17)
EMPLOYMENT
Company: Phone:
Address: Supervisor:
Job Title: Starting Salary: Ending Salary:
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference? YES NO
Rank at Discharge: From: To:
DISCLAIMER AND 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 may result
in my release.
Signature: Date:
Application Process:
1. Complete application.
2. Acquire the needed Georgia Criminal Background Check pay the $50.00 fee and present receipt with
application.
3. Sign and have witness sign the Physical Agility Waiver.
4. Upon being contacted arrive on time for assessment on date given
a. Written Assessment
b. Physical Agility Assessment
c. Interview Assessment
5. Assessment Results will be presented to the Fire Board of Charlton County for confirmation.
6. You will be advised in writing as to the results and next part of the process.
MILITARY
CCFR 20.6 (2/17)
Charlton County Fire Rescue
By signing this document I, , hereby release the
County of Charlton and the Charlton County Fire Rescue Department from any liability in the
event of injury in participating in the Physical Assessment portion of the Assessment Process
for the Charlton County Fire Rescue Department.
Print Name:
Signature: Date:
Witness:
Print Name:
Signature: Date:
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