Wise Co ESD#1                                                                545 S. Allen / P.O. Box 445                           Boyd, Texas 76023                                                  940-215-7937
Dear Applicant,

Thank you for considering volunteering for the Wise Co ESD#1.

This application packet is intended for the use of the Wise Co ESD#1.  You must be truthful and complete all answers requested on these forms.  Information contained herein will be considered to be strictly confidential and will not be disclosed to any unauthorized persons.

The answers to questions contained in this application must be printed, legibly, and in ink only. Each individual question must be answered.  If a particular question does not apply, insert N/A in that blank.

Applicants are cautioned to answer every question truthfully, to the best of your ability, and without evasion. Any false statement of a material fact or for giving any fraudulent or deceptive answer will automatically result in dismissal. Items that need to be turned in with this application include a photocopy of your driver license.

On behalf of the Wise Co ESD#1 and its members, we are honored you chose to apply with us.

Thank you
Wise Co ESD#1

Sign in to Google to save your progress. Learn more
Application for Membership
Name *
First,   MI,     Last
Address (#, Street, City, Tx, Zip) *
Email *
Phone number *
Social Security Number *
Driver’s License Number *
Date of Birth *
MM
/
DD
/
YYYY
Have you been a member with us before? *
Required
Have you ever filed an application with us before? *
Required
May we contact your present employer? *
Required
Have you ever been convicted of a felony within the last  7 years? *
Required
Have you had more than 3 moving violations within the last 3 years? *
Required
Do you have a conviction for driving under the influence (DWI / DUI) within the last 7 years? *
Required
Do you have any convictions for any Class A or Class B Misdemeanor with the last 3 years? If Yes, please explain *
Required
If Yes, please explain
List TCFP, SFFMA, all fire certs. Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Employment
Employer *
Address *
Telephone Number *
Job Title *
How Long Employed? *
Supervisor *
References
Name                Telephone Number *
References
Name                Telephone Number *
References
Name                Telephone Number *
Applicant’s Statement
I certify that answers given herein are true and complete to the best of my knowledge.  I authorize investigation of all statements contained in this application for membership as may be necessary in arriving at a membership decision.  I hereby understand and acknowledge that, unless otherwise defined by applicable law, membership with this organization is of an “at will” nature, which means that the member may resign at any time and the Chief and/or Assistant Chief may discharge membership at any time.  In the event of membership with the Boyd Fire Rescue, I understand that false or misleading information given in my application or interview(s) may result in dismissal.  I understand, also, that I am required to abide by all rules and regulations.

Signature of Applicant *
Date *
MM
/
DD
/
YYYY
AUTHORIZATION TO COLLECT BACKGROUND INFORMATION
I have applied for membership as a volunteer firefighter with the Boyd Fire Rescue. I authorize investigation of all statements contained in this application for membership as may be necessary in arriving at a decision. I authorize representatives of the Boyd Fire Rescue to obtain pertinent information from my previous employers, references, and other persons with knowledge of my work history and background, education, regulatory or police records, driving records, licensing status or professional designation, and character or reputation, and to consider the information provided by the background check when making decisions regarding my membership as a volunteer firefighter with the Boyd Fire Rescue.

I authorize all previous employers, references or other persons having knowledge of my record or myself to release such information to the Boyd Fire Rescue, and hereby release all persons from liability for any damage that may result from furnishing such information to the Boyd Fire Rescue
 
A photocopy of this authorization may be accepted in lieu of the original.

Signature of Applicant *
Date *
MM
/
DD
/
YYYY
CRIMINAL BACKGROUND
NOTE: THIS PORTION OF THE APPLICATION WILL ONLY BE REVIEWED BY MEMBERS OF THE Boyd Fire Rescue (OR THE PERSON(S) IN CHARGE OF MEMBERSHIP) AND ANYONE INVOLVED IN INTERVIEWING THE APPLICANT.
 
Have you ever been convicted of or pleaded guilty or nolo contendere (no contest) to, a violation of any state, federal, county or municipal law? (Do not include minor traffic violations) 
 
If yes, please give information regarding the nature of the charge, the date and location of conviction and the final disposition of the case:
Applicants are not required to disclose the existence of an arrest, criminal charge or conviction for which records have been “erased.” The types of records subject to erasure under Texas law are as follows: (a) a finding of delinquency or that a child was a member of a family with service needs; (b) a sentence as a youthful offender; (c) a criminal charge that was dismissed or “nolled”; (d) a criminal charge for which the person was found not guilty; and (e) a conviction for which the person received an absolute pardon. Any applicant whose criminal records were erased will be considered to have never been arrested and may so swear under oath.
I understand that the information provided above will not necessarily result in the rejection of my application, but that the nature of the information will be considered as it relates to the performance of the firefighting duties in question and in light of the requirements of state and federal law.

*
Required
Applicant’s  Signature: *
NOTICE TO APPLICANTS REGARDING PRE-MEMBERSHIP DRUG TESTING
Any individual applying for volunteer membership with the Boyd Fire Rescue shall submit to a urinalysis drug test as a mandatory part of the application process. This notice serves as a written statement of the Department's intention to conduct such testing as part of the application process. The testing will be conducted by a certified laboratory/testing service selected by the Boyd Fire Rescue, in accordance with the procedures required by applicable state and federal regulations.

Tested applicants will be given a copy of any positive test result. All test results shall be considered confidential by the Boyd Fire Rescue and shall not be disclosed to the members of Boyd Fire Rescue or any other person, other than to those persons for whom such disclosure is necessary. Positive test results, or a refusal to sign this consent form and participate in pre-employment drug testing, shall be grounds for denial of membership. Arrangements for testing will be made by a representative of the Boyd Fire Rescue, in consultation with each applicant. Cooperation in scheduling the testing is important for processing an application.
 
By signing below, you consent to be drug tested and acknowledge you have thoroughly read the foregoing notice and policy, and you understand and agree that in order to be considered for membership with the Boyd Fire Rescue, you will comply in full with the Boyd Fire Rescue drug testing policy.

 Applicant Signature *
Date *
MM
/
DD
/
YYYY
*Digital signature*
The Electronic Signatures in Global and National Commerce Act (ESIGN, Pub.L. 106–229, 114 Stat. 464, enacted June 30, 2000, 15 U.S.C. ch. 96) is a United States federal law passed by the U.S. Congress to facilitate the use of electronic records and electronic signatures in interstate and foreign commerce by ensuring the validity and legal effect of contracts entered into electronically. In 2010, both House of Congress passed a resolution at the request of industry leaders, recognizing June 30 as "National ESIGN Day."[1]

Although every state has at least one law pertaining to electronic signatures, it is the federal law that lays out the guidelines for interstate commerce. The general intent of the ESIGN Act is spelled out in the very first section(101.a), that a contract or signature “may not be denied legal effect, validity, or enforceability solely because it is in electronic form”. This simple statement provides that electronic signatures and records are just as good as their paper equivalents, and therefore subject to the same legal scrutiny of authenticity that applies to paper documents.[2]
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of WCESD. Report Abuse
Google Forms