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:
