Application - Bacliff Volunteer Fire Department
×
Bacliff VFD
Members
Hurricane 2022
Equipment
Photo Stories
History
Application
For Members Only
Bacliff Volunteer Fire Department
600 Grand Ave. Bacliff, TX 77518
281-339-2880
×
Bacliff VFD
Members
Hurricane 2022
Equipment
Photo Stories
History
Application
For Members Only
Go to content
×
Bacliff VFD
Members
Hurricane 2022
Equipment
Photo Stories
History
Application
For Members Only
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
-
Jr Firefighter
Firefighter
First Responder
Auxillary
EDUCATION
Education
-
GED
High School Diploma
Associates Degree
Bachelors Degree
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*
Back to content
To use this website you must enable JavaScript.