Union Road Volunteer Fire Department Inc.

Firemans Prayer

When I am called to duty, God
whenever flames may rage,
give me the strength to save some life
Whatever be its age.

Help me to embrace a little child
before it’s too late,
or some older person
from the horror of that fate.

Enable me to be alert
and hear the weakest shout,
and quickly and efficiently
to put the fire out.

I want to fill my calling
and give the best in me,
to guard my neighbor
and protect his property.

and if according to my fate

I am to lose my life,
Please bless with your protecting hand
my children and my wife.

- Author Unknown.

Remember Our Fallen

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Upcoming Events

Every 1st Tuesday

7:00pm

Department Meeting with Training to Follow

Every 2nd Wednesday

7:00pm - 9:00pm

Ladies Auxilliary Meeting

Every 2nd Saturday

9:00am

Probationary FireFighter Training - Station 51

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Application

Application

For

Union Road Volunteer

Fire Department

Last Name _________________ First Name____________

Middle Name ______________ Date: _______________

I. Personal Data

Address______________________________________________________________

Street and Apartment Number City State Zip

Home Telephone_________________ Work Telephone ____________________

Cell Number ____________________ Date of Birth _____/______/_______

Social Security # ________-_____-________ Drivers License # & State _____________

Are you a United States Citizen? Yes _____ No ______

If no, are you eligible for employment in the United States?

Do any of your relatives work for us? Yes _____ No ____

If yes, list the names and relationship: _______________________________________________________________________

______________________________________________________________________

Have you served in the U.S. Armed Forces? Yes ____ No ____

If yes, Branch _______________ Dates ________ to _________

Highest Rank Attained _______________ Occupational specialty _______________________________________________________________

Have you ever been convicted of a crime other than a minor traffic violation? (Does not automatically disqualify you.) Yes ______ No _____ If yes, list date, place and disposition of case: _______________________________________________________

Education Information

Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 / GED /

College 1 2 3 4 / Graduate school 1 2 3 4

Schools Name & Location Dates Attended Graduate Degree Major_

High School_____________________________________________________

College or

University_______________________________________________________

Graduate or

Professional_____________________________________________________

Business

Trade or

Military_________________________________________________________

EMPLOYMENT HISTORY

List below your previous work experience. Start with your most recent position and back in time. Please include service in the U.S. Armed Forces and any self employment. Use continuation sheet if more space is needed.

LAST OR CURRENT JOB

Employer ___________________________________ Phone # ____________

Employers Address _______________________________________________

Your Title ______________________ Number of people supervised ________

Specific Duties ___________________________________________________

_______________________________________________________________

We will contact references: ________________________________________

Reason for leaving: _______________________________________________

NEXT MOST RECENT JOB

Employer ___________________________________ Phone # ____________

Employers Address _______________________________________________

Your Title ______________________ Number of people supervised ________

Specific Duties ___________________________________________________

_______________________________________________________________

We will contact references: ________________________________________

Reason for leaving: _______________________________________________

NEXT MOST RECENT JOB

Employer ___________________________________ Phone # ____________

Employers Address _______________________________________________

Your Title ______________________ Number of people supervised ________

Specific Duties ___________________________________________________

_______________________________________________________________

We will contact references: ________________________________________

Reason for leaving: _______________________________________________

Personal References (List three people, other than relatives or former employers, who can vouch for your character.)

Name Address City/State Number Years Known

_______________________________________________________________

CERTIFICATION AND CONSENT

A) A criminal background check to be supplied by applicant.

(Gaston County Sheriff’s Office)

B. A driver’s license background must be supplied by applicant.

(North Carolina DMV)

C. A drug test must be taken and results submitted to department

(See Chief Officer for time and date.)

D. If you are from out of state then information above must come from home state as well as NC.

FIREFIGHTING EXPERIENCE

List any firefighting related experience that you have, including department and chief’s name and phone number.

I voluntarily give the Union Road Volunteer Fire Department permission to confirm by personal inquiry, or otherwise, information provided in this application. I release from all liability or responsibility Union Road Volunteer Fire Department and all persons, companies or corporations providing information to the department about me.

Applicants Signature__________________________________Date________

DEPARTMENT USE ONLY

Review Board

Members (Print)

Chief Officer ____________________________________________

Captain ________________________________________________

Firefighter ______________________________________________

Comments and Recommendations

____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

Date submitted to chief ________________________________

Review Board Signatures and Date

Chief __________________________________________________

Captain ________________________________________________

Firefighter ______________________________________________

Union Road Volunteer Fire Department Inc.

4060 Union Road

Gastonia, NC 28056

911

704-865-2611

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