Basic Firefighter Academy Application

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Basic Firefighter Academy Application

Fire Academy * 18422 Bear Valley Rd., Victorville, CA 92395-5850 * www.vvc.edu

ADMISSION APPLICATION - FIRE 95 - Basic Fire Academy
Please complete all sections of this Admission Application & attach all documents required for consideration for admission. A resume may be attached for supplemental information only. The information contained in the resume may not be used in the place of the required documents for consideration for admissions.

All Fields are Required *

Applicant Information

Name

First Name:

Last Name:

Date of Birth:

VVC ID:

State Fire Training ID:

Address

Address Line:

City:

State:

Zip Code:

Contact Information

Phone:

Alternative Phone:

Email:

Employment Information

Please provide your current employment information below.

Are you currently employed?

Current Employer:

Job Title

Years Employed:

Employer Address Line 1:

Employer Address Line 2:

City:

State:

Zip Code:

Point of Contact:

Employer Phone:

Fire Department Affiliation

Please provide information regarding your current Fire Department Affiliation.

Are you currently affiliated with a Fire Department/Station?

References

Please list a personal reference who can verify the information you have provided on this Application.

First Name:

Last Name:

Reference Phone:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Reference Position/Title:

1. Reference

First Name:

Last Name:

Reference Phone:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Reference Position/Title:

Emergency Contact Information

Please provide the requested emergency contact/notification information below.

FirstName

Last Name:

Phone:

Relationship to Applicant

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Why do you want to attend the Basic Fire Academy & What are your Fire Service Goals?

Please answer the question (above) using the space provided below.

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