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Apply to be a member
Links
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Home
News
Newsletter Archives
Run Total History
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Listen to Evansville Dispatch
Apparatus
Gallery
CPR Training
Membership
Membership FAQ
Apply to be a member
Links
Contact Us
Menu
Home
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Run Total History
Facebook News Feed
Listen to Evansville Dispatch
Apparatus
Gallery
CPR Training
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Perry Township Fire Department
Membership Application
To apply for membership please complete all questions prior to submitting the form.
APPLICANT INFORMATION
Full Name
Address
Apartment/Building
City
State
Zipcode
Phone Number
Email
At least 18 years of age?
No
Yes
Fire or EMS? Both?
Fire
EMS
Both
APPLICANT LEVEL OF EDUCATION
High School
High School Address
City
State
Zipcode
College (If Applicable)
College Address
City
State
Zipcode
APPLICANT EMPLOYMENT HISTORY
Present Employer
Position
Employer Address
City
State
Zipcode
Country
Employer Phone Number
Length of Employment
Work Schedule
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Past Employer
Position
Past Employer Address
City
State
Zipcode
Country
Length of Employment
Past Employer Phone Number
Reference #1
Name
Phone Number
City
State
Zipcode
Reference #2
Name
Phone Number
City
State
Zipcode
Reference #3
Name
Phone Number
City
State
Zipcode
What prompted your application to Perry Township Fire Department?
Do you have any previous Fire/EMS Training? (Please explain and list certs.)
Indiana PSID#, if you have an issued number
Do you have any physical handicaps or disabilities that may interfere with your duties as a firefighter?
Yes
No
If yes, please explain.
Have you ever been convicted or made a plea on a felony arrest?
Yes
No
Have you ever been convicted or made a plea on a violation of Controlled Substance Laws?
Yes
No
Please note that Perry Township Fire Department requires a background check.
I agree by signing that I give permission to Perry Township Fire Department to complete a full background check, call my employer for job verification, and to contact my references. I also certify that this application is completed with the correct and legal information to the best of my knowledge.
Signature
Signature Date
SUBMIT MY APPLICATION