On Line Application

On Line Application

Use this form to submit an application to become a member of our organization.  We'll contact you shortly.  

 

  • Insurance restrictions prohibit the acceptance of applications from persons less than 18 years of age.  

 

  • Applicants must live within 5 miles of 102 E. Main Street, Carterville, Missouri.

 

  • While the Carterville Volunteer Fire Department is not an "employer" per se, our Equal Opportunity Policy encourages and supports membership to qualified applicants judged solely on their physical and mental ability to perform required duties, recommendations from previous or current employers or members, prior driving record, and prior criminal record (if any).

 

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Enter yout full, legal name.
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Enter your Social Security number in the form: xxx-xx-xxxx.
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Enter your street address. No PO Boxes.
Enter a second address line, if required. (Apartment number, for example.)
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Select your city. Only nearby cities are listed.
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Enter your 5 or 9 digit Zip Code.
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Enter your area code and phone number.
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Enter your E-Mail address.
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Enter your date of birth in the form mm/dd/yyyy. Your birth date will be used to help identify you in background checks.
Enter your height in feet and inches in the form: X' XX".
Enter your weight in pounds.
Describe in detail any physical disabilities that would prevent you from engaging in strenuous physical activity in a dangerous environment.
Rate your current overall health condition.
Select your marital status.
Have you served in the military?
Service Branch.
Enter your dates of military service: mm/dd/yyyy to mm/dd/yyyy.
How were you discharged?
Select the highest education level you completed.
Enter the name and address of the last school you attended, whether or not you graduated.
Enter the date you last attended the school listed above: MM/YYYY
Select Yes or No.
Enter your current employment status.
Enter the time of day you primarily work.
Enter your current occupation.
Enter the name and address of your current employer.
Enter the name and work telephone number of the person we should contact to verify your employemnt. IF YOU DO NOT WANT US TO CONTACT YOUR EMPLOYER - LEAVE THIS FIELD BLANK.
Select the number of years you have worked at your current job.
Name, address and telephone number of first person, not living with you, that we can contact as a personal reference.
Name, address and telephone number of second person, not living with you, that we can contact as a personal reference:
Name, address and telephone number of third person, not living with you, that we can contact as a personal reference.
Have you ever been a member of a Fire Department, Rescue Squad, or Ambulance Service?
If yes, why did you leave?
Enter the name, address and telephone number of the prior emergency service agency you were affiliated with along with a contact person's name. IF YOU DO NOT WANT US TO CONTACT THE AGENCY THEN DO NOT PROVIDE THE INFORMATION.
List any special training you've received that you think would be helpful to us.
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Briefly explain why you would like to become a member of our department.
If you have ever been convicted of a felony, provide detailed information in the space provided.
List all moving traffic violations and dates for any violations you were convicted of or plead guilty to.
BY TYPING MY NAME AND SELECTING "I Agree" BELOW, I AUTHORIZE INVESTIGATION OF ALL STATEMENTS IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL. FURTHER, I UNDERSTAND AND AGREE THAT, IF ACCEPTED, MY SERVI
Do you agree to the above?
Type your name here only if you agree to the disclaimer above.
 

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