Join | Calloway County Fire-Rescue

Calloway County Fire-Rescue

Proudly serving the citizens of Calloway County, Kentucky since 1980

NOTE: THIS FORM WILL SIMPLY RELOAD UNTIL HOSTED AT CALLOWAYFIRE.ORG

Personal Information

First Name *

Last Name *

Street Address *

City *

State *

Zip *

Phone *

Email *

Age *

Sex *

Date of birth (mm/dd/yyyy) *

Height *

Weight (lbs) *

Medical Information

Physician Name

Physician Phone

Medical History (please include any allergies)

Employer Information

Place of Employment

Job Title

Supervisor Name

Work Phone

Extension

Emergency Contact

First Name *

Last Name *

Street Address

City *

State *

Zip *

Phone *

Existing Training

Firefighter training hours

State Firefighter #

Firefighter State

Firefighter Training Level

First Aid

CPR

EMT

Paramedic

Additional Information

Special skills/abilities that may benefit the department

Reason for applying for membership

Criminal record (if any)

Acknowledgement

I HEREBY ACKNOWLEDGE THAT ALL INFORMATION INCLUDED IN THIS APPLICATION IS COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT PROVIDING INCOMPLETE, MISLEADING, OR ERRONEOUS INFORMATION IS GROUNDS FOR IMMEDIATE DISMISSAL FROM CALLOWAY COUNTY FIRE-RESCUE, INC. AND/OR ANY OTHER FORM OF DISCIPLINARY ACTION DEEMED NECESSARY BY CALLOWAY COUNTY FIRE-RESCUE, INC. I ALSO GIVE PERMISSION FOR CALLOWAY COUNTY FIRE-RESCUE, INC. TO PERFORM A CRIMINAL BACKGROUND CHECK.

Signature of Applicant *