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Munson Fire Academy - Resident Application


MUNSON FIRE DEPARTMENT

APPLICATION FOR CITIZENS FIRE ACADEMY

In order to be considered for participation in the CITIZENS FIRE ACADEMY, which is sponsored by the Munson Fire Department, Inc., each candidate must complete this form and submit it to:

Munson Fire Department
12200 Auburn Road
Munson, Ohio 44024
Phone #440-286-6797

Questions can be directed to Debbie Roche or David Dureiko at 440-286-6797 or via email d.roche@munsonfire.org or d.dureiko@munsonfire.org


NAME: _________________________________________________________

ADDRESS: ______________________________________________________

HOME PHONE: __________________ CELL PHONE: ____________________

E-MAIL ADDRESS: __________________________________________________

DRIVER’S LICENSE NUMBER: _______________________________________

PHYSICAL CONDITION: ____Excellent ____Good _____Fair

KNOWN ALLERGIES: ______________________________________________

OCCUPATION: _____________________________________________________

HAVE YOU EVER BEEN CONVICTED OF A CRIME? (Y/N)________
IF YES, please explain:
______________________________________________________________________________


__________________________________________________________________________________________________________

T-Shirt Size:_______________________________

By signing this form, you are acknowledging that you have been honest in answering the above questions. IF you are selected to participate in this program, you understand that the Munson Fire Department may conduct a criminal background check on you.



SIGNATURE: ____________________________________________________________ DATE: ________________________

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