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 #:
EMPLOYERS 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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