Application - Bacliff Volunteer Fire Department

Bacliff VFD
Members
Hurricane 2023
Equipment
Photo Stories
Application

Bacliff Volunteer Fire Department

600 Grand Ave. Bacliff, TX 77518

281-339-2880

Bacliff VFD
Members
Hurricane 2023
Equipment
Photo Stories
Application

Go to content

Bacliff VFD
Members
Hurricane 2023
Equipment
Photo Stories
Application

Application

PERSONAL INFORMATION

First Name*

Initial

Last Name*

Street Address*

City*

State*

Zip*

Mailing Address

Same as above

yes

How many years in the above named community?

Home Phone

Cell Phone

Email Address*

Repeat Email Address*

Social Security #*

Date of Birth*

Age*

TYPE OF MEMBERSHIP

Type of Membership

EDUCATION

Education

Date of HS Grad or GED

Last School Attended

EMPLOYMENT

Employed By:

Phone #

Position:

Normal Work Schedule

Employer's Address:

LEGAL RECORDS

IMPORTANT:

A conviction record will not necessarily disqualify you from membership. Each conviction will be considered with respect to the recency, nature of crime, job relatedness, and other relevant factors. All information will be held in strict confidence and verified through court records.
I agree

Drivers License #:*

DL Type:*

State of Issue*

List all non-felony arrest, tickets, and accidents within the last three (3) years:

ABOUT YOU:

Why do you want to join the Bacliff Volunteer Fire Department:*

HEALTH

General Health Status: (Check One)

Excellent
Good
Fair
Poor

Blood Type

Allergic to any Medications:

Yes
No

If yes, please explain:

Check the appropriate box(es) if you have the following health problems:

Heart Trouble Respiratory Trouble
High/Low Blood Pressure Hearing
Vision Alcoholism
Diabetes Drug Abuse
Hypertension Mental

Have you been under continued Doctors care within the last three (3) years?

Yes
No

If yes, Explain:

List Any Regular Medications

Name of Current Physician:

Physician Phone #:

Legal Questions

Are there any warrants currently against you?

Yes
No

Have you ever been convicted of a Felony Offense?

Yes
No

If yes, Please explain:

FIRE SERVICE OR MEDICAL EXPERIENCE

1. Department Name:

Dates:

Type of Experience:

Highest Rank Attained:

Reason for Leaving

Superior Officer:

Phone #:

2. Department Name:

Dates:

Type of Experience:

Highest Rank Attained:

Reason for Leaving

Superior Officer:

Phone #:

Have you ever been refused admittance to, or discharged from any part of the FIRE or EMS services:

yes
no

If yes, explain:

List any special service Skills or training

Please use the following space below for any comments you wish to make:

I certify that my answers on this application are true and correct to the best of my knowledge. If accepted, I agree to abide by the rules and regulations as set forth in the constitution and bylaws, SOG's, SOP's and to qualify myself by study of rules of a first class firefighter. It is understood that there can be up to sixty (60) day waiting period to allow the Bacliff Volunteer Fire Department time to complete a background check, to aid in determining my suitability as a member of this fire department. It will be my responsibility to update the information on this application every two (2) years or as often as is necessary.
I agree

Signature

Date*

Any questions or concerns may be sent to the Webmaster: aedqueen44@gmail.com