APPLICATION FOR MEMBERSHIP

Harris Township is an equal opportunity employer and will not exclude any applicant from employment consideration on a basis prohibited by local, state, or federal law.

Personal Information

First Name^*

Middle Name

Last Name

Address

Address Line 1 ^*

Address Line 2

City ^*

State or Region ^*

Country ^*

ZIP ^*

Email^*

Enter email again^*

Phone^*

Do you have a valid State of Ohio Driver License?

Do you hold a Driver License in any other State.

Has your Driver License ever been suspended or revoked?

Have you been involved in any traffic accidents where you were cited?

MEMBERSHIP ELIGIBILITY

Are you legally eligible to work in USA?

Are you willing to submit to a background check?

Are you willing to submit a controlled substance test.

High School

Name of High School

State, City

College/University

State, City

Other

State, City

CURRENT EMPLOYMENT

Current employer (company/Individual)

Employer Address

Address Line 1

Address Line 2

City

State or Region

Country

Zip

Working hours/days

REFRENCES (excluding relatives and employers)

First Name (ref1)

Last Name (ref1)

Phone (ref1)

Address (ref1)

Address Line 1

Address Line 2

City

State or Region

Country

Zip

First Name (ref2)

Last Name (ref2)

Phone (ref2)

Address (ref2)

Address Line 1

Address Line 2

City

State or Region

Country

Zip

Cover Letter, Resume, & References

QUESTIONNAIRE

Firefighting is a physically demanding job requiring mobility and endurance. Firefighter’s protective clothing and equipment are heavy and restrictive and must be worn during extreme hot and cold temperatures

Do you have any physical limitations that need to be consider?

Firefighters are expected to climb to high areas while fighting fires or assisting with rescues

Are you bothered by heights?

Fire and rescue personnel frequently are involved at vehicle accidents and other rescues which may involve the extrication of badly injured victims from very difficult situations.

Would injured victims and/or the sight of blood affect your ability in rescue operatio

Firefighter candidates in Ohio are required to attend a 36-hour training course and pass a test to become certified as a volunteer firefighter. Emergency Medical Technician (E.M.T) candidates in Ohio are required to attend at least 135 hours of training and pass an examination before becoming an EMT-basic. Candidates for membership are required to complete certification classes within one (1) year of being approved for membership by the township trustees.

Can you make time to attend the required State of Ohio training?

Volunteer Firefighters and E.M.T.’s are required to obtain yearly training, usually performed “in-house” during regularly scheduled drills/meetings. Additional continuing education is also highly encouraged. Other training opportunities consist of mutual aid drills which are occasionally scheduled on “off” nights or weekends with neighboring departments

Can you attend monthly scheduled drills/meetings and/or other training activities?

Although this is a volunteer organization, a commitment of time, dedication, and responsibility to the duties of the fire service and this organization must be maintained by each firefighter and EMT. It is essential that department members cooperate with mutual respect for each other and the public we serve.

Are you prepared to make the commitment to the Harris-Elmore Fire Department^*

Why would you like to join this department?^*

Have you ever been a member of a fire department, emergency medical service, or in a related field prior to submitting this application for membership?

Previous member of a fire department, emergency medical service?

Service and Location

Disclaimer^*

I hereby submit my application for membership in the Harris-Elmore Fire Department. I authorize the Harris
Township Trustees to make any investigations of my criminal, motor vehicle, and education histories or any
other related affairs as maybe necessary in arriving at a membership decision. I also release all persons from
liabilities in responding to inquiries regarding my application. I understand that discovery of false or misleading
information in my application may result in my termination from the department. I agree to abide by the Harris
Township personnel manual, the Harris-Elmore Fire Department organization’s constitution and by-laws, the
department’s Standard Operating Guidelines, and the chain of command. I shall be an active member of the
organization and perform my duties to the best of my ability.

I accept