Union Cross Fire & Rescue
4401 High Point Rd. Kernersville, NC 27284
Business/Fax (336) 769-9051
Status:
Volunteer
Paid
Date:_______________
Personal Information
First Name
Middle Init.
Street Address
Last Name
City
Zip
Driver’s License Information
License #
Home Phone #
State
Alt. Phone #
Class
Social Security #
Expiration Date
D.O.B
Education
Name of High School Attended:
City
College – Name of College or University
References
Name
State
Graduate?
Dates Attended
Graduate? Yes
No
Diploma / G.E.D. (Circle) Year
Major
(Please list three.)
Address
Phone
Experience
Please list all training and experience that you have received that you believe is relevant to
membership in the Union Cross Fire & Rescue of Forsyth County. Please include all past
memberships in other Fire Departments or Rescue Squads.
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Employment
(Most recent first.)
Employer
Job Description
Time Worked (years/months)
Reason for Leaving
Junior Firefighters Only
Parent(s) Name
Address (If different form above.)
Name of High School Attending
Grade Completed
Address
Emergency Contact Information
Name
Phone #
All Applicants will be required to submit a Court Background Check. Background checks shall
consist of a criminal history from each county the applicant has resided in for the last five years
and a certified copy of their State DMV Records. THE BACKGROUND CHECK AND DMV RECORDS
MUST BE TURNED IN WITH THE APPLICATION. Applicants will be reviewed by the membership committee
and the Chief. To determine eligibility and status, the departments manpower needs will be assessed with
priority being assigned to: 1.) Transfers, 2.) Past Experience, 3.) New Applicants. Upon acceptance of your
application, you will begin a probationary and introductory training period. This period will be for six months.
Typical training will consist of at least three training meetings a month; two fire meetings and one squad
meeting. Each member must earn at least 36 hours of training a year. These hours must be accumulated at a
rate of at least nine hours every quarter. The members abilities and attitude will be reviewed regularly to assure
that the proper interest is comparable to the time, expense, and effort involved in the training process. No
compensation is involved for volunteer services. While a member you have an obligation to yourself, fellow
firefighters, and the citizens we serve. You shall adhere to the rules, regulations, and laws that govern this
organization. Our actions can affect the lives and well being of others. Union Cross Fire and Rescue of Forsyth
County, Inc. is an equal opportunity organization and does not discriminate on the basis of race, gender, creed,
or nationality.
I _______________________, while a member of Union Cross Fire and Rescue of Forsyth County, Inc.
agree to abide by the rules, regulations, and policies of this department.
Signature:
____________________________________
Date:
_________________________
Chief:
____________________________________
Date:
_________________________
Department Use Only
Interviewed By
Interview Date
Background Check
Probationary Period
From:
To:
Initiated Files
Comments:
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