Membership Application

Background Information

How did you find out about Wheaton Fire & Rescue?

Have you applied to WF&R in the past? *

Yes No

Have you been a member of WF&R in the past? *

Yes No

If yes, dates of service

Have you been a member of a fire department in the past? *

Yes No

If yes, list department name(s) and dates of service

Are you legally eligible for employment in this country? *

Yes No

Proof of U.S. citizenship or immigration status may be required

Education and Training

Name and location of high school attended

If you did not complete high school, do you have a GED equivalency?

Yes No N/A (Completed High School)

Training beyond high school (College, University, other schools)

Relevant training, certifications, licenses, or volunteer work

Organizations, honors, or awards

Work Experience

Provide a description of your past work experience, starting with your most recent job. Include service in the armed forces.

Most Recent Employment

Employer / Supervisor Name

Business Name & Address

Job Title / Duties

Dates Employed

Reason for Leaving

Previous Employment

Employer / Supervisor Name

Business Name & Address

Job Title / Duties

Dates Employed

Reason for Leaving

Additional Employment (Optional)

Employer / Supervisor Name

Business Name & Address

Job Title / Duties

Dates Employed

Reason for Leaving

May we communicate with your present/past employers? *

Yes No

Can you perform the essential duties of the job with or without accommodations? *

Yes No

Agreement & Signature

It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from WF&R service if I have been approved for service. I give WF&R permission to investigate all references and to secure additional information about me, if job related. I hereby release from liability WF&R and its representatives for seeking such information and all other persons, corporations and/or organizations for furnishing such information.

Wheaton Fire & Rescue is an equal opportunity entity. No question on this application is used for the purpose of limiting or excluding any applicant's consideration for service on a basis prohibited by local, state or federal law.

All EMR / EMT applicants shall have successfully completed CPR/AED for the health care provider from the American Heart Association and possess current (within the past 2 years) training credentials for either First Responder, EMT, or Paramedic.

I have read and understand the articles of the application. By typing my name below, I am providing my electronic signature. *

Electronic Signature (Type Full Name) *

Date *

Applicants under 18: If you are under 18 years old, a parent or legal guardian must also sign this application. Please contact us to complete the additional authorization.

Personal Information

Current Address

Contact Information

Driver's License

Background Information

Education and Training

Work Experience

Most Recent Employment

Previous Employment

Additional Employment (Optional)

Agreement & Signature