City of South Bay Fire Department Reserve Program Application



Download 33 Kb.
Sana23.06.2017
Hajmi33 Kb.
#13852
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

Download 33 Kb.

Do'stlaringiz bilan baham:




Ma'lumotlar bazasi mualliflik huquqi bilan himoyalangan ©hozir.org 2024
ma'muriyatiga murojaat qiling

kiriting | ro'yxatdan o'tish
    Bosh sahifa
юртда тантана
Боғда битган
Бугун юртда
Эшитганлар жилманглар
Эшитмадим деманглар
битган бодомлар
Yangiariq tumani
qitish marakazi
Raqamli texnologiyalar
ilishida muhokamadan
tasdiqqa tavsiya
tavsiya etilgan
iqtisodiyot kafedrasi
steiermarkischen landesregierung
asarlaringizni yuboring
o'zingizning asarlaringizni
Iltimos faqat
faqat o'zingizning
steierm rkischen
landesregierung fachabteilung
rkischen landesregierung
hamshira loyihasi
loyihasi mavsum
faolyatining oqibatlari
asosiy adabiyotlar
fakulteti ahborot
ahborot havfsizligi
havfsizligi kafedrasi
fanidan bo’yicha
fakulteti iqtisodiyot
boshqaruv fakulteti
chiqarishda boshqaruv
ishlab chiqarishda
iqtisodiyot fakultet
multiservis tarmoqlari
fanidan asosiy
Uzbek fanidan
mavzulari potok
asosidagi multiservis
'aliyyil a'ziym
billahil 'aliyyil
illaa billahil
quvvata illaa
falah' deganida
Kompyuter savodxonligi
bo’yicha mustaqil
'alal falah'
Hayya 'alal
'alas soloh
Hayya 'alas
mavsum boyicha


yuklab olish