Become a Firefighter

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BECOME A FIREFIGHTER

Info & Requirements

Chackbay Volunteer Fire Department is an Equal Opportunity organization. We do not discriminate on the basis of race, color, religion, national origin, age, gender, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions are based on membership and volunteer position factors. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon volunteer position information.

*Must be eighteen (18) years or older to apply.

Please complete the application and a representative will get back to you shortly.

Application for Membership

Section 1: Personal Data

* Indicates required field

First Name *

Middle Initial *

Last Name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Age *

Phone Number *

Email *

Social Security Number (Last 4) *

Date of Birth *

Drivers License Number *

Allergies / Medical Problems *

EMERGENCY CONTACT INFO:

Name *

First

Last

Relationship *

Phone Number *

Section 2: Employment

Current or Most Recent Employer *

Occupation *

City You Work In *

Days and Hours You Work *

Section 3: Experience and Training

Were you previously/currently a member of another Fire Department? *

Yes No

If Yes, List the Department(s) *

Do you have any Firefighting, EMS, or Rescue Experience? *

Yes No

If yes, Please Explain *

Please check any of the following that apply to you currently *

First Responder (EMR) EMT Paramedic CPR Certified Instructor (I, II) Firefighter 1 Firefighter 2 Firefighter 3 Fire Officer (I, II) NIMS (100, 200, 700, 800) Rope Rescue

Other *

Section 4: Past History

Have you ever been convicted as an adult, of a criminal offense? (Not including minor traffic violations) *

Yes No

Have you had your driver’s license suspended or revoked within the last 3 years? *

Yes No

Have you ever applied for membership in the Chackbay Vol. Fire Department before now? *

Yes No

Are you required to register as a Sex Offender? *

Yes No

Have you ever been turned down for membership in any other Fire/Rescue/EMS department? *

Yes No

Have you been convicted of a DWI/DUI within the last 5 years? *

Yes No

If you answered yes to any question above, explain below *

Section 5: Miscellaneous Information

Briefly Describe Why You Are Interested in Membership with the Chackbay Volunteer Fire Department *

Section 6: Certifications and Authorization

I certify that I have read and that I fully understand this application. I also certify that all of the information is true and complete to the best of my knowledge.

By accepting the terms of this application, I am acknowledging that I understand that should any information given on, or as a result of this application, be false, misleading, or erroneous, it may result in the rejection of my application for membership, or my discharge from the Chackbay Volunteer Fire Department. I hereby give permission to the Chackbay Volunteer Fire Department to conduct a criminal background check and a driving violation check through an authorized law enforcement agency.

I agree to abide by all By laws, Policies and Procedures, Regulations and other directives of the Chackbay Volunteer Fire Department, as well as all laws, rules and regulations of the State of Louisiana and the Parish of Lafourche. I agree to assist, to the best of my ability, in the voluntary work necessary for the operation and maintenance of the Chackbay Volunteer Fire Department.

I understand that completing and signing this application is not a guarantee for admittance into the Chackbay Volunteer Fire Department and that a decision must be made by the general membership of the Chackbay Volunteer Fire Department.

Do you verify that you are over the age of 18 and accept the terms stated above *

I Accept

Submit

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