NEWBURGH VOLUNTEER FIRE DEPARTMENT CADET PROGRAM APPLICATION

	Newburgh Volunteer Fire Department

	Cadet Program Application

NEWBURGH VOLUNTEER FIRE DEPARTMENT
540 STATE STREET
NEWBURGH, IN 47630
Rules and Regulations
TELEPHONE: (812) 853-7651
COORDINATOR: CHARLES MARX

Name: (Last) (MI) (First)
Social Security No.
Current Address:
Previous Address:
Time at this address: From: Month / Year To: Month / Year
City: State: Zip:
Home Phone: Evening Phone:
E-mail:
Date of Birth: month / day / year
Height: Weight:

List parents, guardians, spouse, or nearest relatives for notifications in case of emergency:
1.
2.
3.

Current driver's license number:
Expiration date:
Has your driver's license ever been revoked or suspended? YES NO
If Yes, Give details:

ACADEMIC INFORMATION
Current Grade Level: G.P.A.:
Name of school:

* Notice: All Cadets are to maintain above a 2.0 grade point average.
Cadets suspended or expelled from school will be terminated from the Cadet Program.

After school activities:

EMPLOYMENT INFORMATION:
Current Employer:
Address:
City:
Phone:
Position:
Date Worked:

Previous Employer:
Address:
City:
Phone:
Position:
Date Worked:
Reason for leaving:

Any known health problems need to be listed below. List anything the affects you:

Do you have any known vision problems? YES NO

HISTORY:
Have you ever used any of the following?:
1.) Tobacco Products? YES   NO
2.) Illegal Drugs? YES   NO
3.) Alcohol? YES   NO
Have you ever been convicted of a crime or arrested? Yes   No
If yes, please list all convictions:

Do you have a valid driver's license?:YES   NO
Have you ever been pulled over for a traffic violation? Yes   No
If yes, list violations and dates:

Do you have transportation?:YES   NO

INTEREST SURVEY
Why did you decide to apply for a Cadet Membership?

What would you like to learn as a Cadet?

Do you plan to become a volunteer fire fighter?YES   NO
Do you enjoy learning new things?YES   NO

What do you like to do in your free time?

Do any of the following interest you?
1.) Search and rescueYES   NO
2.) First Aid/EMT/First Responder/ParamedicYES   NO
3.) Water RescuesYES   NO
4.) Driver/OperatorYES   NO
5.) Haz-Mat (Hazardous Materials)YES   NO

If you have checked yes to any of the above, these are some of the possibilities that you can do as a Firefighter

Do you like?:
Challenges? YES   NO
New Tasks?YES   NO
New Friends?YES   NO

Thanks for filling out the application and survey. The survey will help us learn more about you and what you may want to do as a Cadet. The Cadet program is exciting and after being a Cadet, you can possibly move up to be a Firefighter. Anything is possible! You just have to put your mind to it. Looking forward to seeing you!

Charles Marx, Coordinator for the Newburgh Cadet Program

This form may be submitted via e-mail, printed and faxed to (812)853-0489 or you may print it, fill in and bring to 540 State Street Newburgh, IN 47630. All applications are kept on file for six (6) months and are reviewed for all vacant positions for which an applicant is qualified. Newburgh Fire Department is always accepting applications.