Newburgh Volunteer Fire Department Membership Pre-Application

This is a pre-application form for the position(s) of:

Firefighter "Class A" (Ages 18+, High School Diploma/GED,Must Live Within a 4 Mile Radius of Station)
Firefighter "Class B" (Ages 18+, High School Diploma/GED, Must have minimum State Mandatory Cert, Living outside 4 Mile radius of station)
Cadet Volunteer Firefighter (Ages 14 - 18 Having succesfully completed their 8th grade year)

Newburgh, Indiana in Warrick County
 

This application is the first step in seeking membership with the NVFD.  There are three (4) steps in gaining membership with the fire department.

1) Complete this pre-application in full.
2) A more detailed application packet will be forwarded to you to complete.
3) Once completed a meeting time will be scheduled to review your application and conduct a small scale interview.
4) Firefighter Applicants will be voted on by the members of the department at the next scheduled meeting of the Association which is held on the 2nd Wednesday of every month.
5) Cadet Firefighters will be brought on and referred to the Cadet Coordinator.

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.

The Newburgh Volunteer Firefighters, © Copyright 2021 All Rights Reserved.
 

Type of Application:

I am applying for the position of:
 
Pre-Application Information:

First Name and Middle Initial:   Last Name:

Primary Phone:   Secondary Phone: 

Street Address:
                City:        State: IN,      ZIP:

Email address:

Date of Birth:
(Please indicate month/day/year)

Gender:  Male  Female

Driver's License Number:
(Note: Please indicate operator's license number, and month/year of expiration. A Indiana, license is required.)
State: IN OLN #:  Month/Year Expiration:

Experience Questionnaire 

Do you currently hold any Fire/EMS Certifications issued by the Indiana Department of Homeland Security? Yes  No

If yes please answer below questions:

State Issued PSID:

Current State Issued Certifications:
   

Medical Questionnaire

Please read the following statements and determine if they apply to you.

  • Any physical handicaps or limitations.
  • Any serious illnesses or medical conditions in last five (5) years.
  • Any known allergies?
  • Any known reactions to medications?

Do any of the above apply to you?  Yes  No

Physical Condition / Medical / Allergy Explanation:
(If you answered "YES" to the above question, please explain here.)
   

Criminal Questionnaire

Please read the following statements and determine if they apply to you.

  • Previous felony or misdemeanor convictions.
  • Criminal actions currently pending.
  • Any convictions in last ten (10) years?
  • Any traffic or moving violations in the last three (3) three years that resulted in a citation/infraction?

Do any of the above apply to you?  Yes  No

Criminal Convictions / History / Traffic Infraction Explanation:
(If you answered "YES" to the above question, please explain here.)
   

Social Media Links

Please add any Social Media Links you have below:
I do hereby submit this pre-application seeking membership with the Newburgh Volunteer Fire Department as an active Firefighter or Cadet, to aid in the prevention and extinguishment of fires, to protect lives and property.

I certify that the facts in this application are true and complete to the best of my knowledge and I understand that, if employed as a Volunteer Firefighter, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained therein and the references and employers listed above to give any and all information concerning my previous employment and any pertinent information that may result from the utilization of such information.