Roscoe Volunteer Fire Department
APPLICATION FOR MEMBERSHIP
Name ____________________________________________ Date___/___/____
Phone (Days) ______________
TX DL#_____________________________ (Pager)_______________________
DATE OF BIRTH _________ Social Secur= ity #_________________________
Do you have any firefighting, rescue= , or medical experience? Y / N (NOT a requirement, We have training) If yes expl= ain what type experience and what department or Group..
Are you willing to come to training sessions and or work days when offered? Y / N
Are you certified in any of the foll= owing? (circle any held) Firefighter EMT-P EMT ECA CPR<= o:p>
Do you hold any instructor certifica= tes? Y / N
Are you available to respond during = the daytime? Y / N
Are you available to respond to the station within a 15 minute driving time while obeying all traffic laws? Y /= N
Are you available on most nights and weekends to respond? Y / N
Have you had any moving violation tr= affic tickets in the last 3 yrs? Y / N If so, explain
Have you ever been convicted of a fe= lony offense? Y / N
Are you now or have you ever been a = member of another VFD? ______ If yes, what dept
Have you ever been removed or asked = to resign from another volunteer department? Y / N
If Yes, what department? _____________________________
Do you have any medical problems or = health problems or physical handicap that would prevent you from extremely stressf= ul and vigorous firefighting activities? (ie High Blood Pressure, Heart Problem, previous heart problems, etc) Y / N ___= _ If yes, you still could be used for support such as dispatch, fire prevention, and other non fire/rescue operations. In the eve= nt of an accident, injury or death during a RVFD official activity, do you agr= ee that you will not hold the Roscoe Volunteer Fire Depart= ment or any officer or member thereof either liable or financially responsible?<= o:p>
Do you also agree that you would not= bring a lawsuit against the same parties in such an event? __________________
Please write in yes or no.
Do you realize that upon signing this application and you are accepted as a member you are releasing the VVFD and= any officer or member of any further liability to you or your family, in the ev= ent of an accident, injury or death as the result of any VVFD official activity? __________
Write in yes or no.
Do you understand that any false information on this application or any willful misconduct or disregard for = our written constitution and by-laws, or the Standard Operation Procedures could lead to your being removed from the department? Y/N
IF ACCEPTED FOR MEMBERSHIP, YOU WILL= BE ON A PROBATION PERIOD FOR 6 MONTHS?
Signed by ____________________________________________________