Return Application To: Attn: Volunteer Coordinator City of Peoria Fire Department 8351 W Cinnabar Street Peoria, AZ 85345 CITY OF PEORIA FIRE DEPARTMENT VOLUNTEER APPLICATION DATE OF APPLICATION_________________________ LAST NAME________________________ FIRST NAME___________________ ADDRESS____________________________APT#_______ CITY____________ ZIP______ HOME PHONE________________________ WORK_____________________ EMERGENCY CONTACT______________________________________________________ PREVIOUS VOLUNTEER EXPERIENCE:___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ SPECIAL SKILLS, TRAINING, HOBBIES_______________________________________________________________ ________________________________________________________________________________________________________________________________________________ WORK EXPERIENCE___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ EDUCATION: High School Diploma/GED: Yes_____ No_____ College: Name of School____________________Degree Received_______________ TYPE OF VOLUNTEER WORK DESIRED______________________________________________________________________________________________________________________________________________ Return Application To: Attn: Volunteer Coordinator City of Peoria Fire Department 8351 W Cinnabar Peoria, AZ 85345 Please complete both pages PERSONAL REFERENCES (Persons not related to you) Name address phone years known 1_______________________________________________________________________ 2_______________________________________________________________________ 3.______________________________________________________________________ Hours Available On_____________________________________________________________________ Mon Tue Wed Thu Fri Sat Sun How Did You Hear about the Peoria Fire Departments Volunteer Program? ________________________________________________________________________ ________________________________________________________________________ Have you ever been arrested and/or convicted of a felony or misdemeanor? Yes_____ No_____ If yes, please Explain:_________________________________________________________________ ________________________________________________________________________ Date of Birth: __________ AZ Driver’s License/ID Number: _______________ Do you have medical insurance? Yes_____ No_____ I understand that for security reasons a basic background check will be conducted and I will be fingerprinted. Additional background information, including a polygraph, may be requested if a specific volunteer assignment calls for a thorough security check. I hereby release you, your agency, or others from liability or damage which may result from furnishing the information requested. I understand that falsifying statements on this application or during the interview process is cause for my immediate dismissal from the volunteer program. Signature_____________________________________________Date_______________