Davenport Fire Department Volunteer Application

Name: Date:

Date of Birth: Address: Home Phone: Work Phone: Cell Phone:

Drivers License #: Class: Endorsement:Expiration Date:

    Marital Status: School Attended: Highest Grade:

List any special skills or training below:


Emergency Contact: Phone: Relationship:

Name of current Employer: Address: Phone:

Hrs:Type of work:

Physician:Address:Phone:

General Health: Good Fair Poor
Please list any medical problems or surgeries you have or have had in the past.


Have you ever been convicted of a crime? Yes No If yes, please explain the offense, date, location and actions taken.

List 3 references:

Name:Address:Phone:
Name:Address:Phone:
Name:Address:Phone:

The facts set forth in my application are true and complete. I understand that if elected any false statement made will be subject to dismissal. You are hereby authorized to make any investigation of my personal history deemed necessary. The info given from this investigation will be evaluated before my election. And I understand that I will be on probation for 1 year from my start date. During this time I will complete any training required and will be responsible for any equipment issued, including but not limited to proper care and maintenance and will return all equipment to Davenport Fire Department in good condition immediately after leaving.