Roscoe Volunteer Fire Department       Please read prior to Appling

Application for Membership

Date:____________________________________________________

Name:___________________________________________________

Address:_________________________________________________

Date of Birth: _____________________________________________

Texas DL #:_________________________Exp. Date:_____________

Texas CDL#________________________ Exp. Date:_____________

Phone: ___________________________________________________

Note:  Any false information on this application will lead to immediate denial or termination of membership.

Any moving violations in the last 5 years? If so please list:

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Have you ever been convicted of a felony:  yes or no if yes explain:

____________________________________________________________________________________________________________________Are you or have you been in any other fire departments :  if so please list Name and contact information:

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Please list any firefighting training certifications or experience you have including any medical training or certifications:

____________________________________________________________________________________________________________________Please list any medical condition you have that could stop you from performing any /all duties of a Firefighter:  This will not stop the application but will give RVFD placement value. 

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By signing you agree ALL information is True, you agree to a background check and you release the Roscoe VFD and any officer or member of any liability from this point forward.

Sign and date:

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