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Volunteer Membership Application - Mansfield Fire Department
This form has been modified since it was saved. Please review all fields before submitting.
Cell Phone Number
Home Phone Number
Are you over the age of 18?
Why do you wish to become a volunteer with the Town of Mansfield Fire Department?
Do you hold a Valid Driver License?
List any Driver License Endorsements here:
Do you own or have regular access to a vehicle for use in responding to calls?
If convicted of any driving infractions in the past, please explain:
Have you ever been convicted of any felonies or misdemeanors:
If yes, explain. You are not required to disclose any arrest(s), criminal charge(s) or conviction(s) if the records have been erased under law. This information will not necessarily bar you from membership and will be kept confidential.
I will be required to take training courses that are mandatory by the Mansfield Fire Department and Federal and state laws
Supervisor Phone Number
Length of Employment
*If less than 2 years, provide name and address of previous employer
Previous Supervisor Phone
Length of Previous Employment
Reason for Leaving
EDUCATION & TRAINING
High School Attended
Year Graduated College
Briefly describe the following: specialized training, apprenticeships, skills or extra-curricular activities, relevant coursework, foreign language skills, etc.
List any fire departments of which you have previously been a member or afiliated with.
List any certifications you received while previously a member at a fire department.
I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be considered sufficient cause for disqualification or dismissal. I authorize the use of any information in the application to verify my statement. If accepted for membership, I agree to abide by all the rules and regulations of the Mansfield Fire Department.
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