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Derby Fire & Rescue Volunteer Firefighter Application

  1. Are you a U.S. Citizen?*
  2. Are you currently a member of the U.S. Armed Forces*
  3. Have you in the past or are you currently involved in civil litigation? (If yes, explain below)*
  4. Have you ever been convicted of a felony? (If yes explain below)*
  5. Personal References
    List two persons not related to you
  6. #1
  7. #2
  8. Education Record
    Start with last school attended, including high school
  9. 1.
  10. Graduated
  11. 2.
  12. Graduated
  13. 3.
  14. Graduated
  15. 4.
  16. Graduated
  17. Employment Record
    Start with your most recent employer
  18. 1.
  19. 2.
  20. 3.
  21. Will your employer allow you to respond to calls during work hours?*
  22. If you are late for work because of an emergency call will this be a problem?*
  23. Do you understand that besides answering calls, there are also two training meetings a month?*
  24. Print the following files, complete, sign and attach this application
  25. Leave This Blank:

  26. This field is not part of the form submission.