Application Form - Newaygo Fire Department

Full Name (required)

First Name

Middle Name

Last Name

Current Address (required)

Street Address

Street Address 2

City

State

Zip Code

Personal Information (required)

Date of Birth

Email Address

Phone Number

Social Security Number

Emergency Contact Information (required)

Emergency Contact Name

Emergency Contact Phone Number

General Information

Do you have reliable transporation?
YesNo

Year, Make, Model, and VIN of vehicle

Year

Make

Model

VIN Number

Do you have prior EMS or Firefighting experience? (If yes, please explain)

Do you have any physical conditions that may limit your ability to do the job? (If yes, please explain)

Have you ever been convicted of a crime? (If yes, indicate offense, misdemeanor, or felony, and the dates)

Family Doctor Name

Family Doctor Number

Most Recent employer, job title, and contact information (required)

Most Recent Employer Name

Most Recent Job Title

Most Recent Employer Contact Information (email, phone number, etc...)

What is your current work schedule?

Upload any additional files...

I, the undersigned authorize the Newaygo Fire Department to run a criminal history and driving record check. I also agree to complete the State Mandated Michigan Firefighter Training within two (2) years from date of employment.
Note: The Newaygo Fire Department reserves the right to accept or deny any applicant for any reason. Furthermore, it is understood that any employee can be terminated at any time, for any reason by a majority vote of the fire department officers. There will be no appeals process.

Sign name

First Name

Last Name

Today's Date

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. *
I agree