SomervellCounty Volunteer Fire, Rescue, and EMS Department Membership Application

Last Name:__________________________________________First:_________________________MI:____Age:_______________

M E M B E R S H I P

DOB:______________________SSN:________________________________TDL/Class:__________________________________ Note: If you have an out of state license, you will be required to obtain a Texas license before driving of a fire department vehicle is allowed.

Home Address:_______________________________________________________________Phone#:__________________________

Occupation:__________________________________________________________________Work#:__________________________

Experience:___________________________________________________________________________________________________

______________________________________________________________________________________________________________

Certification:__________________________________________________________________________________

A P P L I C A T I O N

Have you ever been convitcted of a felony? Yes/No.  If yes explain:____________________________________

_______________________________________________________________________________________________

Note: By sigining below, you are giving SCVFD permission to conduct a driving and criminal backgroud check on you as it is a standard procedure.  Please read the following requirements that willb e expected of you as a member per calendar year before signing below.  A minimum of 60 calls  (this requires the member to participate in the "on-call" schedule monthly) at least 1 meeting per month, 25 training hours yearly, and you will complete 180-day probation adjacent with a 2-year rookie program.

Applicant Signature:_______________________________________Date:________________________

Background check clear: (Y/N)  Date:_____________________________

Please return completed application to:

SomervellCounty Volunteer Fire Department

P.O. Box 279/111 Shepard   St

Glen Rose, TX76043