Sherman County Rural Fire Department
1006 East 8th Street
Goodland, Kansas 67735
Phone 785-890-7460

APPLICATION FOR MEMBERSHIP
Please complete and return to Chief David by 1. Mail to 824 Colorado, Goodland, KS 67735 2. Return to where you received it. 3. Turn in at Court House, 813 Broadway Goodland, KS.
Type or print clearly in black or blue ink. Answer all questions.
NAME:Last First Middle SS#:
ADDRESS: City State Zip
PHONE: DATE OF BIRTH DRIVER'S LICENSE STATE
EDUCATION
HIGH SCHOOL:Name/Address Major Degree
Diploma
COLLEGE:Name/Address Major Degree
Diploma
TRADE,BUSINESS,OTHER:Name/Address Major Degree
Diploma
SPECIAL SKILLS AND QUALIFICATIONS:List job-related licenses, skills, training, honors,
awards, and special accomplishments:________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
EMPLOYMENT HISTORY
Start with Present or Last Position
Employer: Address:
Phone: Supervisor:
Position Title: From:               To:
Duties: Reason for Leaving:
Employer: Address:
Phone: Supervisor:
Position Title: From:               To:
Duties: Reason for Leaving:
Employer: Address:
Phone: Supervisor:
Position Title: From:               To:
Duties: Reason for Leaving:
MAY WE CONTACT YOUR PRESENT EMPLOYER? YES NO





References Excluding Relatives and Former Employers.
Name: Occupation: Phone: Relationship:
Name: Occupation: Phone: Relationship:
Name: Occupation: Phone: Relationship:

Employer approved you joining the RFD? Employer's Approval Signature
Have you had any previous training of experience on any Fire Department?________
If yes please explain in detail:______________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Please give your reasons for wanting to join the Sherman County RFD:________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please feel free to attach an optional resume. We are an equal opportunity employer and do not discriminate based on race, color, creed, religion, gender, ethnicity, or national origin.
I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT ANY FALSE INFORMATION ON THIS APPLICATION MAY BE GROUNDS FOR NOT HIRING ME.  I am fully, without reservation, consenting to a background investigation, pre-employment drug, alcohol, and tobacco screening, as well as any additional research or investigation that the Fire Chief of his/her designee determines necessary to screen me for potential duties. I am giving my full permission for the potential employer to contact any name, business, or other contact included or not included on this application that I may have been associated with in the past that may have knowledge useful in a background investigation.

Date:_____________ Signature______________________________________


Fire Department use only * Application Approved or Disapproved _________________


Date ____________ Initial of Chief _________ Ass Chief ________ Officer ________


Comments________________________________________________________________________

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Sherman County Rural Fire Deptartment * Chief Alan David
Volunteer Application* Updated 25 April 2006