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:
______________________________________________________________________________________________________________________________________________________________________________
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:
____________________________________________________________________________________________________________________
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.
______________________________________________________________________________________________________________________________________________________________________________
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:
__________________________________________