Griswold Fire and Rescue Department Application for Membership

Griswold Fire and Rescue Department is dedicated to a policy of non-discrimination for membership.

For your security, please don't type a Social Security Number into this form. City Hall will collect that from you separately, by phone or in person, once your application is received.

Name (last, first, middle)Current addressCity, state, ZIPPhoneDate of birthEmailDriver's license # and endorsements

Are you legally authorized to work in the U.S.?

YesNo

Do you have any physical or health limitations that could interfere with your performance on the job for which you are volunteering?

YesNo

If yes, please explain

Have you ever been convicted of a felony?

YesNo

If yes, please explain the nature of the offense, the date, and applicable charges

Employer

OccupationCurrent employerEmployer's phone

Your employer will also need to sign a release allowing you to leave work for emergency calls — we'll follow up separately to collect that signature.

Relevant experience (most recent first, up to 5 years)

Applicant's signature

Type your full legal name to signI certify the information in this application is true and accurate to the best of my knowledge.