City of South Bay Fire Department Reserve Program Application



Download 33 Kb.
Sana23.06.2017
Hajmi33 Kb.
City of South Bay Fire Department

Reserve Program Application


Name _____________________________________________________ Date______________
Address ______________________________________ City___________________________
Home Phone ___________________ Cell ____________________ Other ________________
D.L # _________________________ Height ______ Weight ______ Hair ______ Eyes ______
S.S #_________________________ DOB ____________ Place of Birth __________________

(City & State / or Country)



References (do not use relatives)

1)______________________ Address _______________________________________

Phone___________________ Years Known ____________

2)______________________ Address _______________________________________

Phone___________________ Years Known ____________

3)______________________ Address _______________________________________

Phone___________________ Years Known ____________
Background Information


  1. Have you ever been arrested? Y__ N __ if yes explain where and why? ______________________________________________________________________________________________________________________________________________________________




  1. Have you had your driver’s license suspended or revoked? Y___ N____ If yes explain where and why?________________________________________________________________________________________________________________________________________________________




  1. List all traffic citations received in past 3 years _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Required documents: Office use only:
Drivers License _____ Valid _______ Initials _______

High School Diploma or GED _____ Valid _______ Initials _______

State FF I or II Certificate _____ Valid _______ Initials _______

CPR Card _____ Valid _______ Initials _______

EMT Card (optional) _____ Valid _______ Initials _______

EVOC Certificate _____ Valid _______ Initials _______

Completed Medical form _____ Valid _______ Initials _______

Drug Screen _____ Valid _______ Initials _______

(Have screening agency send SBFD results)

I ___________________ , in return for recognition with the Florida State Fire Marshals Office and to maintain my reserve status as a member of the South Bay Fire Department, will do the following



A: Complete all training and assignments assigned to me in a proficient manner.

B: Will complete a minimum 48 hours of scheduled shift time each month (consisting of at least two 24 hour periods) to gain recognition as a Firefighter with the City of South Bay.

C: Will represent the City in the most up most and professional manner at all times.
By signing this I agree with and understand what is expected of me and will do my best to fulfill theses expectations.

Print Name_____________________________ Date______________


Sign name _____________________________


Applicant Approved by Captain: Yes _______ No _______ Date _____________

Applicant Approved by Chief: Yes _______ No _______ Date _____________


JRF Aug/05

Katalog: Public Documents
Public Documents -> -
Public Documents -> East Windsor Police department Chief of Police
Public Documents -> Business Alarm Residential Alarm new alarm Renewal
Public Documents -> Incomplete applications will not be accepted. There will be no exceptions to this rule
Public Documents -> Supplementary gazette the south australian government gazette
Public Documents -> Pa forestry Association Ramble The Pulpit Rock Hike
Public Documents -> A pennsylvania Recreational Guide for Mont Alto State Park
Public Documents -> December 5, 2013 Department of Conservation and Natural Resources
Public Documents -> Application For Membership
Public Documents -> Adams Hamiltonban Township, $53,000, Development of Community Park, Hamiltonban Township, Adams County. Work to include construction of a parking area and pavilion; installation of play equipment with required safety surfacing

Download 33 Kb.

Do'stlaringiz bilan baham:




Ma'lumotlar bazasi mualliflik huquqi bilan himoyalangan ©hozir.org 2020
ma'muriyatiga murojaat qiling

    Bosh sahifa
davlat universiteti
ta’lim vazirligi
O’zbekiston respublikasi
maxsus ta’lim
zbekiston respublikasi
o’rta maxsus
davlat pedagogika
axborot texnologiyalari
nomidagi toshkent
pedagogika instituti
texnologiyalari universiteti
navoiy nomidagi
samarqand davlat
guruh talabasi
ta’limi vazirligi
nomidagi samarqand
toshkent axborot
toshkent davlat
haqida tushuncha
Darsning maqsadi
xorazmiy nomidagi
Toshkent davlat
vazirligi toshkent
tashkil etish
Alisher navoiy
Ўзбекистон республикаси
rivojlantirish vazirligi
matematika fakulteti
pedagogika universiteti
таълим вазирлиги
sinflar uchun
Nizomiy nomidagi
tibbiyot akademiyasi
maxsus ta'lim
ta'lim vazirligi
махсус таълим
bilan ishlash
o’rta ta’lim
fanlar fakulteti
Referat mavzu
Navoiy davlat
umumiy o’rta
haqida umumiy
Buxoro davlat
fanining predmeti
fizika matematika
universiteti fizika
malakasini oshirish
kommunikatsiyalarini rivojlantirish
davlat sharqshunoslik
jizzax davlat