Please complete the following form.  Include all relevant information that will help us with our decision.

Full Name (First - M.I. - Last) (required)

Address (required)

City (required)

State and Zip Code (Required)

Length of Residency at current address? (required)

Cell Phone (required)         Home Phone (required)
             

Birth Date (required)

Age (required)

Your Email (required)

Military Service & Branch (required)
    

Drivers License Number and Expiration Date (required)
     

Height (6-0)       Weight         Glasses/Contacts (required)
              

Do you have any social / emotional, physical or mental disabilities? Please Explain. (required)

Employment History

Present or most recent employer (required)

Address                                  Phone (required)
    

Job Title                                  Supervisor (required)
    

Previous employer (required)

Address                                  Phone (required)
    

Job Title                                  Supervisor (required)
    

References

Name                                 City                             State (required)

Phone                               Years Known (required)

Name                                 City                             State (required)

Phone                               Years Known (required)

Education and Training

High School                         City                             State

Year of Graduation or GED

College                               City                             State

Did You Graduate Year

Are you currently, or do you have have previous Fire/Rescue Department Affiliation

Department                               Membership Dates
    

List ranks as well as relevant training and certification information

Please upload all relevant certifications







CPR Certified Expiration Date

Current EMT Certified Level

Miscellaneous Information

Have you ever been convicted of a felony? Year

Have you applied for the Granger Fire Department before? ? Year