Volunteeer Application

Position Applying For

Volunteer Firefighter

Resident Volunteer

Junior Firefighter/Cadet

Volunteer Medical Only (EMR/EMT/Paramedic)

Full Name (First, Middle, Last)

Address

Phone Number

Email Address

What is the best way to contact you?

Call

Text

Email

Are you over 18 years of age?

Yes

No

Do yo have a valid Oregon Drivers License?

Yes

No

In the last 5 years, have you had any (check all that apply)

Accidents

Tickets

None

Have you ever been arrested?

Yes

No

If yes, please provide explanation.

Do you authorize MVRFD to perform a mandatory background investigation?

Yes

No

Do you have any mental or physical condition which would substantially hinder or prevent the performance of the essential duties of this position? If yes, please explain in detail and indicate what accommodations, if any, would permit you to perform the duties in question.

Please Provide 3 references and their contact information

By entering your name below, you certify that all the information given is true and complete to the best of your knowledge and authorize the investigation of all statements contained in the application as may be necessary.

Date of Application Submission