City of Newport News Fire Department
Citizen Fire Academy Application
Complete and Return to:
Newport News Fire Department
3303 Jefferson Avenue
Newport News, VA 23607
(757) 975-5030
fdcfa@nnva.gov
Purpose:
The Citizen Fire Academy (CFA) provides an opportunity for citizens to learn firsthand about fire
department operations. Through a series of lectures, field trips, and simulated activities, citizens are provided
training similar to that of an actual firefighter/medic. The Academy is of benefit to the community and the
department because it builds relationships and creates a cadre of citizens who are better informed about the
reality of the Fire Department.
Format:
The academy runs for 14 weeks with most classes held between 6 p.m. – 9 p.m. on Monday nights.
Location:
Unless otherwise specified, classes are conducted at the Newport News Fire Department Training Center
(17300 Warwick Blvd, Newport News, VA 23603). Some off-site visits are made to other relevant locations.
Instruction:
Instruction is provided by Fire Department personnel. This program is not an accredited certification course
to become a certified firefighter or emergency medical technician.
Sample Curriculum:
Overview of Fire Department Operations and Organization
Introduction to Fire Suppression and Emergency Medical Services
CPR-First Aid Training
Fire Extinguisher Training
Fire Station and Fire Apparatus Tours
Introductions Emergency Operations Center and Fire Prevention
Qualifications for Participation:
Must be a minimum of 18 years of age.
Must be either a Newport News resident, business owner, employed in the City or connected to the
City in some way.
Must pass a criminal history background check (document attached).
PLEASE READ CAREFULLY BEFORE PROCEEDING:
Due to the sensitivity and classified nature of the material that will be shared with you during
the CFA, it is essential each fire academy applicant complete this application thoroughly
and truthfully. It is imperative to the security of our agency that each accepted applicant is of
good moral and legal standing. This form must be typewritten or printed in ink. All questions
must be answered, if applicable. If not, indicate N/A (not applicable). Applications which are
not complete or legible will not be considered. The information you provide in this
application will remain confidential.
QUALIFICATIONS FOR PARTICIPATION:
Are you at least 18 years of age or older? _____Yes _____No
Are you at least one or more of the following (check all that apply):
a. N
ewport News resident ______Yes ________No If yes, how long? ________
b. B
usiness owner in Newport News ______Yes ______No
c. E
mployed in Newport News ______Yes ______No
1.
If employed in Newport News, please list the name of your employer and
position held: _________________________________________________
_____________________________________________________________
_____________________________________________________________
d. I
f connected to the City in some way, please explain: _________________________
PERSONAL:
Name: __
____________________________________________________________________
(First) (Middle) (Last)
Curr
ent Address: ____________________________________ _________________________
City: _________________________State: ___________________ Zip Code: _____________
Home Phone #: (_______) ____________ Cell Phone #: (_______) ______________
E-mail Address: _______________________________________________________
_______
Please explain briefly why you wish to become enrolled in the Newport News Fire Department
Citizen Fire Academy.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Are any of your family or friends wanting to also attend this Academy with you? If so, please list
their name(s): ________________________________________________________________
____________________________________________________________________________
A
CKNOWLEDGMENT:
I
certify that the foregoing answers and all supplemental documents are true and correct to
the best of my knowledge and that I have not knowingly withheld or misrepresented any
material fact herein. Any false information may result in the immediate rejection of this
application or shall be grounds for immediate dismissal from the program.
_
_______________________________________________ ____/_______/_____
Signature of Applicant Date
click to sign
signature
click to edit
Memorandum of Understanding
I, (print name) __________________________________________, hereby request to
participate in the Newport News Newport News Citizen Fire Academy (CFA) program. I
understand that this training will involve active physical participation, which includes a
potential risk of personal injury and/or personal property damage. I make this request with
full knowledge of the possibility of personal injury and/or property damage. Further, I have
read and understand the program outline that describes all class sections and the
associated activities. My participation in the CFA program is voluntary. I do hereby agree to
assume all risks which may be associated with or result from my participation in this
program, and hereby waive any and all claims, causes of action and demands against the
City of Newport News, its agents, officers and employees for any personal injury or property
damage arising from my participation in the CFA program. I agree to follow the rules
established by the instructors, and to exercise reasonable care while participating in the
CFA program. I understand that if I fail to follow the instructor’s rules and program
regulations or if I fail to exercise reasonable care, I can be removed from the program. I
understand that I do not become an employee of the City of Newport News via my
participation in the CFA program. By executing this agreement I certify that I have read this
agreement in its entirety, understand all of its terms and have had any questions regarding
this agreement or its effect satisfactorily answered. I sign this release freely and voluntarily.
__
______________________________________________ ____/_______/_____
Signature of Applicant Date
__
_____________________________________________________________________
Printed Name of Applicant
_____________________________________ ________________________________
Emergency Contact Name Relationship to Applicant
(__
____)__________________________________
Emergency Contact Phone Number
click to sign
signature
click to edit
Rev. 08/2017
City of Newport News
Department of Human Resources
Authorization to Release Information
TO: Any Local, State or Federal Law Enforcement Agency; any past or present
employer; any Academic Dean, Registrar, Principal, Guidance Counselor or other
authorized person at any School, College or University; U. S. Armed Forces, or
Maritime services:
I,
First Name Middle Name Last Name
______________________________________________________________________________
Address City State Zip
have applied for employment /volunteer service as a/an ________________________
with the City of Newport News, Virginia. I am aware that my entire background may
be investigated thoroughly. I hereby authorize and request the release of any and all
information you have concerning me (including employment and criminal records) to
any representative of the City of Newport News, Virginia, upon presentation of this
release or copy hereof and release all concerned from all liability in connection
therewith.
Date of Birth Social Security Number
Race Sex Maiden Name
List any other names or aliases previously used
Place of Birth: (County or City) (State or Country)
__________________________________________________ _________________________
Signature of Person to be Investigated Date
Print Application
Save Application
Clear Application
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome