Fire Department ApplicationPlease 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) NoneYesNo NoneArmyAirforceNavyMarinesCoast GuardIowa National GuardOtherDrivers License Number and Expiration Date (required) Height (6-0) Weight Glasses/Contacts (required)   NoneGlassesContactsDo 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 TrainingHigh School City   State Year of Graduation or GED College City   State Did You Graduate N/AYesNo Year Are you currently, or do you have have previous Fire/Rescue Department Affiliation YesNoDepartment   Membership Dates List ranks as well as relevant training and certification information Please upload all relevant certifications CPR Certified YesNo Expiration Date Current EMT Certified YesNo Level Miscellaneous Information Have you ever been convicted of a felony? YesNo Year Have you applied for the Granger Fire Department before? ? YesNo Year