APPLICATION

PERSONAL INFORMATION REQUESTED ON THIS APPLICATION ASSISTS THE DISTRICT IN PROCESSING AND SECURING THE NECESSARY INFORMATION TO DETERMINE ELIGIBILITY. APPLICATIONS ARE HELD IN CONFIDENCE AND CONSIDERED CLOSED RECORDS BY ORDINANCE.
DeSoto Rural Fire District Junior Firefighter Program Application

Date Of Application:

Name
Last:

First:

Middle:

Address:

Email:

Telephone:

Social Security Number:

Birthdate:

Do you have your parent’s permission to apply to be a Junior Firefighter?

Parent/Guardian:
Name
Phone Number
Address

Emergency Contacts:
Name Phone Number
Name Phone Number
Medical Information
Doctor Phone Number
Hospital Phone Number
Medical Conditions

Allergies

Do you take any medication?
If Yes, list the medication and what condition it is for:

Background Information:
(A background check will be done as well, a felony will prevent anyone from becoming a member of the DRFPD)
Have you ever been arrested, ticketed, fined, etc? (Felonies, Traffic Tickets, Misdemeanors, etc)

If Yes, Please list the date(s) and what the charge(s) were/was:

Additional Information:
What interests you the most about becoming involved with the DeSoto Rural Fire District?

Please list other activities, in detail, that you are involved in (Sports, Volunteer Work, Church, etc):