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Email *
Cell Phone *
Address (Street Number, Street Name, City, State, and Zip Code) *
Date of Birth (##/##/####) *
Drivers License Number *
Partner's Name (leave blank if you are single)
Number of Children (leave blank if you have no children under the age of 18)
Employer *
Occupation *
Length of Employment
If so, how often and what length of time?
What are your normal working hours? *
Employer Phone Number *
How Long Have you Lived in Bolivar County? *
When applying, it's important to be upfront about any significant health or fitness concerns. These won't automatically disqualify you, but they will help us determine the best role for you. If you have any questions about how a specific condition might affect your ability to perform your duties, please consult your doctor before submitting your application. It's important to understand that neither Bolivar County or the fire department can be held responsible for any injuries or health issues that arise if you don't disclose a condition on your application or upon future diagnosis. We will do our best to keep your health information confidential, but we can't guarantee complete privacy. By submitting your application, you agree to these terms. *
Please list any fire, EMS, law enforcement, emergency operations, or disaster response organization in which you currently or have previously serve. Please provide your current status with that organization (active, retired, part-time or similar description), your basic duties and responsibilities, and the name and phone number of a current member of the that organization who may be contacted to confirm the information provided. If none, please enter "NA" *
Please list any other organizations to which you belong and if or how they may impact your availability and ability to perform the duties of a volunteer firefighter. If none, please enter "NA". *
Are you a member of a military reserve unit? If so, please provide your unit contact information, current rank, MOS, and remaining service obligation (example, Army Reserve, 401st Civil Affairs Battalion, Webster, New York. I am a staff sergeant, 35G, and have 3 years left on my current contract. My unit contact is Major Strong.) 55-555-1212. If you are not a member of the military, please enter "NA". *
have how to
If you have been arrested, please explain – be sure to provide information about any convictions:
Have you ever been fired from or refused employment due to an inability to gain or maintain employment or membership in an organization due to trust related issues? Respond "Yes" or "No" and provide an explanation if and as needed. *
Please provide three references, their phone number, email address and the best time to reach them. Please inform them about your application as we will contact them. *
