Application

Manchester Fire Department

Full Name:
Work Phone
At least 18 years of age?
Address
Social Security Number
Drivers License #
Height
Weight
Hair Color
Eye Color
Date of Birth
Do you have any impairments that would interfere with your ability to function as a firefighter? If yes explain.
Are you a citizen of the United States?
Have you ever been convicted of a crime? If yes explain.
Have you had any traffic violations in the past three years? If yes explain.
Do you have any previous emergency service experience of certifications? Please list.
Name and address of Employer
Employers Phone #
In case of an emergency who should we contact? Name and Phone #:
Please list any references with phone number
Please list any references with phone number
I hereby make application for membership into the City of Manchester Fire Department.

FOR YOUR LIFE AND PROPERTY