Please print the following application and questionnaire, complete and return by mail or in person to the: 

UMATILLA RURAL FIRE PROTECTION DISTRICT # 7-405
921 6TH STREET / PO BOX 456 UMATILLA, OREGON 97882
PHONE # 541-922-3718 / FAX 541-922-3914

APPLICATION FOR MEMBERSHIP 

     
NAME: _______________________________________________________________________________
                              LAST                                       FIRST                                                   MIDDLE                                      
MAILING ADDRESS:  __________________________________________________________________
 
PHONE :  ____________________________________________________________________________
PHYSICAL ADDRESS:  ________________________________________________________________
SOCIAL SECURITY NUMBER:  _________________________________________________________
DRIVERS LICENSE NUMBER:  _________________________________________________________
ARE YOU OVER 18 YEARS OLD? _______________                                                              SEX:  M    F 
HAVE YOU BEEN CONVICTED OF A FELONY IN THE LAST SEVEN YEARS ?_____________
REFERENCES:
Please Include Name, Address & Phone No.
1)

 

 
2)

 

 
3)

 

 

 

EDUCATION

GRADE COMPLETED:  
 
DEGREE / DIPLOMA :  
 
SPECIAL SKILLS OR TRAINING:

 
WHERE TRAINED:

 
MILITARY SERVICE:

 
MILITARY TRAINING:

 
ARE YOU CURRENTLY UNDER A DOCTORS CARE?
WHY?

 
DO YOU HAVE ANY PHYSICAL LIMITATIONS THAT WOULD PREVENT YOU FROM PERFORMING ANY TASK ASSIGNED?

 

EMPLOYMENT HISTORY
 
EMPLOYMENT: PLEASE LIST PAST AND PRESENT EMPLOYERS, INCLUDE CONTACT PERSON
NAME OF EMPLOYER, ADDRESS AND PHONE NUMBERS.
 
EMPLOYER:
 
ADDRESS:
 
CONTACT PERSON:                                                                                              PHONE #
 
EMPLOYER:
 
ADDRESS:
 
CONTACT PERSON:                                                                                              PHONE #
 
EMPLOYER:
 
ADDRESS:
 
CONTACT PERSON:                                                                                              PHONE #
 
FIRE DEPARTMENT EXPERIENCE:
PLEASE LIST ANY FIRE DEPARTMENTS THAT YOU HAVE BEEN A MEMBER, INCLUDE CHIEF NAME AND PHONE #:

 

 

 
PLEASE LIST ALL FIRE AND EMS CERTIFICATIONS AND LEVELS:

 

 

 

 

Volunteer Work/Schedule Questionnaire

 By answering these questions, you are helping us to provide better fire protection for the residents of this District.  We will attempt to recruit people who work or are available at times when others are not.  This will help to ensure that somebody is available around the clock.

1.    What type of work do you do?

 

2.    What special work related skills do you possess, that you feel may be useful to the Fire District.?

 

3.    What days of the week do you normally work?

 

4.    What hours of the day do you normally work?

 

5.    Will your schedule rotate, i.e. swing for six weeks, grave then days etc…?

 

6.    Do you have regularly scheduled activities that keep you busy on your days off, such as childcare issues etc…?

 

7.    Where do you work, the town or location only?  You do not have to give your employers name if you so desire?

 

8.    Would your employer allow you to leave work if we had a major incident?

 

9.    Will your schedule allow you to attend regular drill meetings every Tuesday night?

 

10. Is there anything else that you know of that would preclude you ability to participate with this Fire District on a regular basis?

 

UMATILLA RURAL FIRE PROTECTION DISTRICT
VOLUNTEER APPLICATION

Please complete all attached forms.

Attach the following information to each application packet.

Photo copy of :             Driver License

                                    S.S. card

                                    1st Aid card

                                    CPR card

Please include a copy of any and all EMS and Fire Certifications.

Please include all information into packet and return to the fire station.

 

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