Membership Application - All Positions - Pine Ridge Fire Department

Name (required)

Phone (required)

Email Address (required)

For which type(s) of membership are you applying? (required)

Volunteer

Part-time Paid

Full-time Paid

For which position(s) are you applying? (required)

Have you completed Incident Command training? (required)

Please select your level of certification: (required)

Driver Training:

EVDT

Pump Ops 1

Pump Ops 2 Mobile Water Supply

Aerial Ops

What is your level of medical training?

HazMat Training

HazMat Awareness

HazMat Ops

HazMat Technician

Other Advanced or Specialized HazMat Training

Just a few more:

Do you have any additional training or certifications that you would like us to know about?

Are you 18 years or older? (required)

What is your level of non-fire related education? (required)

Are you able to safely perform the essential job task required of the job? (required)

Are you currently employed or a member of another fire department? (required)

Yes

No

If you answered "yes" to the question above, please provide some datails including department, position and supervisor:

Why do you want to become a member of Pine Ridge Fire Department? (required)

A criminal background check is required for this position. Do you have any prior convictions or current pending charges? (required)

Yes

No

A driver's record check will be conducted prior to employment and periodically throughout employment. Have you been cited for a traffic violation or involved in a motor vehicle accident within the past twelve months? (required)

Yes

No

Please list two professional references who are not related to you through blood or marriage. (required)

Is there anything else that you would like us to know?

You may upload your resume, transcript, or other non-sensitive documents here. (1)

(2)

(3)

(4)

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