Confidential Application

Today's Date

Personal Information

Full Name

Date of Birth

Mailing Address

Physical Address

Phone Number

Driver's License Number

Driver's License State/Class

Driver's License Expiration

General Information

Do you have previous firefighting experience? (If yes, explain)

List any certifications you have:

Do you have other experience, skills, or qualifications which you think would benefit our department?

Are you able to attend 75% of the meetings required by our Bylaws on the 1st and 3rd Wednesday of each month?

Yes

Are you able to leave work for emergency calls?

Yes

Have you ever been convicted of a crime? If yes, please explain. Include data, place, and nature of crime.

Employment History/References

List your most recent position first

(1) Employeer

(1) Supervisor

(1) Poisiton/Duties

(1) Address

(1) Phone

(1) State Date/ End Date

(1) Reason for leaving

(2) Employeer

(2) Supervisor

(2) Poisiton/Duties

(2) Address

(2) Phone

(2) State Date/ End Date

(2) Reason for leaving

(3) Employeer

(3) Supervisor

(3) Poisiton/Duties

(3) Address

(3) Phone

(3) State Date/ End Date

(3) Reason for leaving

Person References (Do not list former employers or relatives)

Reference 1 Name

Reference 1 Address

Reference 1 Phone

Reference 2 Name

Reference 2 Address

Reference 2 Phone

Reference 3 Name

Reference 3 Address

Reference 3 Phone

Tell us why you want to join the Thayne Fire Department:

I hereby certify that the answers given by me to foregoing questions and all statements made by me herein are true and correct to the best knowledge and belief.

I have read and undertand the following:

Attendance Policy

Pension Policy

Department Bylaws

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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Website Accessibility Statement

Thayne Volunteer Fire Department is fully committed to providing accessible facilities, elements and channels of communication to all members of the public. As part of this commitment, Thayne Volunteer Fire Department has a policy of providing an accessible website compatible with the Web Content Accessibility Guidelines (WCAG 2.1) and commercial screen reading software. All features of the website are coded to allow individuals with vision and other impairments to understand and use the website to the same degree as someone without disabilities. We welcome feedback and can often resolve issues in a timely manner if they arise.

If you need any special assistance or accommodations:

Call us at (307) 880-3473

Ongoing Compliance Information

Compliance Officer

Thayne Volunteer Fire Department has designated a compliance officer for website disability-related accommodations. The compliance officer has received training in website accessibility and updates the site in accordance with those best practices. Contact our accessibility officer to report an issue.

Compliance Procedures and Reports

In addition to testing with users with a wide range of disabilities and coding our website to WCAG standards, Thayne Volunteer Fire Department regularly scans its website to ensure ongoing compliance, and makes timely changes to any inaccessible changes, if any are found.

Linked Documents and Third Parties

Please note that this site may link out to third-party websites, such as state or federal agencies, that do not have accessible content. This site may also include documents provided by third parties included in our agenda packets, for example. While we cannot control the accessibility of content provided by third parties, we are happy to assist any member of the public with reading and accessing content on our site.

See an opportunity for us to improve? Please contact our accessibility officer or call us at (307) 880-3473.

Report a Website Accessibility Issue

We are committed to your ability to access all content, and we will respond to all requests as soon as possible.