Fillable Fire Fighter Application PDF %281%29

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Fire Fighter Application PDF %281%29

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TOWN OF GRANITE QUARRY
143 NORTH SALISBURY AVENUE
P.O. BOX 351
GRANITE QUARRY, NORTH CAROLINA 28072
(704) 279-5596
FIRE DEPARTMENT
STATION #57
Organized in February, 1950
This packet contains the Membership / Employment Application Form, Probationary Statement, and
Probationary Training Outline. The applicant should read and understand all materials.
A thorough background check will be completed on applicants.
NO APPLICATION FOR A VOLUNTEER WILL BE PROCESSED WITHOUT THIS TRANSCRIPT!
PROBATIONARY AGREEMENT FOR VOLUNTEERS
As of January 1, 1988, all new firefighters joining the Granite Quarry Fire Department will serve a twelve (12)
month training/probationary period to gain knowledge and learn their duties as a firefighter with this
department. A six (6) month administration probation will be in effect for all new members. During this period,
you will be required to wear a blue stripe on your helmet. At the end of the first six (6) months you may, if all
training requirements have been met, remove the blue stripe. At the end of the twelve (12) month period, each
applicant will be reviewed by the officers for a final determination as to his/her continuation in the department
on a permanent basis.
The following guidelines must be met during this period. FAILURE TO DO SO WILL RESULT IN DISMISSAL.
1. Attend a minimum of 50% (fifty percent) of all scheduled monthly meetings.
2. Attend one Rowan County Fireman’s Association meeting. (3
rd
Thursday of odd months at 7:30 PM)
Transportation will be provided.
3. Attend a special training class if one is held during this period. If not, then the first one available.
4. During this period, you will be required to begin training for, at least, a Medical Responder Medical
Certification.
5. During this period, probationary personnel WILL NOT be allowed to drive any apparatus emergency
traffic.
6. During this period, you will be instructed as per the Granite Quarry Fire Department’s Probationary
Firefighter Performance Objectives. You will need to read and become familiar with the department’s
Suggested Operating Guidelines (SOG’S) and be proficient in locating Granite Quarry streets and
hydrants.
7. Probationary firefighters WILL NOT be allowed to run red lights or emergency flashers on their
personal vehicles.
8. Probationary firefighters are not eligible for the annual Rookie Award or for participation in the town’s
funded pension program.
The firefighter will have the ultimate responsibility for contacting an officer to schedule training time. If work
schedules cause a conflict, he/she must contact the Chief.
Due to safety consideration, the Fire Department finds it necessary to enforce the following dress code:
• Facial hair in the seal area of SCBA will not be allowed.
• Hair must be kept off the collar.
• Earrings must not be worn during training or emergency calls.
The Granite Quarry Fire Department is proud of the moral character represented by its members. Good
judgment and common sense must prevail in all situations. All persons are to conduct themselves as
professionals at the station and on the fireground. Persons displaying undesirable contact or reflecting an
unfavorable image on the Department may be subject to suspension or dismissal.
STATEMENT: I HAVE READ THE GRANITE QUARRY FIRE DEPARTMENT’S PROBATIONARY
AGREEMENT AND UNDERSTAND WHAT IS EXPECTED OF ME DURING MY PROBATIONARY PERIOD.
FAILURE TO COMPLY WITH THE REQUIRED OBJECTIVES WILL RESULT IN MY DISMISSAL.
____________________________________________________ ___________________
Signature of Applicant Date
____________________________________________________ ___________________
Signature of Witnessing Officer Date
APPLICATION FOR MEMBERSHIP / EMPLOYMENT
(PLEASE PRINT)
Name of Applicant ___________________________________ Date of Application __________________
Last First Middle
Address ___________________________________________________________________________________
Number / Street PO Box City State Zip Code
Telephone Numbers _____________________________________________________________________________
Home Work Cell Email
___________________ _________________ __________________ _______________________________
Driver’s License # & State Driver’s License Class Date of Birth Social Security Number
Are you currently being treated for any drug or alcohol abuse? Yes No (If you answered yes, please explain.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Do you have a history of heart or respiratory disease in your family? Yes No (If you answered yes, please explain.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Name & Address of School
Course of Study
Years
Completed
Diploma or
Degree
Elementary
School
High School
College
Other
(Specify)
1. Employer ____________________________________ Dates Employed: From __________ To __________
Address ____________________________________________________ Phone # _________________________
Work Performed _________________________________________________________________________________
Job Title ___________________________________ Supervisor’s Name ____________________________________
May we contact this employer? Yes No
2. Employer ____________________________________ Dates Employed: From __________ To __________
Address ____________________________________________________ Phone # _________________________
Work Performed _________________________________________________________________________________
Job Title ___________________________________ Supervisor’s Name ____________________________________
May we contact this employer? Yes No
APPLICATION FOR MEMBERSHIP / EMPLOYMENT
(Page 2)
Have you ever been convicted of a crime? Yes No (If you answered yes, please explain.) _____________________
________________________________________________________________________________________________
Could you leave work in case of an emergency? Yes No (Comments? N/A if applying for full-time position)
________________________________________________________________________________________________
________________________________________________________________________________________________
What shift do you work? ______________ Would you be able to attend: Meetings? ______ Training Sessions? _____
Is there any reason you could not drive a fire truck? Yes No (If you answered yes, please explain.) ______________
________________________________________________________________________________________________
Have you ever been a member of or employed by a fire department? Yes No (If you answered yes, please complete the following):
Department’s Name ____________________________________ Length of Membership ___________________
Address _____________________________________________ Phone Number _________________________
Chief’s Name ___________________________ Training Received _________________________________________
Do you belong to any civic organization or club? Yes No (If you answered yes, please explain) __________________
________________________________________________________________________________________________
Why do you want to join the Granite Quarry Fire Department? _______________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Is there any area of the fire department operations that you are particularly interested in? Yes No (If you answered yes,
please explain)
________________________________________________________________________________________________
________________________________________________________________________________________________
References:
Name / Relationship: _________________________________________________________ Years Acquainted? _______
Address & Phone #: __________________________________________________________________________________
Name / Relationship: _________________________________________________________ Years Acquainted? _______
Address & Phone #: __________________________________________________________________________________
Name / Relationship: _________________________________________________________ Years Acquainted? _______
Address & Phone #: __________________________________________________________________________________
DAY – Emergency Contact: Name / Relationship __________________________________________________________
Address & Phone #: __________________________________________________________________________________
NIGHT – Emergency Contact: Name / Relationship _________________________________________________________
Address & Phone #: __________________________________________________________________________________
APPLICATION FOR MEMBERSHIP / EMPLOYMENT
(Page 3)
If you are applying for a full-time or part-time position, please answer the questions below.
Position applying for: Date you can start: ________________________
Full Time
Part time
Night Stand By
Volunteer
Are you prevented from lawfully being employed in this country because of visa or immigration status? Yes No
Do you have any special skills or training that you feel are applicable to this position? Yes No (If yes, please indicate
below.)
I certify that answers given herein are true and complete to the best of my knowledge. I understand that if any false
information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my
employment may be terminated at any time. I understand that employment is contingent upon the satisfactory completion of a
pre-employment physical, drug screening and criminal background check.
In consideration of my employment, I agree to conform to the Town’s rules and regulations, and I agree that my employment
and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the
Town’s option.
I hereby give permission to the Town of Granite Quarry to contact any person or companies listed on this application as it
pertains to joining the Department and/or becoming an employee of the Town.
______________________________________________________ _______________________________
Signature of Applicant Date
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Fire Fighter Application PDF %281%29

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Completed 12 July 2020

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