Fill - Free fillable PORTAGE FIRE DEPARTMENT (City of Portage) PDF form

PORTAGE FIRE DEPARTMENT

APPLICATION FOR PAID-ON-CALL FIREFIGHTER

NAME:

LAST FIRST MIDDLE

PRESENT ADDRESS:

PHONE #: DATE OF BIRTH:

DRIVERS LICENSE #: S.S. #

OCCUPATION: HOURS OF WORK:

PRESENT EMPLOYER: PHONE #:

SUPERVISOR NAME: PHONE #:

EMPLOYER’S ADDRESS:

Do you currently hold a valid Wisconsin driver’s license? Yes No

Do you have transportation to attend fire calls and training? Yes No _____

Have you had previous fire service experience or training? Yes No _____

If you work near Portage can you leave work for fire calls? Yes ____ No _____

List departments where you were a member and certifications if any:

Reason for requesting membership:

List other information that may assist the fire department in its decision to accept you as a member of the Portage Fire

Department:

REFERENCES:

1. Phone #:

2. Phone #:

3. Phone #:

**Complete the attached Authorization for Release of Information sheet attached.**

The information given on this application is true and correct to the best of my knowledge. I understand that any

false information will be grounds for dismissal.

DATE: SIGNATURE:

Please fill out the gear information below to the best of your knowledge:

Coat Size (chest)

: (ex: 44) Pants Size: waist _____ X length _____ (ex: 34 X 32) Shoe Size: _________

OFFICE USE ONLY

DO NOT WRITE BELOW THIS LINE

DATE FILED WITH THE FIRE DEPARTMENT:

ACCEPTED FOR INTERVIEW: YES NO DATE:

ORAL INTERVIEW COMPLETED: YES NO DATE:

PRE-ACCEPTANCE TEST COMPLETED: YES NO DATE:

COMMENTS ON ANY OF THE ABOVE:

ACCEPTED ONTO THE DEPARTMENT: YES NO DATE:

DATE:

EXECUTIVE COMMITTEE CHAIRMAN SIGNATURE

DATE:

FIRE CHIEF SIGNATURE

AUTHORIZATION FOR RELEASE OF INFORMATION

Print Name: ___________________________________________________________

(First) (Middle) (Last)

Former Name(s) and Dates Used: __________________________________________

Current Address Since:___________________________________________________

(Mo/Yr) (Street) (City) (Zip/State)

Previous Address From:__________________________________________________

(Mo/Yr) (Street) (City) (Zip/State)

Previous Address From: _________________________________________________

(Mo/Yr) (Street) (City) (Zip/State)

Social Security Number: _______________________ Date of Birth:_____________

Telephone Number: _(_____)____________________

Driver’s License Number/State:____________________________________________

The information contained in this application is correct to the best of my knowledge. I

hereby authorize the City of Portage and its designated agents and representatives to

conduct a comprehensive review of my background causing a consumer report and/or

an investigative consumer report to be generated for employment and/or volunteer

purposes. I understand that the scope of the consumer report/ investigative consumer

report may include, but is not limited to the following areas: verification of social security

number; current and previous residences; employment history, education background,

character references; drug testing, civil and criminal history records from any criminal

justice agency in any or all federal, state, county jurisdictions; driving records, birth

records, and any other public records. I further authorize any individual, company, firm,

corporation, or public agency and law enforcement agencies to divulge any and all

information, verbal or written, pertaining to me, to the City of Portage or its authorized

agents. I further authorize the complete release of any records or data pertaining to me

which the individual, company, firm, corporation, or public agency may have, to include

information or data received from other sources.

I hereby release the City of Portage, and its agents, officials, representative, or

assigned agencies, including officers, employees, or related personnel both individually

and collectively, from any and all liability for damages of whatever kind, which may, at

any time, result to me, my heirs, family, or associates because of compliance with this

authorization and request to release.

Signature: ______________________________________ Date: ______________

Firefighter Recruitment

Paid on Call Firefighters

• The Portage Fire Department is looking for highly motivated individuals who would like to serve

their community.

Benefits of joining:

• Carrying on the great tradition of the fire service.

• Camaraderie of working with other firefighters.

• Education and training opportunities.

• Respond to emergency calls in the City and Townships.

• Receive pay twice a year.

Requirements to join:

• 18 years of age at time of hiring.

• Valid Wisconsin driver’s license.

• Eagerness to commit.

• Must be able to attend meetings and training drills each month.

Applications can be obtained at the fire station or filled out on line at www.portagewi.gov

Return completed application to the fire station.

Any questions please contact us at:

• 608-742-2172 between 8 am and 4 pm

• 608-697-7064 after hours listed above.

Steps to be taken to become a paid-on-call firefighter:

• Complete application and turn in to the Fire Chief

• Oral interview with the fire department’s Executive Committee

• 3 hour physical fitness test

• Drug test

• Meeting with the Fire Chief

• Placed on roll call and a one year probationary period

• 30 hours in-house training

• Entered into State Entry Level Firefighter training (sponsored by the Portage Fire Department)

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Fillable PORTAGE FIRE DEPARTMENT (City of Portage)

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