JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
NewBrook Fire and Rescue Volunteer Application
NewBrook Fire Department
698 Vermont Route 30
P.O. Box 77
Newfane, VT 05345
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
First, Last, Middle Initial
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Address
#, Street, City, State, Zip
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Under 18?
Yes
No
Clear selection
Employment Information
Current Employer
Phone Number
Job Title
Address, City, State, Zip
Hire Date
Responsibilities
Supervisor
*
Your answer
Emergency Contact Information
Name
Relationship
Phone Number
*
Your answer
What would you like to do at NBFD?
*
Fire
Rescue
Bingo
Fund Raising
Being a Junior Fire Fighter
Other:
Required
Do you have any experience in the above, or any certifications?
*
No
Other:
Available Days?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Required
Available Night?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Any restrictions (ladders, use of air-paks etc.)
*
No
Other:
Are you a US Citizen
*
Yes
No
Have you ever been convicted of a misdemeanor or felony offense or traffic charge?
*
Yes
No
Do you have any pending charges against you at this time?
*
Yes
No
If "yes" to above questions, provide full details here.
Please Note that misdemeanor, felony, or traffic convictions / offenses do not necessarily exclude you from membership with NBFD
*
N/A
Other:
Do you have a valid Vermont drivers license?
*
Yes
No
License number
*
Your answer
Short medical history
*
Your answer
Reference
Name
Relationship
Phone Number
Address
*
Your answer
Reference
Name
Relationship
Phone Number
Address
*
Your answer
NewBrook Sponsor
*
Your answer
What is the best way to contact you?
*
Email
Phone Call
Text
Acknowledgement
I have read the above acknowledgement and agree to all terms
*
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms