NORTH CHATHAM VOLUNTEER FIRE DEPARTMENT 

Application for Firefighter Or Firefighter/Driver 

Name: _______________________________________     Date: __________________ 

SSN: ______ - _____ - ______           N.C. Driver’s Lic.#:_______________ 

Home Phone:  (   ) _____ - _______     Cell Phone: (   ) ______ - ________ 

Current Address: _________________________________________________________

Previous Address: ________________________________________________________ 

Present Employer: ___________________________Phone:(   ) _____ - _______ 

Employer Address:_______________________________________________________ 

Type of Work: __________________________________________________________

Person to notify in case of emergency: _________________________________ 

Address: ________________________________  Phone:(   ) _____ - _______ 

Have you ever been convicted of felony? _________ 

If yes, explain in full: ______________________________________________ 

_______________________________________________________________________ 

Have you been convicted of a traffic violation in the last three(3)

years? __________  If yes, explain in full:____________________________ 

_______________________________________________________________________ 

List Fire/Rescue Departments that you have been affiliated with in the

past/present, also include phone number and contact person. 

1. ________________________________________________________________

 2. ____________________________________________________________________

 3. ____________________________________________________________________ 

What is your present level of EMS training? ____________________________ 

List two (2) character/work references: ( that we may contact ) 

Name: ___________________________      Phone: (   ) _____ - _______ 

Name: ___________________________      Phone: (   ) _____ - _______ 
 

I give my consent for drug and alcohol testing if requested. 

Signature of Applicant: _________________________  Date:___________ 
 

I hereby certify that the information that I have supplied is accurate

and true to the best of my knowledge. I give my consent for a driving,

criminal background and reference check to be completed by North Chatham

Volunteer Fire Department. 
 

Signature of Applicant: ________________________   Date:___________ 
 
 

04-05-2007 

APPLICATION FOR STAFF EMPLOYMENT 

YOUR JOB REQUIREMENTS: 

 
Position(s) applied for: _________________________________ 

This application is for: ☐ Full Time   ☐ Part Time 

Will you accept employment requiring? 

Night Work?  ☐ yes  ☐ no

Weekend Work? ☐ yes  ☐ no

Rotating Shifts? ☐ yes  ☐ no

Overtime?  ☐ yes  ☐ no 

Minimum annual salary Acceptable: ____________ 

Date available for work: __________  
 
 

EDUCATION AND TRAINING: 

 Circle highest Grade completed.

                                                  Ending Date:

High School ___________________________________ ______ ______  1 2 3 4 5 6 7 8 9

                  Name   Location      Month   Year 10 11 12  or GED 
 

EDUCATION BEYOND HIGH SCHOOL: 

List any N.C. State Certifications that you currently hold.( supply copy ) 

List any related courses taken that apply to the job position.(except listed above) 

List any skills or abilities you wish considered for this position. 

04-05-2007 

EMPLOYMENT RECORD: 

List your present or most recent position FIRST. If you held more than one position with any employer, list separately each position held. 

Title of present or last position _______________________ Starting Salary _____________Last/Present Salary _____________  

Employed From: _____Mo. _____Yr.    Employer: ___________________________________ 

To:   _____Mo. _____Yr.    Address:  ___________________________________

Duties:   ___________________________________ 

Supervisor’s Name And Title: _____________________________ Phone:________________ 

Reason for leaving/applying. ____________________________________________________ 

If you are employed now, may we contact your present employer regarding your

experience and qualifications?   ☐ yes  ☐ no 

Title of next to last position __________________________ Starting Salary _____________

Last/Present Salary _____________ 
 

Employed From: _____Mo. _____Yr.    Employer: ___________________________________ 

         To:   _____Mo. _____Yr.    Address:  ___________________________________

Duties:   ___________________________________ 

Supervisor’s Name And Title: _____________________________ Phone:________________ 

Reason for leaving/applying. ____________________________________________________ 

 
Title of next position __________________________________ Starting Salary _____________

Last/Present Salary _____________  

Employed From: _____Mo. _____Yr.    Employer: ___________________________________ 

         To:   _____Mo. _____Yr.    Address:  ___________________________________

Duties:   ___________________________________ 

Supervisor’s Name And Title: _____________________________ Phone:________________