ORANGE COUNTY FIRE AUTHORITY EXPLORING PROGRAM
Post #
MEMBERSHIP APPLICATION
INSTRUCTIONS: All answers are to typewritten or printed legibly in ink. Each question on this form must be answered, leaving no blanks. If the question does not
apply, enter "DNA" in the space provided for the answer. Any false statement made on this application will cause the applicant's name to be removed from the eligible list
or be cause for immediate dismissal if an appointment is made.
PERSONAL INFORMATION
Full Name:
Aliases or Nicknames:
Residence Address:
(Number & Street) (City) (Zip code)
Phone Number:
Mailing Address:
(Number & Street) (City) (Zip code)
Date of Birth: Place of Birth:
City County State
Social Security #:
If a Naturalized Citizen, list the City, County, and State where Naturalized:
Sex: Age: Height: Weight: Hair: Eyes: Build: Light Medium Heavy
I live with: Father Mother Stepfather Stepmother Other
Parent/Guardian Names:
Person to Notify in Event of Emergency: Phone Number:
REFERENCE INFORMATION (List three references other than relatives or past employers)
Name: Address: Phone Number:
Employer's Name: Years Known:
Name: Address: Phone Number:
Employer's Name: Years Known:
Name: Address: Phone Number:
Employer's Name: Years Known:
SCHOOL INFORMATION
School Name: Counselor's Name:
School Address:
(Number & Street) (City) (State) (Zip code)
Grade Point Ave.: Current Grade Level: Dates of Attendance: to
Have you ever received a referral or detention from school? Yes
No
Have you attended more than one high school in the past two years? Yes
No
PLEASE ATTACH A COPY OF YOUR MOST RECENT GRADE REPORT FROM SCHOOL.
EMPLOYMENT INFORMATION
Employer's Name: Phone Number:
Your Job Title: Number of Hours per Week:
Briefly describe duties:
Print Form
TRAFFIC INFORMATION
CA Driver License #: Class of License: Expiration Date:
List below every driver's license you have possessed
State
Number
Approximate Issue Date
Approximate Expiration Date
ARREST INFORMATION
Have you ever been detained for investigation, held on suspicion, or arrested by any law enforcement agency? Yes No
Have you ever been arrested for any traffic violation? Yes
No
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS 'YES', LIST THE INFORMATION REQUESTED BELOW.
Date
Charge
Arresting Agency
Penalty
REMARKS:
By submitting application to the Orange County Fire Authority Exploring Program, we understand that any appointment tendered will
be contingent upon the results of a thorough character and fitness investigation conducted by the Orange County Fire Authority. This
investigation may include, but is not limited to, criminal record checks by computer, contacts with official law enforcement agencies,
personal references, employers (past and present), and officials of schools of attendance.
We are aware any false statement made on this application will cause the applicant to be removed from further consideration for
membership.
We hereby waive any claim against the Orange County Fire Authority, its officers and employees, the Director of Fire Services, and all
members of the Orange County Fire Authority for pursuing an aggressive and detailed background investigation into the applicant for
Fire Explorer. We understand that such investigation shall remain confidential whether or not the applicant is allowed membership as
an Orange County Fire Authority Explorer.
Date
Exploring Applicant's Signature
Date
Parent/Legal Guardian's Signature
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