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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

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): ________________________________________________________________

____________________________________________________________________________

CKNOWLEDGMENT:

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

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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

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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:

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

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