DMRVFD Volunteer Firefighter Application
                                                                                                                Davis Mountains Resort VFD
                                                                                                                            FIRE CHIEF
                                                                                                                    101 A Yellowknife Trail
                                                                                                                   Fort Davis, Texas 79734

Application For Membership As A Firefighter
DMPOA Volunteer Fire Department, Inc. (AKA DMRVFD)

Name (Last, First, Middle):  _________________________________________________________________

Address:  _______________________________________________________________________________


Date of Birth:    _________ / _________ / _________        E mail:   __________________________________

Phone:  __________________ Home   ______________ Work   ________________ Cell ________________

Have you ever worked in fire suppression or prevention before?  [    ] Yes    [    ] No
If yes, where and when:    


List any specific training or certification that you have: (e.g. SFFMA, EMS, Scuba diver, Law enforcement, SAR,
HAZMAT,...)   ____________________________________________________________________________


Have you ever been convicted of a non-class C misdemeanor or felony [    ] Yes    [    ] No

Read Below Before Signing:
I attest to the fact that the above information is true and complete, and understand that there will be a criminal
and civil background check performed on me.  I understand that I will be on a 180-day probationary period, and at
the end of the period will be considered for full membership in the department.  I have received a copy of and
read the By-laws/rules and the ESD/TESRS packet.  I agree to follow the by-laws and rules of the DMPOA
Volunteer Fire Department, Inc. and the requirements of the ESD and TESRS.

Applicant Signature:    ________________________________________    Date: ____________________

The Fire Chief acknowledges with his signature below that he has received the applicant’s SSN, verified the
applicant has a valid driver’s license, and meets all requirements to be a member thus recommends approval.

Chief Signature:    _______________________________________             Date:    ___________________

Board Signatures/Date:     ____________________     ____________________    ____________________

                                     _____________________    ____________________