For Office Use Only

Date Hiring Period

Began: .
Family Interview
Complete:

For Office Use Only DOT Physical Has

Been Done:
Sponsor assigned to
this member: Driver/Criminal
Check Done:
. Date Hired by
Station Assignment: Personnel: .
Approved by Board/
. Council:

The Stevensville Volunteer Fire Department (SVFD) makes decisions regarding applicants without regard to Race, Color, Sex,
National Origin, Religion, Marital Status, Age, Prior industrial injury, Mental or Physical Handicaps or any other protected classification
unrelated to job performance. Please complete ALL parts of this application, ALL incomplete applications will not be considered.
The completion of this application does not indicate that there are vacant positions currently available, and in no way obli-
gates this department or the town of Stevensville.
Should you be offered a membership with this department, such membership is contingent upon supplying the proper identifi-
cation and authorization documentation, educational certifications, physical fitness certifications, as well as pending criminal history
and drivers history background checks.

Applicants Name .
Date Submitted .
Applicants Signature .

Cover Sheet 1