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