Fire Academy Application

High School

City, County, State

From

To

Did you graduate?

If no, Did you get your GED?

College/University:

City, State

From

To

Did you graduate?

Degree

Major

Technical School:

City, State

From

To

Did you graduate?

Degree

Major

Are you currently affiliated with a fire or rescue department?

If yes, list Department Affiliation:

List other courses, workshops, and educational experience which relate to firefighting:

Company:

Phone

Address

Supervisor

Job Title

Start Date

End Date

Company:

Phone

Address

Supervisor

Job Title

Start Date

End Date

Full Name

Relationship

Phone

Full Name

Relationship

Phone

State and Federal regulations State and Federal regulations prohibit discrimination based on race, sex, color, age, or handicap. The information requested below will in no way affect you as an applicant; its sole use will be to see how well our recruitment efforts are reaching all segments of the population.

Date of Birth

Sex

Ethnic Group

If other, please clarify

I certify I certify that my answers are true and complete to the best of my knowledge. I authorize investigation of all statements contained in the application for GTCC Firefighter Academy as may be necessary in arriving at an acceptance to the Academy. In the event of acceptance to the Academy, I understand that false or misleading information given in my application or interview(s) may result in discharge from the Academy. I understand, also, that I am required to abide by all policies and procedures of Guilford Technical Community College. Entrance to the Fire Academy will be contingent upon satisfactory completion of a physical agility assessment test and satisfactory completion of a reading comprehension placement test. I also authorize the use of any photos or other media that may be taken during the Academy for the use of advertising the Firefighter Academy now and in the future.

Signature *

Date *

Initials *